Showing papers in "Gerontologist in 2019"

The Effectiveness of Social Robots for Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Studies.

Abstract: Background and Objectives: Social robots may promote the health of older adults by increasing their perceived emotional support and social interaction. This review aims to summarize the effectiveness of social robots on outcomes (psychological, physiological, quality of life, or medications) of older adults from randomized controlled trials (RCTs). Research Design and Methods: A mixed-method systematic review of RCTs meeting the study inclusion criteria was undertaken. Eight databases were electronically searched up to September 2017. Participants’ characteristics, intervention features, and outcome data were retrieved. The mean difference and standardized mean difference with 95% confidence intervals (CI) were synthesized to pool the effect size. Results: A total of 13 articles from 11 RCTs were identified from 2,204 articles, of which 9 studies were included in the meta-analysis. Risk of bias was relatively high in allocation concealment and blinding. Social robots appeared to have positive impacts on agitation, anxiety, and quality of life for older adults but no statistical significance was found in the meta-analysis. However, results from a narrative review indicated that social robot interactions could improve engagement, interaction, and stress indicators, as well as reduce loneliness and the use of medications for older adults. Discussion and Implications: Social robots appear to have the potential to improve the well-being of older adults, but conclusions are limited due to the lack of high-quality studies. More RCTs are recommended with larger sample sizes and rigorous study designs.

The Digital Divide in Health-Related Technology Use: The Significance of Race/Ethnicity.

Abstract: Background and objectives Technology can enhance the health and quality of life of diverse populations and may play an important role in reducing health disparities. Although a "digital divide" between the young and the old has been noted, it is unclear whether the use of technology for managing health differs by race/ethnicity among older adults. This study uses nationally representative data from community-dwelling older Americans to characterize racial/ethnic differences in health-related technology use. Design and methods Data came from 1,336 white, black, and Hispanic adults aged 54 and older who completed the 2014 technology module of the Health and Retirement Study. Racial/ethnic differences in overall health-related technology use were assessed using Poisson regression. Then, F-tests were used to assess differences in the use of phone calls, text messages, E-mails, social media, health management sites, health-related mobile applications, web searches, and brain games for health purposes. Results Compared to whites, older blacks and Hispanics were less likely to use technology for health-related purposes after accounting for demographic characteristics, education, and health conditions. They were also less likely to make or receive phone calls, use health management sites, search the web for health information, and use brain games for their health. Discussion and implications Older racial and ethnic minorities are less likely than whites to use certain technologies when managing their health. These findings highlight the importance of understanding the patterns of health-related technology use across racially and ethnically diverse populations to appropriately tailor interventions aimed at improving minority health and eliminating health disparities.

Technology Adoption by Older Adults: Findings From the PRISM Trial.

Abstract: Background and objectives There is growing evidence of the benefits of computers for older adults. Yet, adoption rates are lower compared with younger adults. Extant theoretical models of technology acceptance are limited in their application to older adults-studies on which these models are based included a limited sample of older adults or none at all; none assessed use of a technology specifically designed for older adults; and most only measured intention to use a technology or short-term use, rather than longer-term use (i.e., adoption). We assessed adoption of a computer system specifically designed for older users, for a diverse sample, over an extended period of time. Research design and methods We analyzed archival data from 150 ethnically diverse older adults (65-98 years of age) who participated in the Personal Reminder Information and Social Management (PRISM) randomized controlled trial (Czaja SJ, Boot WR, Charness N, Rogers WA, Sharit J, Fisk AD,…Nair SN. The personalized reminder information and social management system (PRISM) trial: Rationale, methods and baseline characteristics. Contemp Clin Trials. 2015;40:35-46; Czaja SJ, Boot WR, Charness N, Rogers WA, Sharit J. Improving social support for older adults through technology: Findings from the PRISM randomized controlled trial. Gerontologist. 2017;58:467-477). We examined the extent to which attitudes, personal characteristics (e.g., age, gender, and personality), and cognitive abilities predicted mid-term and long-term adoption of a computer system designed for older adults. Results There were individual differences in PRISM use over time. Regression analyses indicated that individual differences in earlier use of the system, executive functioning, and computer efficacy predicted long-term use. Discussion and implications These data provide insights for broader-based models of technology acceptance to guide design, instruction, and deployment of products for older adults. Specifically, the provision of opportunities to foster efficacy and gain positive experience with computer technologies may play a critical role in the likelihood that older adults adopt such technologies. Trial registration NCT01497613.

Longitudinal Analysis of the Relationship Between Purposes of Internet Use and Well-being Among Older Adults

Abstract: Purpose There is support for the role of Internet use in promoting well-being among older people. However, there are also contradictory findings which may be attributed to methodological issues. First, research has focused on frequency of online activity rather than how engagement in different types of online activities may influence well-being. Secondly, previous studies have used either cross-sectional designs, which cannot elucidate causality or intervention designs with uncontrolled extraneous variables. In this longitudinal observational study, we test the indirect impact of online engagement for social, informational, and instrumental purposes on older adults' well-being via reducing loneliness and supporting social engagement. Design and method A population sample of 1,165 adults aged 60-77 (M = 68.22, SD = 4.42; 52.4% female) was surveyed over 3 waves. Using longitudinal mediation analysis with demographic controls, the indirect effects of types of Internet use on well-being through loneliness and social engagement were estimated. Results Participants engaged online for 3 purposes: social (e.g., connecting with friends/family), instrumental (e.g., banking), and informational (e.g., reading health-related information). Social use indirectly impacted well-being via decreased loneliness and increased social engagement. Informational and instrumental uses indirectly impacted well-being through engagement in a wider range of activities; however, were unrelated to loneliness. Implications Findings highlight that Internet use can support older adults' well-being; however, not every form of engagement impacts well-being the same way. These findings will inform the focus of interventions which aim to promote well-being.

The Healthy Immigrant Effect and Aging in the United States and Other Western Countries

Abstract: The rising number of immigrants to the United States and other western countries has been accompanied by rising interest in the characteristics of immigrants including their mortality risk and health status. In general, immigrants to the United States, Canada, and Australia enjoy a health advantage over the native populations, which has been coined the healthy immigrant effect. The purpose of this review is to summarize findings on aging and the immigrant health effect in the 3 most common immigrant destinations the United States, Canada, Australia, as well as in Europe. Much of the research in the United States has focused on the so-called Hispanic Paradox or the favorable health of Hispanics relative to non-Hispanic whites despite lower average socioeconomic status as well as other risk factors, with recent research beginning to pay attention to dietary and genetic factors. In all 3 countries, there is evidence of a health convergence of immigrants relative to the native-born population over approximately 10-20 years. By the time they reach old age, immigrants experience high rates of comorbidity and disability. Immigrant health selection appears to be the key reason explaining the immigrant health advantage. Immigrants to Europe also appear to be health selected but not as consistently as in the United States, Canada, and Australia. Immigrant enclaves appear to confer health advantages in the United States among older Hispanics but appear to have negative consequences in Europe. More attention needs to be given to the health and health care needs of the rising numbers of refugees to Europe as well as refugees in the Middle East, Africa, and elsewhere.

Participatory Design in Gerontechnology: A Systematic Literature Review.

Abstract: Purpose of the Study Participatory design (PD) is widely used within gerontechnology but there is no common understanding about which methods are used for what purposes. This review aims to examine what different forms of PD exist in the field of gerontechnology and how these can be categorized. Design and Methods We conducted a systematic literature review covering several databases. The search strategy was based on 3 elements: (1) participatory methods and approaches with (2) older persons aiming at developing (3) technology for older people. Results Our final review included 26 studies representing a variety of technologies designed/developed and methods/instruments applied. According to the technologies, the publications reviewed can be categorized in 3 groups: Studies that (1) use already existing technology with the aim to find new ways of use; (2) aim at creating new devices; (3) test and/or modify prototypes. The implementation of PD depends on the questions: Why a participatory approach is applied, who is involved as future user(s), when those future users are involved, and how they are incorporated into the innovation process. Implications There are multiple ways, methods, and instruments to integrate users into the innovation process. Which methods should be applied, depends on the context. However, most studies do not evaluate if participatory approaches will lead to a better acceptance and/or use of the co-developed products. Therefore, participatory design should follow a comprehensive strategy, starting with the users' needs and ending with an evaluation if the applied methods have led to better results.

Transportation and Aging: An Updated Research Agenda to Advance Safe Mobility among Older Adults Transitioning From Driving to Non-driving.

Abstract: Engagement in civic, social, and community life plays an important role in health, well-being, and quality of life, and requires individuals to be mobile in their environment. In this article, we review what is currently known about 2 areas relevant to safe mobility for older drivers and identify future research in these areas. Using a framework for transportation and safe mobility, 2 key areas were selected for review: the process of transitioning to non-driving and the maintenance of mobility after driving has ceased. This article serves as a companion to another article that used the same approach to explore safe mobility issues for older adults who are still driving. We found that although there has been progress in supporting transitioning process to non-driving and improving mobility options for older adults following driving cessation, many knowledge gaps still exist. We identified several research topics that would benefit from continued scientific inquiry. In addition, several themes emerged from the review, including the need for: multidisciplinary, community-wide solutions; large-scale, longitudinal studies; improved education and training for older adults and the variety of stakeholders involved in older adult transportation; and the need for programs and interventions that are flexible and responsive to individual needs and situational differences.

From Intervention to Co-constitution: New Directions in Theorizing about Aging and Technology.

Abstract: We propose directions for future research on aging and technology to address fundamental changes in the experience of later life that come with the "digitization" of societies. Our argument is contextualized by the massive investments of policy makers and companies in gerontechnologies and their failure to create scale and impact. Partly this failure is due to an interventionist logic that positions new technologies as interventions or solutions to the problems of aging. What has been overlooked - at least theoretically - is how aging is already co-constituted by gerontechnology design, the socio-material practices it enacts, and the policy discourse around them. Goals are (a) reviewing elements of the current aging and technology agenda, (b) demonstrating how the interventionist logic has hampered theory development (and practical impact), (c) pulling together key insights from the emerging body of empirical literature at the intersection of social gerontology and Science and Technology Studies (STS), with the objective of (d) providing directions for future research on aging and technology. Our argument presents the theoretical gains that can be made by combining insights from STS and social gerontology to research the co-constitution of aging and technology.

Reducing Ageism: Education About Aging and Extended Contact With Older Adults.

Abstract: Background and objectives Ageism is of increasing concern due to the growing older population worldwide and youth-centered focus of many societies. Research design and methods The current investigation tested the PEACE (Positive Education about Aging and Contact Experiences) model for the first time. Two online experimental studies examined 2 key factors for reducing ageism: education about aging (providing accurate information about aging) and extended contact (knowledge of positive intergenerational contact) as well as their potential combined effect (education plus extended contact). Results and discussion In Study 1, 354 undergraduates in all 3 experimental conditions (vs. control participants) reported less negative attitudes toward older adults (delayed post-test) and greater aging knowledge (immediate and delayed post-tests), when controlling for pre-study attitudes. In Study 2, 505 national community participants (ages 18-59) in all experimental conditions (vs. control participants) reported less negative attitudes toward older adults (immediate post-test) and greater aging knowledge (immediate and delayed post-tests). In summary, across 2 online studies, education about aging and knowledge of intergenerational extended contact improved attitudes toward older adults and aging knowledge. Implications Thus, brief, online ageism-reduction strategies can be an effective way to combat ageism. These strategies hold promise to be tested in other settings, with other samples, and to be elaborated into more in-depth interventions that aim to reduce ageism in everyday culture.

Ageism in health care : a systematic review of operational definitions and inductive conceptualizations

Abstract: Purpose International and national bodies have identified tackling ageism in health care as an urgent goal. However, health professionals, researchers, and policy makers recognize that it is not easy to identity and fight ageism in practice, as the identification of multiple manifestations of ageism is dependent on the way it is defined and operationalized. This article reports on a systematic review of the operational definitions and inductive conceptualizations of ageism in the context of health care. Design and methods We reviewed scientific articles published from January 1995 to June 2015 and indexed in the electronic databases Web of Science, PubMed, and Cochrane. Electronic searches were complemented with visual scanning of reference lists and hand searching of leading journals in the field of ageing and social gerontology. Results The review reveals that the predominant forms of operationalization and inductive conceptualization of ageism in the context of health care have neglected some components of ageism, namely the self-directed and implicit components. Furthermore, the instruments used to measure ageism in health care have as targets older people in general, not older patients in particular. Implications The results have important implications for the advancement of research on this topic, as well as for the development of interventions to fight ageism in practice. There is a need to take into account underexplored forms of operationalization and inductive conceptualizations of ageism, such as self-directed ageism and implicit ageism. In addition, ageism in health care should be measured by using context-specific instruments.

Racial/Ethnic and Nativity Differences in Cognitive Life Expectancies Among Older Adults in the United States.

Abstract: Background and objectives To document racial/ethnic and nativity differences by gender in cognitive life expectancies among older adults in the United States. Research design and methods Sullivan-based life tables were used to estimate cognitively normal, cognitively impaired/no dementia (CIND), and dementia life expectancies by gender for White, Black, U.S.-born Hispanic, and foreign-born Hispanic adults 50 years and older in the Health and Retirement Study. Results Among women, the number of years spent living with dementia for Whites, Blacks, U.S.-born Hispanics, and foreign-born Hispanics was 1.6, 3.9, 4.7, and 6.0 years, respectively. For men, Whites lived 1.1 years with dementia compared to 3.1 years for Blacks, 3.0 years for U.S.-born Hispanics and 3.2 years for foreign-born Hispanics. Similar patterns were observed for race/ethnic and nativity differences in CIND life expectancies. Blacks and Hispanics spend a larger fraction of their remaining years with CIND and dementia relative to Whites, regardless of gender. Foreign-born Hispanic men and women and Black men are particularly disadvantaged in the proportion of years spent after age 50 with CIND and/or dementia. Discussion and implications Disparities in cognitive life expectancies indicate that intervention strategies should target the specific needs of minority and immigrant older adults with dementia. Given that education is a strong predictor of cognitive health, improving access to the social and economic resources that delay dementia onset is key to improving the well-being of diverse older adults.

"She Had a Smile on Her Face as Wide as the Great Australian Bite": A Qualitative Examination of Family Perceptions of a Therapeutic Robot and a Plush Toy.

Abstract: Background and objectives Recent years have seen social robotic pets introduced as a means of treating behavioral and psychological symptoms of dementia, and many show promising potential. In this study, we sought to explore family members' perceptions of the Japanese-developed baby harp seal, Paro (version 9), and a look-alike, nonrobotic Plush Toy, when used by their relative with dementia for 15 min, 3 afternoons per week for 10 weeks. Research design and method The study employed a descriptive qualitative approach, which was nested within a larger cluster randomized controlled trial. A convenience sample of 20 family members (n = 10 each from the Paro and Plush Toy conditions) with relatives in 9 long-term care facilities in Queensland, Australia, completed individual semi-structured interviews (telephone or face-to-face). Inductive, data-driven thematic analysis of the data was undertaken with the assistance of the qualitative management software, ATLAS.ti®. Results Family members of long-term care residents with dementia expressed positive perceptions of the Paro, perceiving that it improved mood, reduced agitation, and provided opportunity for communication for their relative. Negative perceptions of the Plush Toy were given by family members, primarily because of its lack of movement and engagement. Conclusion Family members were keen for their older relative with dementia to use a social robot that moved and engaged with them, and Plush Toys that were static and unresponsive were perceived as being unimportant in improving quality of life. However, the current cost of Paro was identified by family members as a major limitation to use.

Domains and Measurements of Healthy Aging in Epidemiological Studies: A Review

Abstract: Purpose of the Study: Few studies have recommended the essential domains of healthy aging and their relevant measurement to assess healthy aging comprehensively. This review is to fill the gap, by conducting a literature review of domains and measures of healthy aging in epidemiological studies. Design and Methods: A literature search was conducted up to March 31, 2017, supplemented by a search of references in all relevant articles in English. We made a final selection of 50 studies across 23 countries or regions. Results: Nineteen studies applied Rowe and Kahn’s three standards to assess healthy aging. Thirty-seven studies measured physical capabilities mainly by (instrumental) activities of daily living. Cognitive functions were included in 33 studies. Nineteen of them applied Mini-Mental State Examination (MMSE). Twenty-six studies considered metabolic and physiological health, but they mainly asked the self-reported absence of diseases. Twenty-four studies assessed psychological well-being by employing diverse scales. Questions about participation in social activities were mainly asked to measure social well-being in 22 studies. Sixteen studies considered individuals’ general health status, which was mainly measured by self-rated health. Security questions were asked in five studies. Health behaviors were taken into account by three studies. Fifteen studies either applied SF-12/36 or developed health indices to assess healthy aging. Implications: This review summarizes detailed scales or methods that have been used to assess healthy aging in previous epidemiological studies. It also discusses and recommends the essential domains of healthy aging, and the relevant instruments for further epidemiological research to use in the assessment of healthy aging.

The Burden and Benefits of Caregiving: A Latent Class Analysis

Abstract: Background and objectives Informal caregiving to older adults is a key part of the U.S. long-term care system. Caregivers' experiences consist of burden and benefits, but traditional analytic approaches typically consider dimensions independently, or cannot account for burden and benefit levels and combinations that co-occur. This study explores how benefits and burden simultaneously shape experiences of caregiving to older adults, and factors associated with experience types. Research design and methods 2015 National Health and Aging Trends Study (NHATS) and National Study of Caregiving (NSOC) data were linked to obtain reports from caregivers and recipients. Latent class and regression analysis were conducted on a nationally representative sample of U.S. informal caregivers to older persons. Results Five distinguishable caregiving experiences types and their population prevalence were identified. Subjective burden and benefits level and combination uniquely characterize each group. Primary stressors (recipient depression, medical diagnoses), primary appraisal (activities of daily living, instrumental activities of daily living, medical task assistance, hours caregiving), and background/contextual factors (caregiver age, race, relationship to recipient, mental health, coresidence, long-term caregiving) are associated with experience types. Discussion and implications Findings highlight caregivers' experience multiplicity and ambivalence, and identify groups that may benefit most from support services. In cases where it is not possible to reduce burden, assistance programs may focus on increasing the benefits perceptions.

Fifty-Five Years of Research Into Older People’s Civic Participation: Recent Trends, Future Directions

Abstract: Background and objectives This study analyzes critically existing knowledge concerning older people's civic participation, pinpoints gaps in the literature, and proposes new directions for research. Research design and methods We conducted a scoping review of literature on older people's civic participation. To conduct this review, we followed the 5-step framework developed by Arksey and O'Malley (Arksey H, O'Malley L. Scoping studies: Towards a methodological framework. Int J Soc Res Method. 2005; 8: 19-32), and expanded by Levac and colleagues (Levac D, Colquhoun H, O'Brien KK. Scoping studies: Advancing the methodology. Implement Sci. 2010; 5: 69). Results Research into older people's civic participation has grown steadily over the past 55 years. However, the increasing number of publications mainly concerns collective forms of social participation, particularly volunteering, with other types of participation being more stable over time. Contextual as well as dynamic aspects of civic participation remain underdeveloped. Diversity of older people is scarcely represented in current research. Discussion and implications This scoping review identifies 4 critical gaps in the literature that should be at the forefront of future research. These are classified as conceptual, contextual, processual, and diverse aspects of research into older people's civic participation.

"Who's Caring for Us?": Understanding and Addressing the Effects of Emotional Labor on Home Health Aides' Well-being.

Abstract: BACKGROUND AND OBJECTIVES Interventions to strengthen the home care workforce focus on workers' economic and physical well-being, without acknowledging the caring labor affecting emotional well-being. Our study examined workers' perceptions of the emotional effects of caring work, coping mechanisms, and desired support. RESEARCH DESIGN AND METHODS We conducted 4 worker focus groups (n = 27). Moderators cross-checked codes and themes, and aides provided input through report-backs. RESULTS Building close, trusting relationships with clients was central to aides' emotional well-being. Well-being was also influenced by relationships with client families and agency supervisors, work-life balance, and the level to which aides felt their work was valued. Aides were largely alone in managing job stressors and desired more communication, connection, and support from supervisors and peers. DISCUSSION AND IMPLICATIONS Recognizing and supporting the emotional demands of caring work is crucial to strengthening the workforce. Policy makers and agencies must realign reimbursement systems, job descriptions, and care plans to include measures of emotional labor, improve communication between workers and supervisors, and provide training, mental health benefits, and peer support.

Attitudes Toward Computers Across Adulthood From 1994 to 2013.

Abstract: Background and objectives Regardless of the increased deployment of technologies in everyday living domains, barriers remain that hamper technology adoption by older adults. Understanding barriers to adoption such as individual differences in attitudes toward computers is important to the design of strategies to reduce age-related digital disparities. Research design and methods This article reports a time-sequential analysis of data from the Edward R. Roybal Center on Human Factors and Aging Research and the Center for Research and Education on Aging and Technology Enhancement (CREATE) on computer attitudes among a large (N = 3,917), diverse sample of community-dwelling adults aged from 18 to 98 years. The data were gathered from 1994 to 2013. Results The findings indicated that there are still age disparities in attitudes; older adults report less comfort with and less efficacy about using computers than younger people. We also found a cohort (birth year) effect; attitudes are generally more positive among more recent birth cohorts. Those who have more education and experience with computers also have more positive attitudes. Males generally have more positive attitudes than females; however, the gender difference decreases with increased age. Discussion and implications Technology affords potential benefits for older people, but lack of uptake in technology clearly puts older adults at a disadvantage in terms of negotiating today's digital world. This article provides insight into attitudinal barriers that may affect on technology uptake among older adults. The findings have implications for the design of technology training programs, design of technology systems, and policy.

Perspectives on the Delirium Experience and Its Burden: Common Themes Among Older Patients, Their Family Caregivers, and Nurses

Abstract: Background and objectives While there are qualitative studies examining the delirium-related experiences of patients, family caregivers, and nurses separately, little is known about common aspects of delirium burden among all three groups. We describe common delirium burdens from the perspectives of patients, family caregivers, and nurses. Research design and methods We conducted semistructured qualitative interviews about delirium burden with 18 patients who had recently experienced a delirium episode, with 16 family caregivers, and with 15 nurses who routinely cared for patients with delirium. We recruited participants from a large, urban teaching hospital in Boston, Massachusetts. Interviews were recorded and transcribed. We used interpretive description as the approach to data analysis. Results We identified three common burden themes of the delirium experience: Symptom Burden (Disorientation, Hallucinations/Delusions, Impaired Communication, Memory Problems, Personality Changes, Sleep Disturbances); Emotional Burden (Anger/Frustration, Emotional Distress, Fear, Guilt, Helplessness); and Situational Burden (Loss of Control, Lack of Attention, Lack of Knowledge, Lack of Resources, Safety Concerns, Unpredictability, Unpreparedness). These burdens arise from different sources among patients, family caregivers, and nurses, with markedly differing perspectives on the burden experience. Discussion and implications Our findings advance the understanding of common burdens of the delirium experience for all groups and offer structure for instrument development and distinct interventions to address the burden of delirium as an individual or group experience. Our work reinforces that no one group experiences delirium in isolation. Delirium is a shared experience that will respond best to systemwide approaches to reduce associated burden.

Can MoCA and MMSE Be Interchangeable Cognitive Screening Tools? A Systematic Review.

Abstract: Background and objectives Cognitive disorders may be an early sign of neuropsychiatric disorders; however, it remains unclear whether the screening measures are interchangeable. The aim of this study was to contrast the most commonly used screening tools-Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA)-for early detection of neurocognitive disorder (NCD). Research design and methods This study presents a descriptive systematic review and informative literature according to the Cochrane Foundation's guidelines. The keywords "Mini-Mental State Examination" and "Montreal Cognitive Assessment" were searched in the Web of Science, SciELO, and LILACS databases. Results Fifty-one studies were selected including a total sample of 11,870 participants (8,360 clinical patients and 3,510 healthy controls). Most studies were published in the past 5 years using a cross-sectional design, carried out across the world. They were organized by age ranges (18-69 years and 20-89 years), years of schooling, and mental status (with and without mental and behavior disorders). Sixteen of 18 studies had participants aged 18-69 years, and 21 out of 33 studies within the older set suggested that the MoCA is a more sensitive tool for detecting NCD. Discussion and implications Thirty-seven studies suggested that the MoCA is a more sensitive tool for NCD detection because it assesses executive function and visuospatial abilities. Some individuals who demonstrated normal cognitive function on the MMSE had lower performance on the MoCA. However, it seems necessary to establish different cutoffs based on years of schooling to avoid false positives. Future studies should contrast MoCA with other screening tools designed for NCD assessment.

The Effectiveness of Mindfulness- and Acceptance-Based Interventions for Informal Caregivers of People With Dementia: A Meta-Analysis.

Abstract: BACKGROUND AND OBJECTIVES: The application of mindfulness- and acceptance-based interventions (MABIs) for informal caregivers of people with dementia (PwD) is relatively novel, and the current state of the evidence base is unclear. This meta-analysis examined the effectiveness of MABIs on reducing symptoms of depression and burden in informal caregivers of PwD. The quality of included studies was evaluated and moderator variables explored. RESEARCH DESIGN AND METHODS: A literature search of six electronic databases (PsycARTICLES, PsycINFO, MEDLINE Complete, SCOPUS, Web of Science, and ProQuest) was conducted from the first available date to 20 December 2016. Inclusion criteria involved studies that quantitatively investigated the impact of MABIs on depression and/or burden in informal caregivers of PwD. RESULTS: Twelve studies, providing data on 321 caregivers, were included. Most used mindfulness-based stress reduction and were conducted in the United States. The average attrition among participants was 15.83%. The pre-post effect of MABIs was large for depression and moderate for burden. These effects were largely maintained at follow-up. Significant heterogeneity of effect sizes was observed, with no significant moderators identified. Study quality varied from very poor to moderately good. DISCUSSION AND IMPLICATIONS: The low attrition and moderate to large effects suggest that MABIs are acceptable and beneficial for informal caregivers of PwD. The lack of significant moderators could advocate services using more cost-effective forms of MABIs. Further higher-quality research is needed to improve the robustness of the evidence base and enable a meta-analysis to thoroughly examine and quantify moderator variables.

Depression Among Older Adults in the United States by Disaggregated Race and Ethnicity.

Abstract: Background and objectives As the population becomes increasingly diverse, it is important to understand the prevalence of depression across a racially and ethnically diverse older population. The purpose of this study was to compare rates of depression by age and disaggregated racial and ethnic groups to inform practitioners and target resource allocation to high risk groups. Research design and methods Data were from the Centers for Medicare and Medicaid Services Health Outcomes Survey, Cohorts 15 and 16, a national and annual survey of a racially diverse group of adults aged 65 and older who participate in Medicare Advantage plans (N = 175,956). Depression was operationalized by the Patient Health Questionnaire-2 (PHQ-2); we estimated a logistic regression model and adjusted standard errors to account for 403 Medicare Advantage Organizations. Results Overall, 10.2% of the sample (n = 17,957) reported a PHQ-2 score of 3 or higher, indicative of a positive screen for depression. After adjusting for covariates, odds of screening positively for depression were higher among participants self-reporting as Mexican (odds ratio [OR] = 1.19), Puerto Rican (OR = 1.46), Cuban (OR = 1.57), another Hispanic/Latino (OR = 1.29), and multiple Hispanic/Latino (OR = 1.84) ethnicities, compared with non-Hispanic whites. Odds were also higher among participants reporting that their race was black/African American (OR = 1.20), Asian Indian (OR = 1.67), Filipino (OR = 1.30), Native Hawaiian/Pacific Islander (OR = 1.82), or two or more races (OR = 1.50), compared with non-Hispanic whites. Discussion and implications Prevalence varied greatly across segments of the population, suggesting that certain racial/ethnic groups are at higher risk than others. These disparities should inform distribution of health care resources; efforts to educate and ameliorate depression should be culturally targeted.

A Framework of Minority Stress: From Physiological Manifestations to Cognitive Outcomes.

Abstract: Cognitive impairment and dementia continue to threaten the aging population. Although no one is immune, certain groups, namely black older persons, are more likely to have a diagnosis of certain dementias. Because researchers have not found a purely biological reason for this disparity, they have turned to a biopsychosocial model. Specifically, black persons in the United States are more likely to live with social conditions that affect their stress levels which in turn affect physiological regulation leading to conditions that result in higher levels of cognitive impairment or dementia. Here we discuss some of these social conditions such as discrimination, education, and socioeconomic status, and how physiological dysregulation, namely allostatic load that can lead to cognitive impairment and dementia in black persons especially.

Towards a Holistic Approach to Studying Human–Robot Interaction in Later Life

Abstract: Background and objectives Implementation of robotics technology in eldercare depends on successful human-robot interaction (HRI). Relying on a systematic literature review, this article proposes a holistic approach to the study of such interaction. Research design and methods A literature search was carried out in five databases. A Boolean phrase search included the term robot and at least one term referencing older age, leading to an initial corpus of 543 articles. Articles were included in this review if they described older adults' interaction with robots. Exclusion of articles that did not meet this criterion, as well as duplicate material, led to a total of 80 articles, that were then subjected to quantitative and qualitative analyses. Results Studies tended to focus on older users, typically community-dwelling adults, without sufficient consideration of the users' characteristics and the physical, social, and cultural context of the HRI. Using a variety of methods, many studies were snapshot inquiries. The chief topics explored were use patterns, the resulting outcomes thereof and factors that constrain use. Commonly, however, these topics were examined separately. In addition, most studies lacked any theoretical framework. Discussion and implications Additional studies are needed to more fully understand what makes HRI successful. The model presented here suggests scholars to conduct theory-driven research, and distinguish among various segments of older users, different types of robots, and group and individual HRI. It also proposes paying greater attention to the users' cultural, physical and social environment, and application of longitudinal and simultaneous examination of uses, outcomes, and constraints.

A New Multidimensional Questionnaire to Assess Awareness of Age-Related Change (AARC).

Abstract: Background and objectives This two-study article describes the development and evaluation of a multidimensional questionnaire based on the subjective aging construct Awareness of Age-Related Change (AARC). AARC captures the inherent multidimensionality and complexity of aging attitudes, which are strongly linked to indicators of successful aging, including health and well-being. Research design and methods In Study 1, we generated a large item pool related to subjective aging experiences and then evaluated the psychometric properties of a 189-item version of the AARC questionnaire in a sample of 396 adults aged 40-95 years. Based on findings from Study 1, we retained the best-performing items and arrived at a more parsimonious 50-item version (AARC-50). In Study 2, the psychometric properties of the 50-item version were examined in an expanded sample of 424 adults ages 40-98. Results Factor analyses in Study 1 indicated a two-factor structure of the questionnaire, representing the awareness of positive (AARC-Gains) and negative (AARC-Losses) age-related changes across five behavioral domains. Confirmatory factor analysis in Study 2 further supported this two-factor structure. In both studies, the AARC questionnaire demonstrated strong psychometric properties, including scale and item reliability, convergent and divergent validity, and predictive validity. Discussion and implications The availability of a reliable and valid assessment tool for measuring AARC-Gains and AARC-Losses allows researchers to capture detailed information about adults' positive and negative self-perceptions of aging across multiple behavioral domains, which are instrumental for promoting successful aging.

Primary Care Physicians' Perceived Barriers to Optimal Dementia Care: A Systematic Review.

Abstract: Background and objectives Primary care physicians (PCPs) have a key role in providing care for people with dementia and their carers, however, a range of barriers prevent them from delivering optimal care. We reviewed studies on PCPs' perceptions of barriers to providing optimal dementia care, including their methodological quality, whether they focused on barriers related to diagnosis and/or management, and the patient-, provider-, and system-level barriers identified. Research design and methods Studies were included if they were quantitative studies published since 2006 which reported on PCPs' perceptions of the barriers to providing dementia care. The methodological quality of identified studies was assessed using an adapted version of accepted rating criteria for quantitative studies. Data were extracted from studies which were rated as "moderate" or "strong" quality. Results A total of 20 studies were identified, 16 of which were rated as "moderate" or "strong" methodological quality. Patient-related barriers included a reluctance to acknowledge cognitive decline and patient nonadherence to management plans. Provider-related barriers included a lack of training and confidence. System-related barriers included a lack of time during consultations and lack of support services. Discussion and implications This review highlights a range of barriers to dementia diagnosis and management from studies rated as being methodologically adequate. Future studies should also utilize theory-driven approaches to exploring a comprehensive range of barriers to optimal dementia care across the care trajectory.

Measuring Awareness of Age-Related Change: Development of a 10-Item Short Form for Use in Large-Scale Surveys.

Abstract: Background and objectives Existing measures of subjective aging have been useful in predicting developmental outcomes. Unlike other constructs of subjective aging, Awareness of Age-Related Change (AARC) focuses on how adults' self-perceptions of aging result in an awareness of age-related gains and losses. We developed a 10-item short form (SF) of the existing 50-item AARC questionnaire as a reliable, valid, and parsimonious solution for use primarily in large-scale surveys but also in applied contexts. Research design and methods AARC was assessed in a German and North American sample of 819 individuals. Item selection for the suggested AARC-10 SF was based on multidimensional item response theory (MIRT). Multi-group confirmatory factor analysis (CFA) was used to test for measurement invariance (MI) across groups of participants in middle age (40-69 years), early old age (70-79 years), and advanced age (80+ years). Concurrent and discriminant validity in old age was assessed with regard to established measures of subjective aging, well-being, and health. Results The AARC-10 SF showed adequate fit to the data and reliability for the perceived gains and losses composites. Valid comparison of latent means was confirmed for early old and advanced age respondents and with some reservation also for middle-aged individuals due to partial MI. Concurrent and discriminant validity were confirmed. Discussion and implications The proposed AARC-10 SF offers an economic device to measure AARC and use the construct as an antecedent or outcome in the context of substantive model testing in large-scale survey data.

Delayed Hospital Discharges of Older Patients: A Systematic Review on Prevalence and Costs.

Abstract: Purpose of the study To determine the prevalence of delayed discharges of elderly inpatients and associated costs Design and methods We searched Medline, Embase, Global Health, CAB Abstracts, Econlit, Web of Knowledge, EBSCO - CINAHL, The Cochrane Library, Health Management Information Consortium, and SCIE - Social Care Online for evidence published between 1990 and 2015 on number of days or proportion of delayed discharges for elderly inpatients in acute hospitals Descriptive and regression analyses were conducted Data on proportions of delayed discharges were pooled using a random effects logistic model and the association of relevant factors was assessed Mean costs of delayed discharge were calculated in USD adjusted for Purchasing Power Parity (PPP) Results Of 64 studies included, 52 (813%) reported delayed discharges as proportions of total hospital stay and 9 (141%) estimated the respective costs for these delays Proportions of delayed discharges varied widely, from 16% to 913% with a weighted mean of 228% This variation was also seen in studies from the same country, for example, in the United Kingdom, they ranged between 16% and 600% No factor was found to be significantly associated with delays The mean costs of delayed discharge also varied widely (between 142 and 31,935 USD PPP adjusted), reflecting the variability in mean days of delay per patient Implications Delayed discharges occur in most countries and the associated costs are significant However, the variability in prevalence of delayed discharges and available data on costs limit our knowledge of the full impact of delayed discharges A standardization of methods is necessary to allow comparisons to be made, and additional studies are required-preferably by disease area-to determine the postdischarge needs of specific patient groups and the estimated costs of delays

Performance-Shaping Factors Affecting Older Adults' Hospital-to-Home Transition Success: A Systems Approach.

Abstract: Background and objectives Facilitating older adults' successful hospital-to-home transitions remains a persistent challenge. To address this challenge, we applied a systems lens to identify and understand the performance-shaping factors (PSFs) related older adults' hospital-to-home transition success. Research design and methods This study was a secondary analysis of semi-structured interviews from older adults (N = 31) recently discharged from a hospital and their informal caregivers (N = 13). We used a Human Factors Engineering approach to guide qualitative thematic analysis to develop four themes concerning the system conditions shaping hospital-to-home transition success. Results The four themes concerning PSFs were: (a) the hospital-to-home transition was a complex multiphase process-the process unfolded over several months and required substantial, persistent investment/effort; (b) there were unmet needs for specialized tools-information and resources provided at hospital discharge were not aligned with requirements for transition success; (c) alignment of self-care routines with transition needs-pre-hospitalization routines could be supportive/disruptive and could deteriorate/be re-established; and (d) changing levels of work demand and capacity during the transition-demand often exceeded capacity leading to work overload. Discussion and implications Our findings highlight that the transition is not an episodic event, but rather a longitudinal process extending beyond the days just after hospital discharge. Transition interventions to improve older adults' hospital-to-home transitions need to account for this complex multiphase process. Future interventions must be developed to support older adults and informal caregivers in navigating the establishment and re-establishment of routines and managing work demands and capacity during the transition process.

Implementation of the Stopping Elderly Accidents, Deaths, and Injuries Initiative in Primary Care: An Outcome Evaluation.

Abstract: BACKGROUND AND OBJECTIVES Older adult falls pose a growing burden on the U.S. health care system. The Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative was developed as a multifactorial approach to fall prevention that includes screening for fall risk, assessing for modifiable risk factors, and prescribing evidence-based interventions to reduce fall risk. The purpose of this study was to determine the impact of a STEADI initiative on medically treated falls within a large health care system in Upstate New York. RESEARCH DESIGN AND METHODS This cohort study classified older adults who were screened for fall risk into 3 groups: (a) At-risk and no Fall Plan of Care (FPOC), (b) At-risk with a FPOC, and (c) Not-at-risk. Poisson regression examined the group's effect on medically treated falls when controlling for other variables. The sample consisted of 12,346 adults age 65 or older who had a primary care visit at one of 14 outpatient clinics between September 11, 2012, and October 30, 2015. A medically treated fall was defined as a fall-related treat-and-release emergency department visit or hospitalization. RESULTS Older adults at risk for fall with a FPOC were 0.6 times less likely to have a fall-related hospitalization than those without a FPOC (p = .041), and their postintervention odds were similar to those who were not at risk. DISCUSSION AND IMPLICATIONS This study demonstrated that implementation of STEADI fall risk screening and prevention strategies among older adults in the primary care setting can reduce fall-related hospitalizations and may lower associated health care expenditures.