Innovation in Aging最新文献

{"title":"Social Care Costs of Depressive Symptoms in the English Older Population: Then Role of Housing Quality Improvements.","authors":"Bo Hu, Nicola Brimblecombe, Javiera Cartagena-Farias","doi":"10.1093/geroni/igaf017","DOIUrl":"https://doi.org/10.1093/geroni/igaf017","url":null,"abstract":"<p><strong>Background and objectives: </strong>Poor housing conditions pose a substantial threat to older people's mental health and create inequalities in social care needs. However, their economic consequences for the social care sector have not been thoroughly investigated. This study projects the costs of social care for community-dwelling older people with depressive symptoms under different housing intervention scenarios in England.</p><p><strong>Research design and methods: </strong>Drawing on data collected from 10,601 individuals (33,461 observations across 4 waves) participating in the English Longitudinal Study of Ageing, we combined a Markov model with a Macrosimulation model to make projections of social care costs. Multinomial logistic regression and linear regression analyses were conducted to derive the parameters for the 2 simulation models.</p><p><strong>Results: </strong>We estimate that the costs of unpaid care for older people with depressive symptoms will rise from £33.6 billion in 2022 to £59.9 billion in 2042, and the costs of formal home care will rise from £4.2 billion in 2022 to £8.1 billion in 2042 in the base case scenario of no interventions to improve housing quality. In a scenario where the number of housing problems is reduced to zero, the costs of unpaid care and formal home care in 2042 are projected to rise to be £3.5 billion lower and £0.3 billion lower, respectively, than the no intervention scenario.</p><p><strong>Discussion and implications: </strong>Housing improvements reduce social care demand in the older population by delaying and reversing the progression of depressive symptoms, which has the dual benefits of elevating personal well-being and generating long-term cost savings in the social care sector.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"9 4","pages":"igaf017"},"PeriodicalIF":4.9,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to Neighborhood Amenities and Services and the Risk of 2-Year Nursing Home Placement Among Persons Living With Dementia.","authors":"Yeon Jin Choi, Gillian Fennell, Jennifer A Ailshire","doi":"10.1093/geroni/igaf011","DOIUrl":"10.1093/geroni/igaf011","url":null,"abstract":"<p><strong>Background and objectives: </strong>Older adults prefer to age in their homes and communities, but due to increased care needs associated with dementia, persons living with dementia are much more likely to move into nursing homes. Living in communities with greater access to neighborhood amenities and supports may reduce the risk of nursing home placement by helping persons living with dementia maintain their health and independence and lowering caregiving burden and stress. This study aims to identify neighborhood amenities and services that are associated with nursing home transitions among persons living with dementia.</p><p><strong>Research design and methods: </strong>We used data from the 2004-2016 waves of the Health and Retirement Study (HRS), which includes 3 507 older adults with dementia, linked with the HRS Contextual Data Resource and the National Neighborhood Data Archive. Logistic regression models were estimated adjusting for sociodemographic and neighborhood characteristics.</p><p><strong>Results: </strong>Findings suggest that access to more park areas, healthy food outlets, and home health services was associated with a lower risk of 2-year nursing home placement.</p><p><strong>Discussion and implications: </strong>These findings emphasize the importance of neighborhood amenities and services as essential components of supportive communities, enabling persons living with dementia to age in place.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"9 5","pages":"igaf011"},"PeriodicalIF":4.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cultural Safety in Clinical Research: A Conceptual Overview and Call to Action.","authors":"Hector Salazar, Carey E Gleason, Jennifer H Lingler","doi":"10.1093/geroni/igaf015","DOIUrl":"https://doi.org/10.1093/geroni/igaf015","url":null,"abstract":"<p><p>Black Americans are two to three times more likely to develop ADRD than their white counterparts, yet Black Americans make up only 2.4% of ADRD clinical trial participants. Here we provide an overview of the current state of initiatives to maximize racial and ethnic inclusivity in clinical research, particularly among ethnoracialized groups, and introduce the Indigenous-rooted concept of cultural safety through an integrative review and outline of its applicability to the research context. Cultural safety ensures that cultural identities, values, and experiences of minoritized persons are respected, understood, and integrated in their health care journey, empowering them to define and evaluate their own experiences. Implementing cultural safety challenges individuals to confront and critically examine their own perspectives on the dominant culture's traditions and values, as well as their implicit racism, biases, privileges, and inherent power structures. We extend prior conceptual work on cultural safety by proposing two subdimensions: environmental and internal. These must be synergistically integrated to heal fractured relationships between communities of color and researchers. By championing cultural safety, we can create a workforce of self-aware researchers who embody cultural safety's true essence as defined by the communities they serve. Community-engaged research serves as an ideal platform for cultural safety to be meaningfully implemented and sustained. This approach can uplift previously silenced voices in research, build long-term relationships, and generate empirical data that substantiates its positive effects. Importantly, applying environmental and internal cultural safety can empower participants in ADRD research where it is critically needed.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"9 4","pages":"igaf015"},"PeriodicalIF":4.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12008768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Climate Change and Healthy Aging: What Are the Existing Data in Aging Studies?","authors":"Yu-Tzu Wu, Matthew Prina, Paola Zaninotto","doi":"10.1093/geroni/igaf008","DOIUrl":"https://doi.org/10.1093/geroni/igaf008","url":null,"abstract":"","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"9 4","pages":"igaf008"},"PeriodicalIF":4.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12019628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare Clinicians' Perspectives on Managing Suspected Elder Abuse: \"We Don't Want to Just Swoop in and Do What We Think Is Best\".","authors":"Lena K Makaroun, Naomi Shin, Kristina L Hruska, Tony Rosen, Melissa E Dichter, Carolyn T Thorpe, Keri L Rodriguez, Ann O'Hare, Ann-Marie Rosland","doi":"10.1093/geroni/igaf012","DOIUrl":"10.1093/geroni/igaf012","url":null,"abstract":"<p><strong>Background and objectives: </strong>Elder abuse (EA) is common and has significant health impacts. New initiatives seek to capitalize on opportunities to respond to EA from within the healthcare system, but little is known about what clinicians may need to be successful in these efforts. Our objective was to understand perceived barriers and facilitators to managing all phases of EA within an integrated healthcare system from the perspectives of frontline clinicians from a range of different disciplines.</p><p><strong>Research design and methods: </strong>Thirty-seven clinicians (10 social workers, 9 physicians, 7 psychologists, 6 nurses, and 5 advanced practice providers) from different clinical sites within 2 large Veterans Health Administration (VHA) medical centers participated in semistructured interviews. The interview guide was designed to elicit facilitators and barriers to discrete stages in the process of addressing EA, including detection, reporting, intervention, and monitoring. Transcripts were coded using deductive (based on a prespecified conceptual model) and inductive approaches and analyzed using thematic analysis.</p><p><strong>Results: </strong>Most (78%) participants were women, ranging in age from 33 to 64 years, and practicing in a variety of settings (e.g., primary care and emergency department) with between 4 and 25 years of VHA experience. We identified 5 interrelated themes that cut across the different stages of EA care: situational context (theme 1), degree of trust in familial and healthcare relationships (theme 2), extent of education and skills (theme 3), and existing system infrastructure (theme 4) all contributed to clinician empowerment and motivation toward action (theme 5).</p><p><strong>Discussion and implications: </strong>Efforts to enhance skills training, build trusting relationships, and improve system infrastructure could help to equip clinicians to engage in healthcare system interventions to reduce harm from EA.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"9 5","pages":"igaf012"},"PeriodicalIF":4.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trajectories of Burden or Benefits of Caregiving Among Informal Caregivers of Older Adults: A Systematic Review.","authors":"Yongjing Ping, Jeremy Lim-Soh, Truls Østbye, Shamirah D/O A'Azman, Yong Ting, Rahul Malhotra","doi":"10.1093/geroni/igaf014","DOIUrl":"https://doi.org/10.1093/geroni/igaf014","url":null,"abstract":"<p><strong>Background and objectives: </strong>Informal caregiving for older adults can be both burdensome and beneficial. Given that the informal caregiving situation may evolve over time, and care needs of older adults can result from diverse health conditions, it is valuable to understand the trajectories of burden or benefits of caregiving and how these trajectories vary across health conditions common among older care-recipients. This review is the first to summarize the literature on trajectories of burden or benefits of caregiving, including caregiver and care-recipient characteristics associated with the trajectories.</p><p><strong>Research design and methods: </strong>We reviewed longitudinal observational quantitative studies, from 5 bibliographic databases, that assessed burden or benefits of caregiving at 3 or more time points among informal caregivers of older adults (60 years or above).</p><p><strong>Results: </strong>The narrative synthesis included 41 studies, with only 7 (17%) considering trajectories of benefits. A stable average trajectory of burden or benefits of caregiving was the most common pattern over time across various care-recipient health conditions. However, an increasing burden over time was primarily observed among caregivers of persons with dementia, while a decreasing burden was noted among caregivers of persons discharged from the hospital after an acute health event. Only 6 (10%) studies, which reported heterogeneity in the progression of burden or benefits separately or jointly, identified distinctive trajectories within the same set of caregivers. Risk factors consistently identified to be associated with trajectories indicating persistently higher burden or persistently lower benefits included more care-recipient functional limitations and behavioral problems, being a non-spousal caregiver, being a solo caregiver, and perceiving less self-efficacy or competence.</p><p><strong>Discussion and implications: </strong>Future studies should focus on the trajectories of benefits of caregiving, untangle heterogeneity in trajectories of burden or benefits of caregiving, and consider both burden and benefits concurrently to identify factors that both enhance benefits and alleviate burden over time.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"9 4","pages":"igaf014"},"PeriodicalIF":4.9,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Employment Status and Life Satisfaction Among Older Adults: Disentangling the Gendered Effects of Entering and Exiting Employment.","authors":"Sujeong Park, Jinho Kim","doi":"10.1093/geroni/igaf013","DOIUrl":"https://doi.org/10.1093/geroni/igaf013","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study examines the relationship between employment transitions and life satisfaction among Korean adults aged 65 and older, with a focus on the distinct effects of entering and exiting employment. Moreover, the study explores whether these associations vary by gender.</p><p><strong>Research design and methods: </strong>Utilizing data from the Korean Longitudinal Study of Ageing, the study employed innovative asymmetric fixed effects models to separately assess the impacts of entering and exiting employment. Gender-stratified analyses were also conducted to explore potential differences in these effects between men and women.</p><p><strong>Results: </strong>Conventional fixed effects models suggested that employment status is not significantly related to life satisfaction in older adults. However, the asymmetric fixed effects models revealed a more nuanced picture: entering employment is associated with an increase in life satisfaction whereas exiting employment shows no significant association. The gender-stratified analysis further indicated that for men, entering employment improved life satisfaction, whereas exiting had no effect. In contrast, for older women, entering employment did not enhance life satisfaction, but exiting employment had a positive impact.</p><p><strong>Discussion and implications: </strong>These findings highlight the need for gender-sensitive employment policies for older adults, aimed at enhancing their well-being based on their unique experiences of employment transitions.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"9 4","pages":"igaf013"},"PeriodicalIF":4.9,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11979769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Loneliness as a Risk Factor for Time to Care Home Entry for Older Adults Receiving Community Care.","authors":"Sam Rickman, Jose-Luis Fernandez, Juliette Malley","doi":"10.1093/geroni/igaf010","DOIUrl":"10.1093/geroni/igaf010","url":null,"abstract":"<p><strong>Background and objectives: </strong>International efforts to contain long-term care costs have prioritized personal care. However, reductions in services aimed at addressing loneliness or promoting social participation may affect demand for long-term care facilities. Research on the impact of loneliness on entry to residential or nursing care is based on survey data, which under-represents those with highest needs. Administrative records include such individuals and, unlike surveys, contain continuous data on service receipt, enabling accurate modeling of time to care home entry.</p><p><strong>Research design and methods: </strong>We use administrative data for 1 101 individuals receiving care in a London local authority. We extract loneliness from free text notes using a large language model and model its impact on care home entry 5 years after assessment, controlling for needs and demographics. We use logistic regression and a competing risks survival model to measure the time until care home entry.</p><p><strong>Results: </strong>The odds ratio for care home entry associated with loneliness is 1.45 with logistic regression (95% CI 1.04-2.01). The hazard ratio is 1.32 (95% CI 1.01-1.72) with a cause-specific model, and 1.39 (95% CI 1.08-1.79) using the Fine and Gray method. Among those most likely to enter a care home, the median time to entry is 9 months (95% CI 228-328 days) earlier for those who are lonely.</p><p><strong>Discussion and implications: </strong>The hazard ratio of loneliness on care home entry is around the magnitude associated with gender, ethnicity, or living alone. However, loneliness is modifiable. Reductions to services for social participation, such as day centers, are likely to cause an increase in loneliness. We demonstrate that for those with the highest needs, loneliness is a significant risk factor for time until care home entry. Policymakers seeking to delay care home entry should consider the impact of services for loneliness.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"9 6","pages":"igaf010"},"PeriodicalIF":4.9,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations Between Regional Supply and Integration of Home and Community-Based Service Providers and Risk of Institutionalization: Evidence From South Korea.","authors":"Sunghun Yun, Hongsoo Kim","doi":"10.1093/geroni/igaf007","DOIUrl":"10.1093/geroni/igaf007","url":null,"abstract":"<p><strong>Background and objectives: </strong>To examine whether the regional density of integrated home and community-based services (HCBS) providers affects long-term care (LTC) service utilization pattern and institutionalization risk in South Korea.</p><p><strong>Research design and methods: </strong>This observational study utilized data from the National Health Insurance Service (NHIS) on individuals aged 65 and older who became newly eligible for LTC insurance benefits in 2018. The final sample excluded individuals admitted to long-term care hospitals during the previous year or those living away from home, resulting in a total of 91,302 individuals included in the study. We analyzed the impact of regional HCBS and integrated care provider density on 4 outcomes: choice of HCBS over LTC facilities (LTCF) as first LTC service, intensity and comprehensiveness of HCBS use, and risk of institutionalization within a year.</p><p><strong>Results: </strong>Higher regional densities of integrated care providers are associated with increased odds of using HCBS as the first LTC service (odds ratio 1.066, model 1, <i>p</i> < .01). Increased density was also associated with higher odds of using multiple HCBS (Odds Ratio 1.108, model 1, <i>p</i> < .01). Additionally, higher density of integrated care providers was associated to decreased risk of institutionalization into LTC facilities (hazard ratio 0.98, model 1, <i>p</i> < .01).</p><p><strong>Discussion and implications: </strong>The density integrated care providers significantly reduce institutionalization rates, by increasing the possibility of choosing HCBS over LTCF as their first LTC service and using a more comprehensive combination of HCBS services. Further investment in integrated care models may enhance the effectiveness of LTC systems.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"9 3","pages":"igaf007"},"PeriodicalIF":4.9,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latent Class Analysis Identifies Four Distinct Patient Deprescribing Typologies Among Older Adults in Four Countries.","authors":"Kristie Rebecca Weir, Vincent D Marshall, Sarah E Vordenberg","doi":"10.1093/geroni/igaf002","DOIUrl":"10.1093/geroni/igaf002","url":null,"abstract":"<p><strong>Background and objectives: </strong>Polypharmacy, the concurrent use of multiple medicines, is a growing concern among older adults and those with chronic conditions. Deprescribing through dose reduction or discontinuing selected medicines is a strategy for reducing medicine-related harm. The Patient Deprescribing Typology was developed using qualitative methods to describe the varying factors that are important to older adults when they consider deprescribing. The objective of this study was to use quantitative methods to define distinct classes of older adults via the Patient Deprescribing Typology.</p><p><strong>Research design and methods: </strong>This study used a cross-sectional experimental design in which data was collected via an online survey from participants 65 years and older in Australia, the Netherlands, the United Kingdom, and the United States. A latent class analysis was performed using the 4-item Patient Deprescribing Typology that collected data about the beliefs about the importance of medicines, how older adults learn about medicines, medicine decision-making preferences, and attitudes towards stopping medicines.</p><p><strong>Results: </strong>Older adults (<i>n</i> = 2,250) were a median of 70 years and 2-thirds reported that their highest level of education was an associate's degree or trade school or less. We identified 4 distinct Patient Deprescribing Typology classes: Class 1 \"Trusts their doctor\" (41.6%), Class 2 \"Makes own decisions\" (30.2%), Class 3 \"Avoids deprescribing\" (15.5%), and Class 4 'Medicines not important' (12.7%).</p><p><strong>Discussion and implications: </strong>Older adults report diverse perspectives about deprescribing, emphasizing the need for tailored communication strategies in clinical settings. Additional research is needed to examine older adults' preferences in real-world contexts to refine and improve deprescribing interventions.</p><p><strong>Clinical trial registration: </strong>NCT04676282.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"9 2","pages":"igaf002"},"PeriodicalIF":4.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}