Innovation in Aging最新文献

{"title":"Older adults' perspectives on using virtual reality to view nature landscapes in long-term care homes: a qualitative study.","authors":"Yu-Chen Chi, Hsiao-Ling Hu, Shou-Yu Wang, Yeu-Hui Chuang","doi":"10.1093/geroni/igag045","DOIUrl":"10.1093/geroni/igag045","url":null,"abstract":"<p><strong>Background and objectives: </strong>Older adults residing in long-term care (LTC) homes (also referred to as LTC facilities) often have limited opportunities to access nature environments, which are known to support psychological well-being. Virtual reality (VR) offers a novel approach to delivering immersive nature experiences for this population. This qualitative study explored the perceptions of using VR to view nature landscapes among older adults in LTC homes.</p><p><strong>Research design and methods: </strong>Using purposive sampling, we recruited 16 older adults (aged 60-84) from 10 LTC facilities in Taiwan. Participants viewed six 360-degree nature videos (each about 2 min long) in a single VR session via a VR headset. Within 1 week of the VR session, participants completed individual, face-to-face, semi-structured interviews. Data were analyzed using content analysis.</p><p><strong>Results: </strong>Five themes and corresponding categories were generated: (1) as a window to the past, revisiting childhood/youth and reconnecting with places once visited; (2) embracing serenity, feeling relaxed/lightness, savoring the joy, sensing ease/comfort, and feeling inner calm/tranquility; (3) escaping the confines of reality, unlocking a sense of freedom and revisiting natural landscapes; (4) rekindling the healing power of dreams/hope, reigniting hope and motivation and fulfilling unfinished dreams; and (5) unreal and unsettling realities, expressing negative experiences including loneliness, dizziness, and a virtual-reality gap.</p><p><strong>Discussion and implications: </strong>Immersive VR nature experiences can evoke nostalgic memories, promote relaxation, provide a temporary sense of freedom, and inspire hope. However, some participants also reported challenges such as dizziness, feelings of artificiality, or loneliness, highlighting the importance of careful design and individualized implementation.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 7","pages":"igag045"},"PeriodicalIF":6.2,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13283472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301452","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":"Changes in conversational pattern as a clinical trial outcome: a proof-of-concept study using the I-CONECT data.","authors":"Liu Chen, Chao-Yi Wu, Hiroko H Dodge","doi":"10.1093/geroni/igag041","DOIUrl":"10.1093/geroni/igag041","url":null,"abstract":"<p><strong>Background and objectives: </strong>Recent advancements in natural language processing show that linguistic measures can detect subtle cognitive decline. However, most analyses rely on restrictive tasks (eg, picture descriptions). In this proof-of-concept study, we use semantic noise (SN) to quantify conversational patterns and monitor changes following a behavioral intervention.</p><p><strong>Methods: </strong>We analyzed text derived from semi-structured conversations of the I-CONECT project. Participants in the intervention group, who were either cognitively normal (normal cognition [NC]) or had mild cognitive impairment (MCI), engaged in frequent conversational interactions (4 times/week) via an internet/webcam for 6 months. The mean semantic noise (MSN) from the second week and 24th week was used to represent the baseline and month 6, respectively.</p><p><strong>Results: </strong>Using a 2-tailed <i>t</i>-test, baseline MSN was significantly higher in the MCI group than in the NC group (MCI: 2.09 [<i>SD</i> = 0.34], NC: 1.87 [<i>SD</i> = 0.35], <i>p</i> = .024). MCI and NC did not differ significantly 6 months post-intervention (MCI: 1.81 [<i>SD</i> = 0.47], NC: 1.95 [<i>SD</i> = 0.47], <i>p</i> = .280). Using the paired 2-tailed <i>t</i>-test, MSN in the MCI group decreased significantly from baseline to month 6 (<i>p</i> = .009), while no significant difference was observed in the NC group (<i>p</i> = .426).</p><p><strong>Discussion and implications: </strong>After 6 months of conversational engagement, the MCI group's MSN came to resemble that of the NC group. These findings suggest that linguistic measures derived from spontaneous, naturalistic conversations may be sensitive to cognitive changes over time. Further research on extracting linguistic measurements from spontaneous conversations could facilitate cognitive monitoring in daily life.</p><p><strong>Clinical trial registration number: </strong>NCT02871921.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 8","pages":"igag041"},"PeriodicalIF":6.2,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390804","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":"A dynamic approach to unmet needs in long-term care for older people across Europe.","authors":"Ricardo Rodrigues, Victoria Kontrus, Rebekka Steinlechner, Stefan Hopf, Susana R Marques","doi":"10.1093/geroni/igag042","DOIUrl":"10.1093/geroni/igag042","url":null,"abstract":"<p><strong>Background and objectives: </strong>Studies on unmet needs in long-term care (LTC) have focused on specific time points and have not adopted a dynamic approach that considers changes over time. This study examined the trajectories of unmet needs for care and support with activities of daily living (ADLs) and instrumental ADLs (IADLs) among adults aged 50+ across European countries up to 9 years after the onset of needs.</p><p><strong>Research design and methods: </strong>Using the longitudinal data from the SHARE survey (2011-2022; <i>n </i>= 6,154), we used latent profile analysis to identify 5 trajectory types defined by time until onset of unmet needs, number of changes of state, time spent with unmet needs, ADL/IADL limitations, and age at onset of needs. These trajectories are marked by early periods of unmet needs (short-delayed met needs; long-delayed met needs; high needs and delayed), ambivalent (U-shaped met needs), or outright positive (met needs from onset).</p><p><strong>Results: </strong>An overwhelming majority of older adults experienced unmet needs at some point after the onset of needs. Multivariate analysis shows that having a cohabiting spouse/partner and higher income are associated with trajectories where care is available early on. Country-level public expenditure on LTC is also a strong determinant of belonging to different trajectories. We further explored the association between these trajectories and mortality and ADL/IADL limitations.</p><p><strong>Discussion and implications: </strong>Results confirm the relevance of transition points, such as the time around the onset of needs, highlighting the potential role for case management and discharge teams at such transitions.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 8","pages":"igag042"},"PeriodicalIF":6.2,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13329069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390750","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":"Self-employment of older workers and the transition to retirement: using machine learning to uncover heterogeneity in work arrangements.","authors":"Joelle Abramowitz, Andrew Joung","doi":"10.1093/geroni/igag043","DOIUrl":"10.1093/geroni/igag043","url":null,"abstract":"<p><strong>Background and objectives: </strong>Self-employment increases with age, but heterogeneity in the self-employment arrangements of older workers and their transitions across these work arrangements is not well understood. This paper uses novel data to examine such heterogeneity before and after retirement.</p><p><strong>Research design and methods: </strong>We use machine-learning methods and internal narrative descriptions of industry and occupation in the 1994-2018 Health and Retirement Study to classify self-employment as (a) informal, (b) formal, and (c) business ownership. We then examine work and demographic characteristics associated with these different self-employment arrangements and how workers transition between these work arrangements across survey waves and at retirement.</p><p><strong>Results: </strong>Formally self-employed workers and business owners perform more abstract work and substantially less manual work and report more schooling, higher earnings, and better physical and mental health than informally self-employed workers, who are the most likely to transition out of the labor force by the next survey wave. Many self-employed workers transition into other self-employment arrangements across waves and at retirement and are less likely than employees to transition out of the labor force at retirement. Substantial shares of the formally self-employed, business owners, and employees pre-retirement transition into informal self-employment at retirement.</p><p><strong>Discussion and implications: </strong>Our findings reveal important differences in older workers' self-employment arrangements and transition patterns that were previously unobservable. Policymakers should be sensitive to this distinction, as policies targeting small business owners may not address the needs of other self-employed workers.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 7","pages":"igag043"},"PeriodicalIF":6.2,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13278833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148294958","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":"Does sit-to-stand transition velocity vary across the day? Association with physical functioning and fatigability in community-dwelling older adults.","authors":"Antti Löppönen, Laura Karavirta, Merja Rantakokko, Katja Lindeman, Christophe Delecluse, Evelien Van Roie, Taina Rantanen, Lotta Palmberg","doi":"10.1093/geroni/igag040","DOIUrl":"10.1093/geroni/igag040","url":null,"abstract":"<p><strong>Background and objectives: </strong>Physical fatigability increases with age and may act as a barrier to activity and a marker of functional decline. In older adults, strength-demanding, device-based variables such as free-living sit-to-stand (STS) transitions may be associated with physical fatigability. This study examines STS velocity patterns across a 24-hr cycle and their associations with physical fatigability and functioning in older adults.</p><p><strong>Research design and methods: </strong>This cross-sectional study included a population-based sample of 75-, 80-, and 85-year-old people (<i>n </i>= 479, 60% women). STS transitions were recorded for 3-7 days using a thigh-worn accelerometer, with velocities summarized in two-hour intervals and normalized to daily means. Participants were grouped by self-reported walking fatigability, performance fatigability, and physical functioning. Group differences were analyzed using non-parametric tests and logistic regression, adjusted for age cohort and sex.</p><p><strong>Results: </strong>Individuals with high self-reported walking fatigability showed greater declines in free-living STS angular velocities in the late afternoon (4-6 p.m.: odds ratio [OR] = 1.39 per 5% decrease, <i>p </i>= .009) than those with low fatigability. Similarly, individuals with high performance fatigability exhibited greater velocity declines in the afternoon and early evening (2-4 p.m.: OR = 1.19, <i>p </i>= .034; 6-8 p.m.: OR = 1.15, <i>p </i>= .035). Evening declines were also most pronounced among those with physical functioning limitations (6-8 p.m.: OR = 1.19, <i>p </i>= .028; 8-10 p.m.: OR = 1.21, <i>p </i>= .003).</p><p><strong>Discussion and implications: </strong>Measuring STS velocity decline may help in the identification of older individuals with higher fatigability and poorer physical functioning and may open new possibilities for wearable-based remote monitoring and individualized care.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 6","pages":"igag040"},"PeriodicalIF":6.2,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13186197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981616","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":"Cognitive dispersion in established adulthood: etiology and implications for cognitive aging.","authors":"Anqing Zheng, Elizabeth Muñoz, Robin P Corley, Daniel E Gustavson, Naomi P Friedman, Robert Plomin, Sally J Wadsworth, Chandra A Reynolds","doi":"10.1093/geroni/igag039","DOIUrl":"10.1093/geroni/igag039","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cognitive dispersion, reflecting intraindividual variability across tasks, may signal dementia risk in older adults, but its origins and relevance before midlife are unclear. We examined dispersion as a potential marker of cognitive reserve in established adulthood and distinguished it from general ability using heritability analyses.</p><p><strong>Research design and methods: </strong>1,245 primarily non-Hispanic White twins and siblings were assessed at 33.3 years (SD = 5.0; 53% female) using 2 cognitive batteries. Bayesian mixed effects location scale models estimated mean performance and dispersion across cognitive tasks, with tasks standardized against current sample-based norms (age 33) and adolescent norms (age 16). The mean of task scores standardized to current norms reflects current ability, while the mean of the same scores standardized to adolescent norms reflects growth in ability. The respective dispersion estimates represent task-specific deviations from general ability and task-specific gains.</p><p><strong>Results: </strong>Across 4 models fitted by battery and standardization, greater cognitive dispersion was associated with higher general ability (<i>r </i>= 0.23-0.56) and developmental gains (<i>r </i>= 0.62-0.93). Verbal tasks showed lower dispersion relative to performance tasks (β = 0.83-0.87). Dispersion was strongly heritable overall (43%-84%), and moderately heritable independent of general ability (36%-37%) and growth (2%-16%). Dispersion did not predict education or occupational outcomes beyond general ability and growth.</p><p><strong>Discussion and implications: </strong>Before midlife, cognitive dispersion is distinct from general ability and moderately heritable. Dispersion is associated with higher cognitive ability and growth, but not directly with educational or occupational attainment, suggesting dispersion may relate to cognitive reserve through other pathways.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 6","pages":"igag039"},"PeriodicalIF":6.2,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13189861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015421","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":"Smartphones as a gateway to independence and adaptation: older Mandarin-speaking immigrants' use of smartphones for everyday living.","authors":"Prince C Ekoh, Sepali Guruge, Jie Zhang, Kateryna Metersky, Denise S Cloutier, Hongmei Tong, Christine A Walsh","doi":"10.1093/geroni/igag032","DOIUrl":"10.1093/geroni/igag032","url":null,"abstract":"<p><strong>Background and objectives: </strong>The growing integration of digital technologies into everyday life has reshaped how older adults engage with their social environments, access information, and navigate health and community services. Yet, limited research has examined these dynamics among Mandarin-speaking older immigrants in Canada, a rapidly expanding population facing intersecting challenges of ageing, migration, and linguistic adaptation. Drawing on qualitative data from the national Inclusive Communities for Older Immigrants project, this study explores how Mandarin-speaking older immigrants use smartphones in their daily lives and how these technologies contribute to adaptation, independence, and well-being.</p><p><strong>Research design and methods: </strong>Data were obtained from 102 participants living in 7 cities across 4 provinces in Canada. The data were deductively and inductively coded with NVivo 15© and analyzed thematically.</p><p><strong>Results: </strong>Findings reveal 3 interconnected domains of smartphone use in support of daily living: (a) access to community resources, healthcare, home, and community safety; (b) play and leisure, including digital gaming, music, and online reading; (c) empowerment, navigating unfamiliar environments, enhanced autonomy, and reduced dependence on family members. Despite these benefits, participants reported persistent barriers to smartphone use, including linguistic inaccessibility, inconsistent translation services, and fears of digital dependence.</p><p><strong>Discussion and implications: </strong>The study highlights the dual role of smartphones as both facilitators and barriers to digital inclusion, underscoring the need for culturally and linguistically responsive digital supports to promote equitable digital technological participation among Mandarin-speaking older immigrants in Canada.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 8","pages":"igag032"},"PeriodicalIF":6.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13332434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390730","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":"Co-developing implementation strategies to support STEADI (Stopping Elderly Accidents, Deaths, and Injuries) for older adult fall prevention in outpatient physical therapy.","authors":"Jennifer L Vincenzo, Sarah K Council, Mariana Wingood, Aaron J Scott, Jamie M Caulley, Emily Kocurek, Jennifer S Brach, Geoffrey M Curran","doi":"10.1093/geroni/igag036","DOIUrl":"10.1093/geroni/igag036","url":null,"abstract":"<p><strong>Background and objectives: </strong>Evidence-based quality improvement (EBQI) is an approach to co-develop implementation strategies with implementation partners. This study describes an EBQI approach for co-developing implementation strategies to support the adoption of the Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) falls prevention initiative in outpatient physical therapy.</p><p><strong>Methods: </strong>A multidisciplinary panel (<i>n </i>= 10), representing key partner groups including physical therapists, clinic managers, a referring physician, an older adult with prior physical therapy experience, and a caregiver, collaborated with a research team across 5 outpatient physical therapy clinics within a U.S. health system. Eight virtual EBQI panel sessions conducted over 9 months included meetings, barriers/facilitator ranking, strategy identification/rating, concept mapping, consensus building, and group discussion. Strategies were evaluated on feasibility and importance using Likert-scale surveys and iteratively refined. The main outcome measures were partner-rated rankings of barriers and facilitators to address implementation challenges, rankings of strategy feasibility and importance, and a finalized package of tailored implementation strategies.</p><p><strong>Results: </strong>Twenty barriers and 20 facilitators were prioritized and ranked by each partner group. Prioritized barriers were matched with prioritized facilitators and/or implementation strategies to address barriers. Of the 78 implementation strategies considered, 39 unique specifications from 22 strategies were identified. Key strategies included clinician education, workflow and electronic health record integration, clinician and older adult-facing materials, clinic champions, and communication templates.</p><p><strong>Discussion and implications: </strong>EBQI effectively engaged implementation partners in identifying and prioritizing barriers, facilitators, and co-developing tailored, actionable implementation strategies to support STEADI adoption in outpatient physical therapy.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 7","pages":"igag036"},"PeriodicalIF":6.2,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148307830","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 socioeconomic trajectories and cognitive aging in Chinese middle-aged and older adults.","authors":"Mingyue Gao, Wenxin Cai, Yixuan Ma, Min Yang, Lingxiao He, Leah Li, Ya Fang","doi":"10.1093/geroni/igag030","DOIUrl":"10.1093/geroni/igag030","url":null,"abstract":"<p><strong>Background and objectives: </strong>Socioeconomic positions (SEPs), operationalized by education, occupation, and income, are widely recognized determinants of cognitive function (CF). However, the effect of life-course SEP on cognitive aging remains inconclusive. This study investigated the impact of life-course SEP trajectories on later-life cognitive aging across SEP dimensions among Chinese adults born in the 1940s-70s who experienced distinct social mobility in the rapid social transformation.</p><p><strong>Methods: </strong>We used data from the China Health and Retirement Longitudinal Study (2011-2020, 20 055 participants aged ≥45 years). Life-course SEP included early-life and adult education, occupation, and income. CF was measured as a composite cognitive score. Latent class analysis was conducted to identify heterogeneous SEP trajectory groups, and mixed-effects models were applied to estimate the impact of SEP trajectory on cognitive aging.</p><p><strong>Results: </strong>All life-course SEP indicators were positively associated with late-life CF, with adult SEP showing stronger impacts than childhood SEP. Upward mobility was notable in education (55.5%) and income (65.6%), whereas occupational transitions were relatively stable (68.0-71.3%). Participants with high early-life SEP and upward mobility had higher CF and slower decline than disadvantaged SEP trajectory groups, especially in women. Education and occupation trajectories had stronger impacts on cognitive aging than income trajectories.</p><p><strong>Discussion and implications: </strong>Life-course SEP exerts protective effects on cognitive aging, with education and occupation showing stronger influences than income. Chinese women could gain greater cognitive benefits from SEP improvements than men. Optimizing lifelong SEP trajectories should be targeted as priorities to mitigate cognitive aging in developing countries.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 6","pages":"igag030"},"PeriodicalIF":6.2,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147928974","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":"When context matters: social disparities in preventable hospitalizations among Medicare beneficiaries with dementia.","authors":"Viktoryia A Kalesnikava, Brian Madden, Nela Vugdalic, Paul Lin, Elham Mahmoudi","doi":"10.1093/geroni/igag035","DOIUrl":"10.1093/geroni/igag035","url":null,"abstract":"<p><strong>Background and objectives: </strong>We examined geographic variation in the risk of potentially preventable hospitalization (PPH) among individuals with Alzheimer's disease and related dementias.</p><p><strong>Research design and methods: </strong>In this cross-sectional study, we analyzed a 20% random sample of 2017-2018 traditional Medicare claims (<i>n </i>= 67,110), merged with the Area Health Resource File and National Neighborhood Data Archive. Multivariable generalized estimating equation models adjusted for age, sex, frailty index, rurality (metropolitan; micropolitan; rural), and county-level numbers of primary care physicians and hospitals. PPH risk was assessed for the overall cohort, residents of highly disadvantaged areas, and those in rural-or-micropolitan areas.</p><p><strong>Results: </strong>One-third of hospitalizations were PPHs. Urinary tract infection (33.8%), heart failure (25.7%), and pneumonia (18.6%) accounted for 78% of all PPHs. Unadjusted PPH rates were higher in highly disadvantaged areas (23.9%) compared to low-disadvantaged areas (20.6%). In the overall sample, Black and Hispanic individuals had higher odds of PPH than White individuals, as did those in highly disadvantaged areas compared to low-disadvantaged areas. Among highly disadvantaged urban and rural-or-micropolitan area residents, adjusted PPH rates were 23% and 27%, respectively. Odds of PPH were markedly higher in highly disadvantaged rural-or-micropolitan areas compared with low-disadvantaged areas. Racial/ethnic disparities diminished in these areas, while risk increased for female adults compared with male adults.</p><p><strong>Discussion and implications: </strong>The highest PPH risk occurred in highly disadvantaged rural-or-micropolitan areas. Although racial/ethnic disparities were attenuated in these populations, the overall PPH risk was elevated. Policy efforts should prioritize expanding access to ambulatory care in disadvantaged areas.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"10 6","pages":"igag035"},"PeriodicalIF":6.2,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147971831","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}