Innovation in Aging最新文献

{"title":"Factors influencing older adults' intention to use social chatbots: examining technology acceptance, anthropomorphism, authenticity, and artificial intelligence social interaction.","authors":"Ka Lon Sou, Wei Quin Yow, Matthew Zhi Yuan Lau, Fuxi Ouyang","doi":"10.1093/geroni/igag073","DOIUrl":"10.1093/geroni/igag073","url":null,"abstract":"<p><strong>Background and objectives: </strong>Despite emerging evidence showing that older adults have begun engaging social chatbots for companionship in recent years, little is known about the factors influencing their adoption decisions. We developed an age-friendly social chatbot and examined older adults' intention to use it by integrating the Senior Technology Acceptance Model (STAM) with sociorelational factors relevant to human-artificial intelligence (AI) interaction.</p><p><strong>Research design and methods: </strong>A final sample of 140 community-dwelling older adults interacted with the chatbot for approximately 20 min and then completed questionnaires assessing their attitudes toward the chatbot, perceptions of the chatbot, and their intention to use it in daily life.</p><p><strong>Results: </strong>Higher control belief (e.g., perceived ease of use and facilitating conditions), one of the STAM factors, predicted higher intention to use the chatbot among older adults, whereas higher self-rated health predicted lower intention. Importantly, the stronger the sociorelational factors (e.g., authenticity; AI social interaction intensity), the higher the intention to use. However, higher levels of anthropomorphism of the chatbot predicted lower intention to use. Incorporating sociorelational factors into the STAM framework accounted for an additional proportion of variance, comparable to STAM factors alone.</p><p><strong>Discussion and implications: </strong>Our findings suggest that control belief, authenticity, and social interaction intensity with social chatbots are key drivers of adoption intention among older adults. Unmet needs in life may also drive chatbot engagement. However, overly human-like chatbots may deter adoption. Taken together, integrating human-AI interaction factors with the STAM framework is essential when evaluating older adults' adoption of social chatbots.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 9","pages":"igag073"},"PeriodicalIF":6.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13495109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792613","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":"Walk a mile in my old shoes: an intervention study on age simulation suit training for correctional staff.","authors":"Diete Humblet","doi":"10.1093/geroni/igag075","DOIUrl":"10.1093/geroni/igag075","url":null,"abstract":"<p><strong>Background and objectives: </strong>Correctional populations are ageing rapidly, yet correctional staff often lack the knowledge and attitudinal competencies required to address ageing-related needs. While simulation technologies, such as simulation suits, have demonstrated improvements in cognitive and affective learning outcomes within educational and clinical healthcare settings, their application in correctional training remains unexplored. This study examined the feasibility and exploratory outcomes of a training program incorporating ageing simulation into correctional staff training.</p><p><strong>Research design and methods: </strong>A mixed-methods pilot study was conducted with 19 correctional officers working with older incarcerated individuals in Flanders (Belgium) and included experiential learning using the GERT ageing simulation suit. Quantitative pre-post survey data were collected to explore changes in knowledge, attitudes toward older adults, willingness to work with this population, and ageism; qualitative focus groups provided in-depth insights into participants' experiences.</p><p><strong>Results: </strong>Quantitative findings showed limited and variable changes, consistent with the small sample size and exploratory design. However, qualitative findings indicated that the intervention facilitated reflection on ageing-related physical and psychosocial challenges and increased awareness of the lived experience of ageing in prison. Notably, reluctance to engage with the ageing simulation emerged as an important finding, suggesting that emotional and professional resistance may shape engagement with experiential learning.</p><p><strong>Discussion and implications: </strong>Rather than directly changing attitudes, ageing simulation appeared to function primarily as a catalyst for reflection. These findings highlight the importance of contextual and cultural factors in implementing experiential training in correctional settings and provide initial insights to inform the design of future interventions.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 9","pages":"igag075"},"PeriodicalIF":6.2,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701265","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":"Escalating loneliness among Chinese American older adults in an affordable housing community: a repeat cross-sectional study (2012-2025).","authors":"Jingyuan Liu, Shinyi Wu, Crystal Kwan, Iris Chi","doi":"10.1093/geroni/igag072","DOIUrl":"10.1093/geroni/igag072","url":null,"abstract":"<p><strong>Background and objectives: </strong>Loneliness is a significant public health problem, particularly among older immigrant adults. The study investigates the temporality of changes in loneliness among Chinese American older adults living in affordable housing and factors influencing these changes within the context of broader societal transformations.</p><p><strong>Research and methods: </strong>Using a repeated cross-sectional design, two independent cohorts of Chinese American older adults in the same affordable housing complex were surveyed in 2012 (<i>N </i>= 120) and in 2025 (<i>N </i>= 118). The analyses were conducted in three phases: descriptive statistics summarized the sample characteristics; the Oaxaca-Blinder decomposition assessed whether loneliness scores varied between cohorts and examined the observed differences into explained and unexplained components; and ad hoc multivariate regression analysis examined the erosion of social support as the main factor driving the temporal change of loneliness.</p><p><strong>Results: </strong>The Blinder-Oaxaca decomposition revealed a significant rise in loneliness from 2012 (<i>M </i>= 3.99) to 2025 (<i>M </i>= 5.18; <i>p</i> = .002). Reductions in social support (<i>β</i> = -0.52; <i>p</i> = .020) and fewer children (<i>β</i> = -0.64; <i>p</i> = .029) were the strongest contributors to this rise. Ad hoc analyses suggested that less physical contact with children and trouble using mobile devices correlated with declining social support across cohorts.</p><p><strong>Discussion and implications: </strong>Findings indicate a dramatic increase in loneliness among Chinese American older adults in affordable housing over time. The results highlight the imperative to enhance alternative sources of connection and culturally tailored interventions for supporting social engagement. Promoting peer relationships, digital inclusion, and flexible intergenerational support may help reduce increasing loneliness and enhance well-being in later life.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 10","pages":"igag072"},"PeriodicalIF":6.2,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13573598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148968208","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":"Assessing home environmental hazards for older adults receiving in-home supportive services: the healthy homes assessment tool.","authors":"Steven M Albert, Jemima Ohwobete, Jenn McCartney, Meredith Hughes, Sarah Haig, James Fabisiak, Jonathan Pearlman, Dan Ding, A Everette James, Shannah Gilliam, Pamela Toto","doi":"10.1093/geroni/igag078","DOIUrl":"10.1093/geroni/igag078","url":null,"abstract":"<p><strong>Background and objectives: </strong>Home- and community-based services (HCBS) assessments often fail to include environmental health hazards that can be a barrier to aging in place. This study describes the development of a tool assessing two categories of environmental health hazards found in older homes-poor chemical and physical indoor air quality (IAQ) and moisture-related mold conditions-and the evaluation of the feasibility of integrating it into HCBS assessment workflows.</p><p><strong>Research design and methods: </strong>The Healthy Home Assessment Tool (H-HAT) includes resident reports and HCBS care coordinator observations/reports of indoor air quality (IAQ) and moisture-related mold conditions, conducted in partnership with an area agency on aging. For preliminary pilot validation, H-HAT ratings were assessed relative to consumer-grade IAQ monitoring and mold analysis.</p><p><strong>Results: </strong>The sample included 41 low-income older adult households (median resident age: 76; 78% female; 31.7% African American). Care coordinators successfully fielded the tool, sharing results via standardized reports and proposing remediation strategies with residents. Mold odor was noted in 23% of residences, and water damage in 48.7%. Relative to current EPA standards, 61.0% had fine particulate matter (PM_2.5) concentrations above the recommended limit (9 µg/m³), and 21.9% had radon levels above the action level of 4 pCi/L. PM_2.5 was significantly higher in residences with H-HAT reports of smoking and a higher fungal burden in households with visible mold/mildew.</p><p><strong>Discussion and implications: </strong>H-HAT is feasible to deliver in partnership with care management agencies. Poor IAQ and moisture/mold conditions are common and may be relevant in designing care plans and improving health outcomes.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 9","pages":"igag078"},"PeriodicalIF":6.2,"publicationDate":"2026-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149037784","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":"Disease-specific drivers of sex- and locality-related disparities in life expectancy at age 65: two decades of progress before COVID-19.","authors":"Galina Gorbunova, Arseniy P Yashkin, Julia Kravchenko, Svetlana Ukraintseva, Eric Stallard, Anatoliy Yashin, Igor Akushevich","doi":"10.1093/geroni/igag065","DOIUrl":"10.1093/geroni/igag065","url":null,"abstract":"<p><strong>Background and objectives: </strong>The distribution of life expectancy at age 65 (<i>LE₆₅</i> ) in the United States is characterized by profound sex- and locality-related disparities. Quantifying the disease-specific drivers of these disparities prior to the coronavirus disease 2019 (COVID-19) pandemic provides a critical baseline for understanding subsequent health shocks.</p><p><strong>Methods: </strong>Using CDC WONDER data (1999-2018) and Pollard's decomposition method, we analyzed cause-specific contributions to disparities in LE₆₅, establishing a pre-pandemic baseline for trends in years of life lost (YLL) at age 65.</p><p><strong>Results: </strong>Sex-related disparities (YLL_sex) narrowed, particularly in disadvantaged localities, driven by reductions in YLL from macrovascular diseases and lung cancer. Conversely, locality-related disparities (YLL_loc) widened, especially for females, due to increasing YLL from Alzheimer's disease and the persistent impacts of diabetes, chronic lower respiratory diseases, and heart failure. This created a pre-existing landscape of vulnerability concentrated in low-LE states.</p><p><strong>Discussion and implications: </strong>The 2 decades before COVID-19 saw a critical divergence: progress in reducing sex-based gaps was offset by rapidly widening geographic disparities. The systemic failures that drove the increasing burden of chronic conditions in disadvantaged regions likely predetermined the populations most vulnerable to the pandemic's shock. Our findings highlight that building future resilience requires targeted investments to address these specific, pre-existing health challenges.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 8","pages":"igag065"},"PeriodicalIF":6.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470367","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":"BrainHealth 360: cognitive intervention for older adults designed using a participatory framework.","authors":"Jamie F Mayer, Ryanne C Anderson, Jamie Ward, Laura R Johnson, Makenna Green, Yessenia Chavez, Hongdao Meng, William Baker","doi":"10.1093/geroni/igag064","DOIUrl":"10.1093/geroni/igag064","url":null,"abstract":"<p><strong>Background and objectives: </strong>Despite increasing evidence of the critical impact of modifiable lifestyle factors and cognitive self-efficacy in healthy aging, programs to address these components have been limited for rural-dwelling adults. Therefore, this study aimed to develop and test <i>BrainHealth 360</i>, a co-created multi-component healthy aging protocol, via a community-based transcreation framework within a rural context.</p><p><strong>Research design and methods: </strong>Following iterative co-creation, implementation outcomes and preliminary efficacy data for BrainHealth 360 were gathered using a mixed-methods convergent design with 40 older adults.</p><p><strong>Results: </strong>High levels of intervention acceptability and appropriateness were tied to themes (self-efficacy, social connection, and applicability) in the context of individualized instruction. Identified barriers included accessibility challenges and aging-related fear. Participants reported increased memory self-efficacy and implementation of selected lifestyle changes and cognitive strategies. No change was detected on an objective measure of cognitive function nor in participants' self-perceptions of the aging process.</p><p><strong>Discussion and implications: </strong>These results provide preliminary support for the co-design approach to develop context-specific educational interventions for the promotion of brain health among older adults, with future testing warranted to confirm the efficacy of the resulting intervention.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 8","pages":"igag064"},"PeriodicalIF":6.2,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470360","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":"Behavior change techniques in a care partner-assisted oral health intervention for people with mild dementia: a secondary mixed-methods analysis.","authors":"Jing Wang, Courtney Caiola, Chiao-Hsin Teng, Youngmin Cho, Zhijing Xu, Jackie Finik, Shahrzad Siamdoust, Ya-Ning Chan, Eunjung Ko, Justine Seidenfeld, Ayomide Okanlawon Bankole, Donald E Bailey, Cappye Mott, Bei Wu, Brenda L Plassman, Ruth A Anderson","doi":"10.1093/geroni/igag069","DOIUrl":"10.1093/geroni/igag069","url":null,"abstract":"<p><strong>Background and objectives: </strong>Oral hygiene declines early in mild dementia (MD), yet few interventions specify which behavior change techniques (BCTs) drive improvement. We examined the use of BCTs in relation to oral health outcomes in a care-partner-assisted intervention for persons living with MD.</p><p><strong>Research design and methods: </strong>Using a secondary convergent mixed-methods design, we analyzed the coaching arm of a three-arm randomized trial. Seventeen dyads (persons living with MD-care partners) completed four coaching sessions (68 coaching session transcripts). Seventeen BCTs were specified for use in the coaching manual. Transcripts were double-coded to denote frequency of BCTs used. Changes in the Gingival Index (GI) of persons living with MD between pre- and post-intervention were categorized as <i>Stable/Worsened</i>, <i>Improved</i>, or <i>Meaningfully Improved</i>. BCT frequencies were compared across these categories and integrated with qualitative data using joint displays.</p><p><strong>Results: </strong>The most frequently used BCTs were reviewing behavior goals, problem-solving, behavioral instruction, and prompts/cues. Two unspecified BCTs (action planning and emotional/relational support) were also commonly used. Meaningfully Improved dyads showed coordinated routines, greater autonomy for persons living with MD, and flexible BCT adaptation; Improved dyads used iterative action planning; Stable/Worsened dyads relied more on coach-led BCTs with limited adaptation. Care partners most often delivered prompts/cues and problem-solving, whereas persons living with MD engaged in goal setting and skill acquisition.</p><p><strong>Discussion and implications: </strong>While planned instructional BCTs established a necessary foundation, adaptive elements (e.g., action planning and relational support) proved essential for integrating oral care into daily life and achieving meaningful health improvement.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 9","pages":"igag069"},"PeriodicalIF":6.2,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759313","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":"From family support to smart health devices: addressing subjective community healthcare gaps in aging China.","authors":"Yue-Xuan Mu, Ru Wang, Yi Xiao, Hong-Peng Sun","doi":"10.1093/geroni/igag063","DOIUrl":"10.1093/geroni/igag063","url":null,"abstract":"<p><strong>Background and objectives: </strong>Population aging is increasing pressure on community health services in China, while family support remains central to later-life care. It remains unclear whether smart health devices can help reduce subjective gaps between older adults' service needs and actual service use, and whether such effects depend on family support.</p><p><strong>Research design and methods: </strong>We analyzed pooled person-wave observations from the 2018, 2020, and 2023 waves of the China Longitudinal Aging Social Survey, including 34,482 observations from 18,292 respondents in 1,277 village or urban neighborhood community clusters. Subjective service gaps were measured as a binary indicator of severe unmet need, defined as unmet need for three or more community health services, and as a count of unmet services from 0 to 7. Mixed-effects logistic and negative binomial models examined the associations of intergenerational support, smart health device ownership, and comprehensive community care capacity with these outcomes. Interaction terms, predicted probabilities, and subgroup analyses were used to aid interpretation.</p><p><strong>Results: </strong>Intergenerational support alone did not show a stable gap-reducing association. Smart health devices moderated the association between intergenerational support and subjective service gaps, such that device ownership was more beneficial when family support was stronger. This pattern was more evident among urban residents, women, and adults aged 60-69 years.</p><p><strong>Discussion and implications: </strong>Smart health devices are unlikely to reduce subjective service gaps on their own. Their value depends on whether older adults can use them within supportive family and community contexts.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 8","pages":"igag063"},"PeriodicalIF":6.2,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13385345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548965","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":"Life-course pathways from childhood starvation to late-life depressive symptoms: a double machine learning approach.","authors":"Chaoxin Jiang, Hao Feng","doi":"10.1093/geroni/igag071","DOIUrl":"10.1093/geroni/igag071","url":null,"abstract":"<p><strong>Background and objectives: </strong>Although previous research has documented the adverse effects of childhood starvation as a profound early-life adversity, most studies have focused on physical health outcomes or mortality, with limited integration of life-course theory and Bourdieu's capital-based framework. This study examined whether childhood starvation predicted depressive symptoms in later life and further investigated whether these associations were mediated by economic, social, and cultural capital.</p><p><strong>Research design and methods: </strong>Data were drawn from the 2018, 2020, and 2023 waves of the China Longitudinal Aging Social Survey. An unbalanced panel dataset comprising 25,852 observations was constructed, with participants being older adults in China. The double machine learning approach was applied to estimate the causal impact of childhood starvation on late-life depressive symptoms and analyze the mediating roles of the 3 types of capital.</p><p><strong>Results: </strong>The findings indicated that (a) individuals who experienced frequent hunger in childhood reported significantly higher levels of depressive symptoms in old age and (b) economic, social, and cultural capital each partially mediated the association between childhood starvation and late-life depressive symptoms.</p><p><strong>Discussion and implications: </strong>This study advanced life-course scholarship by integrating a capital-based framework to understand the enduring psychological consequences of childhood starvation, linking early adversity to late-life mental health through cumulative depletion of key resources. It identifies capital erosion as a key mechanism and offers implications for policies aimed at reducing childhood food insecurity, strengthening life-course resources, and expanding mental health services.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 9","pages":"igag071"},"PeriodicalIF":6.2,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701287","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":"Examining family and facility characteristics associated with family satisfaction in assisted living: the Minnesota Assisted Living Report Card project.","authors":"Tetyana P Shippee, Romil R Parikh, Molin Ji, Timothy J Beebe, Mark Woodhouse, Martina Johnson, Julie Angert, Lauren Glass","doi":"10.1093/geroni/igag067","DOIUrl":"10.1093/geroni/igag067","url":null,"abstract":"<p><strong>Background and objectives: </strong>Family members play an essential role in monitoring and advocating for quality of care in assisted living (AL) communities. Despite their importance, few population-based studies have examined how family and facility characteristics influence family satisfaction in AL. We evaluated family and facility characteristics associated with family satisfaction in AL.</p><p><strong>Methods: </strong>Using cross-sectional survey data from the Minnesota Assisted Living Report Card project (2024), we identified resident- and facility-level predictors of AL resident-reported quality of life in 8 domains, including experience, choice, needs, housekeeping, food, environment, staff, and overall satisfaction, using multivariable linear mixed regression with facility-level random intercept to account for facility-level clustering.</p><p><strong>Results: </strong>Among 15 320 family member respondents in licensed AL facilities with more than 5 beds (51.1% of age <65 years, 65.4% female, 92.3% White), mean domain scores ranged from 67.2 (Food) to 82.1 (Overall), indicating generally positive perceptions. Across all domains, lower satisfaction was observed among respondents who are younger, people of color, and female, and among spouses or siblings of residents. Families visiting or communicating less frequently tended to report lower satisfaction with choice and overall satisfaction. Smaller and non-profit facilities received higher ratings across most domains, while facilities in the Twin Cities metropolitan area scored higher than those in the rest of the state.</p><p><strong>Discussion and implications: </strong>Family satisfaction in AL reflects both family composition and facility context. Policymakers and providers can leverage family satisfaction metrics to inform targeted quality improvement and promote equitable, family-centered care across the AL sector.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 9","pages":"igag067"},"PeriodicalIF":6.2,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712246","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}