Gerontologist最新文献

{"title":"Morality in the Making: The Collaborative Relationship Between Formal Caregivers, Informal Caregivers and Nursing Home Residents.","authors":"Marleen D W Dohmen, Mandy Visser, Johanna M Huijg, Barbara C Groot, Tineke A Abma","doi":"10.1093/geront/gnaf082","DOIUrl":"https://doi.org/10.1093/geront/gnaf082","url":null,"abstract":"<p><strong>Background and objectives: </strong>Collaboration between formal and informal caregivers is essential for providing good care to nursing home residents. Yet, ambiguity regarding mutual roles and responsibilities often impedes effective collaboration. To address this issue, we examined how formal caregivers, informal caregivers, and residents establish a moral understanding of their responsibilities, and how these understandings affect their triadic relationship.</p><p><strong>Research design and methods: </strong>We conducted a responsive evaluation including 28 semi-structured interviews with formal caregivers, informal caregivers, and residents. Walker's expressive-collaborative model of morality (2007) was used as a theoretical lens to identify identities, values and roles in the triad.</p><p><strong>Results: </strong>Formal caregivers were assigned more moral responsibilities in the care process than residents and informal caregivers, particularly regarding decision-making authority. Formal caregivers considered this justified, while informal caregivers generally desired more influence. The attitude of residents on this matter remained relatively unclear. The diverging views on moral responsibilities between formal and informal caregivers led to relational tensions, impacting mutual trust and recognition between them.</p><p><strong>Discussion and implications: </strong>Walker's model of morality provides a deeper understanding of the moral dynamics underlying the collaboration between formal caregivers, informal caregivers, and residents. Traditional hierarchies and a mismatch between healthcare and family ethics are implied to hinder informal caregiver involvement. Our findings call for practical and cultural adaptations on different levels within and outside nursing home organizations to improve the triadic collaborative relationship.</p>","PeriodicalId":51347,"journal":{"name":"Gerontologist","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When is the best time to deliver supportive interventions to hospice family caregivers? A Multi-Method Study.","authors":"Oonjee Oh, Debra Parker Oliver, Karla Washington, George Demiris","doi":"10.1093/geront/gnaf085","DOIUrl":"https://doi.org/10.1093/geront/gnaf085","url":null,"abstract":"<p><strong>Background/objectives: </strong>While problem-solving interventions can teach caregivers effective coping skills throughout hospice, the optimal timing for introducing such resources remains unclear. We explored how the timing of a problem-solving intervention impacts its effectiveness for hospice caregivers.</p><p><strong>Research design/methods: </strong>We conducted a multi-method study analyzing quantitative and qualitative data from a randomized clinical trial of a Problem-solving Intervention to Support Caregivers in End-of-life care Settings (PISCES). Caregivers were randomly assigned to 3 intervention groups: PISCES delivered face-to-face (F2F), PISCES delivered in a hybrid format, and PISCES integrating positive appraisal elements (PISCESplus). We compared the anxiety and depressive symptoms before and after the intervention among 318 caregivers across various stages of hospice. We conducted a content analysis of 45 exit interviews to explore how caregivers perceived PISCES and their hospice experience in relation to its timing.</p><p><strong>Results: </strong>Caregivers' anxiety showed significant pre-post differences regardless of the intervention timing, modality, and components. The impact on depressive symptoms differed: While the PISCES F2F group showed significant changes at all timings, only bereaved caregivers had significant changes in the PISCES Hybrid group (p<0.001). In the PISCESplus group, caregivers in the midst of hospice and bereaved showed significant changes (p=0.043 and <0.001, respectively). Three themes emerged from the qualitative analysis: timing for PISCES to be most effective, emotions during various stages of hospice, and the length of PISCES.</p><p><strong>Discussion/implications: </strong>Strategically integrating PISCES into hospice practice can help alleviate caregivers' distress. More work is needed to improve the real-world applicability of caregiver-focused interventions in hospice.</p>","PeriodicalId":51347,"journal":{"name":"Gerontologist","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systems Approach to Homelessness Prevention for Older Adults.","authors":"Amy Van Berkum, Abe Oudshoorn, Anna Garnett","doi":"10.1093/geront/gnaf087","DOIUrl":"https://doi.org/10.1093/geront/gnaf087","url":null,"abstract":"<p><p>An aging population and increase in the number of older adults experiencing homelessness in North America requires a more effective response to prevent and end older adult homelessness. While there are few research evidence-based policy solutions to preventing older adult homelessness, there are several promising practices that with further analysis could point to quality policy reform. Using the five-level typology by Fitzpatrick et al. (2021), this discussion paper outlines policy-oriented recommendations at varying levels of prevention: 1) Universal, 2) Upstream, 3) Crisis, 4) Emergency, and 5) Repeat. Key policy implications include intersectoral collaboration and policy design that seeks to successfully reach functionally zero homelessness by activating policy strategies at each of the five-levels of prevention. Health and housing practitioners play an essential role in policy planning, design, implementation, and evaluation and can participate in and advocate for opportunities to improve services and address older adult homelessness connected to their practice environments. Promoting research that enhances systematic evaluation of the outcomes of older adults through various housing models is critical to driving policy reform- a necessary action to promote a safe, healthy, and opportunistic future for older adults.</p>","PeriodicalId":51347,"journal":{"name":"Gerontologist","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between pre-widowhood psychological resilience and subsequent depressive symptom recovery following spousal loss among men and women.","authors":"Shekhar Chauhan, Dawn C Carr, Miles Taylor","doi":"10.1093/geront/gnaf084","DOIUrl":"https://doi.org/10.1093/geront/gnaf084","url":null,"abstract":"<p><strong>Background and objectives: </strong>Most older widowed men and women experience elevated depressive symptoms after spousal loss, and many recover to pre-widowhood levels over time. However, not all widows return to pre-loss mental health, and recovery may differ by gender. Pre-widowhood psychological resilience (PR) has been shown to influence these effects. This study evaluates changes in depressive symptoms for older men and women to determine how PR shapes acute and long-term depressive symptom responses to spousal loss.</p><p><strong>Research design and methods: </strong>Using longitudinal Health and Retirement Study data, we evaluate changes in depressive symptoms from baseline PR pre-widowhood to (1) the first study wave in which individuals report widowhood (acute effects) and (2) the second wave after reporting widowhood (recovery period), for men and for women. We use inverse probability weighted regression models, comparing new widows with their continuously married counterparts.</p><p><strong>Results: </strong>Both widowed men and women experienced increased depressive symptoms in the acute period following spousal loss regardless of PR level. However, moderate to high levels of PR for men and high PR for women predicted recovery to pre-widowhood depressive symptoms two years later. High PR was also associated with fewer depressive symptoms over time among continuously married men and women.</p><p><strong>Discussion and implications: </strong>Results suggest interventions that bolster PR preceding spousal loss could enhance likelihood of recovery following widowhood for both men and women and may also provide protective effects regarding overall depressive symptoms among married individuals over time.</p>","PeriodicalId":51347,"journal":{"name":"Gerontologist","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Aging with Innovations in Technology and Housing.","authors":"Melinda L Jenkins, Judith Barberio","doi":"10.1093/geront/gnaf083","DOIUrl":"https://doi.org/10.1093/geront/gnaf083","url":null,"abstract":"<p><p>Emphasizing personal autonomy and community support, this paper presents three independent housing models in which older adults may be empowered to age successfully at home and engage in self-care and shared community care with innovations in technologies, financing, and nurse care coordination. Cooperative communities, naturally occurring retirement communities, and virtual villages are described and mapped to the AARP \"age friendly\" Livability Index, stakeholders, and partners. Helpful neighborhood services are mapped to innovative technologies that will enable them. On-site nurse-led Wellness Hubs are proposed to bridge from self-care in the community to established health care systems. Medicare payment for remote care, care coordination, and transitional care, as well as home-based care for dementia, will support this evolution toward what matters most to the growing population of older Americans.</p>","PeriodicalId":51347,"journal":{"name":"Gerontologist","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Diagnose & Adios': Multi-Perspective Insights on Formal Service Use in Dementia Family Caregivers.","authors":"Francesca Falzarano, Annabelle Greenfield, Francesco Osso, Katerina Bumbalova, Rachel F Bloom","doi":"10.1093/geront/gnaf081","DOIUrl":"https://doi.org/10.1093/geront/gnaf081","url":null,"abstract":"<p><strong>Background and objectives: </strong>Dementia family caregiving is a complex role that becomes increasingly intense and demanding over time. The utilization of home and community-based services (HCBS) can provide knowledge and skills to foster preparedness, which may protect against adverse caregiving outcomes; yet actual uptake of services remains low. The current study aims to gather multi-perspective insights underlying the disconnect between caregivers' need for - versus utilization of - HCBS using Pearlin et al.'s (1990) stress process model as a guiding theoretical framework.</p><p><strong>Research design and methods: </strong>Five focus groups of 4-8 participants each were conducted with dementia family caregivers (n=13) and Subject Matter Experts (n=17). A deductive-inductive thematic approach was used for data analysis.</p><p><strong>Results: </strong>Three overarching concepts were identified: \"Pathways to Preparedness'', \"Multi-Level Barriers\", and \"Bridging the Gap.\" Findings reflected caregivers' need for support in four core areas: 1) Dementia-specific education/training; 2) Competent mental health support; 3) Financial/legal navigation, and 4) Emergency readiness. Results revealed cross-dimensional barriers across individual-, provider-, and systemic-contexts impeding HCBS access and utilization. Personalized caregiving navigation and technology were deemed potential solutions to facilitate clearer clinical pathways between unmet needs and relevant services.</p><p><strong>Discussion and implications: </strong>Results underscore the complexity of the HCBS system in the United States and highlight the multidimensional barriers disrupting the pipeline connecting caregivers to HCBS. Findings can inform web-based behavioral interventions aiming to enhance family caregivers' knowledge of, access to, and utilization of formal services in community settings.</p>","PeriodicalId":51347,"journal":{"name":"Gerontologist","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Meaning in the Retirement Transition: Scoping Review.","authors":"Rachel E Wood, Nancy A Pachana","doi":"10.1093/geront/gnaf076","DOIUrl":"https://doi.org/10.1093/geront/gnaf076","url":null,"abstract":"<p><strong>Background and objectives: </strong>The retirement transition is a period of major change and instability, which may challenge a person's sense of meaning in life. This scoping review sought to characterize the current research on the role of meaning in the retirement transition.</p><p><strong>Research design and methods: </strong>This scoping review was conducted according to JBI and PRISMA reporting guidelines. Database searches of Scopus, PubMed, PsycINFO, and Social Science Database, and ProQuest Dissertations and Theses Global yielded 738 records (after duplicates removed). Accessory searches yielded an additional 286 records. Eligible articles included peer-reviewed literature and theses (qualitative and quantitative) that explored an aspect of meaning in the context of the retirement transition.</p><p><strong>Results: </strong>A total of 30 studies (21 qualitative and nine quantitative) were included. These studies examined a broad range of research questions on different aspects of meaning - meaning in life, meaning making, meaningful engagement, and meaning of retirement. Most were single, stand-alone studies (not part of a broader research program) that included only a single time point. Only six studies were longitudinal.</p><p><strong>Discussion and implications: </strong>This review revealed a heterogeneous set of studies and identified gaps in reporting of important participant characteristics, lack of conceptual clarity in defining meaning, and few longitudinal studies. There is a need for more theoretically driven, programs of research that include longitudinal designs, ideally using mixed methods approaches, to build a richer understanding of the role of meaning during this major life transition.</p>","PeriodicalId":51347,"journal":{"name":"Gerontologist","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"What does gerotranscendence mean to you?\" Older adults' lay perspectives on the theory.","authors":"Taiane Abreu, Lia Araújo, Laetitia Teixeira, Oscar Ribeiro","doi":"10.1093/geront/gnaf077","DOIUrl":"https://doi.org/10.1093/geront/gnaf077","url":null,"abstract":"<p><strong>Background and objectives: </strong>Gerotranscendence, a recent adaptive aging theory developed by Tornstam, postulates a mindset shift in old age from a materialistic viewpoint to a more transcendent one. Gerotranscendence is considered a promising aging model, as it approaches specific developmental challenges in late life. However, knowledge of this theory is still maturing and lacks laypersons' perspectives to further validate its components. This study aimed to explore how older adults perceive gerotranscendence and gain insights of their understanding.</p><p><strong>Research design and methods: </strong>Three focus group discussions were conducted with 18 participants (59-98 years old; mean: 79.5 years). The protocol included open-ended questions on what gerotranscendence, and its dimensions meant (based exclusively on their designations), as well as on the theory's components (after further explanation). The discussions were recorded and transcribed, and a content analysis was performed.</p><p><strong>Results: </strong>The data were organized into two themes: general suppositions and personal perceptions. This second theme was divided into (i) relatable thoughts and experiences and (ii) a different and complementary understanding of the theory.</p><p><strong>Discussion and implications: </strong>Despite the lack of knowledge of the meaning of gerotranscendence, older persons presented clear evidence that this topic was meaningful for them and that they experienced aspects of the cosmic, coherence, and solitude dimensions of gerotranscendence. However, in specific points, some participants had distinctive and complementary ideas compared with those espoused by gerotranscendence theory. Obtaining laypersons' perspectives provides a more in-depth understanding of gerotranscendence theory and the cultural aspects it may encompass.</p>","PeriodicalId":51347,"journal":{"name":"Gerontologist","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can we borrow your intervention? A randomized controlled trial of an older adult telehealth wellness promotion program in middle-aged adults with physical disability.","authors":"Ivan R Molton, Katie Singsank, Nova Rivera, Leah Munroe, Aaron Flaster, Andrew Humbert, Deidre Daymon, Meghan Thompson, Bishan Yang, Paige Denison","doi":"10.1093/geront/gnaf079","DOIUrl":"https://doi.org/10.1093/geront/gnaf079","url":null,"abstract":"<p><strong>Background and objectives: </strong>The widespread availability of evidence-based, community embedded health promotion programs for older adults represents a major achievement in gerontology. Many of these programs may also be suitable for younger adults with early-acquired disability, creating an opportunity to leverage existing resources and networks. However, the evidence base supporting these programs has often excluded people with early-acquired or long-term disability.</p><p><strong>Research design and methods: </strong>This project represented a \"bridging\" partnership among a group of academic disability researchers and a community service organization serving older adults. The team identified an existing health coaching program for older adults (EnhanceWellness), engaged in a formal adaptation process, and conducted a 3-arm randomized controlled trial in 505 middle-aged adults with long-term, physical disability. Participant reported outcomes (mood, community participation and self-efficacy) were assessed at baseline, mid-intervention (3 months), post-intervention (6 months) and 12 months, utilizing PROMIS measures. Enhance Wellness was compared to health education or treatment as usual.</p><p><strong>Results: </strong>Participants were middle-aged (M=55.8 years) and primarily women (79%), who had lived with a disability-associated health condition for an average of 23 years. Linear mixed effects modeling suggested superiority of Enhance Wellness in increasing participation outcomes, and effects were maintained at the 12-month follow-up. Intervention effects were partially mediated by improvements in disease management self-efficacy. There were no significant treatment effects on depression.</p><p><strong>Discussion and implications: </strong>Results emphasize the potential for adaptation as a strategy to extend the existing network of older adult interventions to serve those living with long-term disability.</p>","PeriodicalId":51347,"journal":{"name":"Gerontologist","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outdoor Environmental Risk Factors for Falls and Fear of Falling: A Systematic Review.","authors":"Pamela M Dunlap, Erica K Fan, Zachary L Hubbard, Helena M VonVille, Elsa S Strotmeyer, Andrea L Rosso","doi":"10.1093/geront/gnaf078","DOIUrl":"https://doi.org/10.1093/geront/gnaf078","url":null,"abstract":"<p><strong>Background and objectives: </strong>The objective of this systematic review was to determine the outdoor environmental factors that are associated with increased risk of falls and fear of falling in middle-aged and older adults.</p><p><strong>Research design and methods: </strong>PubMed, Medline, EMBASE, APA Psych INFO, and CINAHL electronic databases were searched through August 2024 for studies that included participants 45 years or older, falls or fear of falling as an outcome, and measure the outdoor environment (i.e., uneven sidewalks, neighborhood disorder). Title and abstract screenings, full text screenings, and critical appraisal assessments were independently reviewed.</p><p><strong>Results: </strong>The search retrieved 7474 records, 627 full texts were reviewed, and 51 unique studies met the inclusion/exclusion criteria. The number of participants ranged from 12 to 6,720,937. There were 41 studies that included fall outcomes, 5 studies that included fear of falling outcomes, and 5 studies that included both outcomes. Micro-walkability (e.g., sidewalk quality) were the most frequently studied outdoor environmental characteristics and many studies found associations with falls and fear of falling. Macro-walkability (e.g., land use), crime and safety, socioeconomic, greenspace, terrain, physical disorder, and social features were studied to a lesser extent and had mixed findings.</p><p><strong>Discussion and implications: </strong>The most consistent associations were found between micro-walkability features of the outdoor environment with falls whereas other environmental domains and fear of falling were studied to a lesser extent. Environmental contributors to falls should be considered in future research, policy implementation, and clinical interventions to reduce falls and their negative outcomes for older adults.</p>","PeriodicalId":51347,"journal":{"name":"Gerontologist","volume":" ","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}