Innovation in Aging

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EISSN : 2399-5300
Published by: Oxford University Press (OUP) (10.1093)
Total articles ≅ 19,726
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, Janel R Ramkalawan, Jackie F Ring, Nathan A Boucher
Background and Objectives: Many patients lack understanding of hospice services and their preparation for the transition to hospice at home may be insufficient. This study explored how hospice admissions staff and caregivers of hospice patients perceive the hospice admission process and the transition to hospice at home. Research Design and Methods: We conducted in-depth, semi-structured interviews with two subgroups: hospice admissions staff (n=15) and bereaved caregivers of former hospice patients (n=20). We performed three-coder descriptive content analysis. Findings: There were 4 overall themes: 1) issues relating to the referring/pre-hospice provider 2) issues relating to hospital discharge/care transition home 3) issues relating to the first touch of hospice and 4) the impact of COVID-19 on hospice admissions. Patients are often referred to hospice without clear prognostic understanding, at times placing staff in the uncomfortable position of breaking difficult news. Stigma may make patients and families fearful of enrolling in hospice and misconceptions about hospice are common. Caregivers emphasize the need for increased attention to their emotional needs. Staff revealed the emotional challenges they experience conducting admissions. Both staff and caregivers indicate that the transition to hospice is often emotionally and logistically burdensome, especially when discharging home from the hospital. Both subgroups report insufficient caregiver preparation for taking care of a dying patient at home, particularly regarding medication management. COVID-19 created challenges yet prompted innovative changes to hospice admission processes. Discussion and Implications: Findings demonstrate a need to improve the hospice admissions process, better supporting terminally ill patients and their families.
, Joanna Bryan Ringel, Jacklyn Cho, Catherine A Riffin, Ariel C Avgar
Background and Objectives: While family caregivers have traditionally provided care for older adults with chronic conditions and disabilities, the demand for paid home care workers has increased in the last decade. Although typically thought to assist with personal care emerging data suggest that paid home care workers assist with a wider scope of care. However, the extent and quality of the care they deliver remains poorly understood. Research Design and Methods: Using the Empire State Poll, a telephone-based cross-sectional survey of 800 adults in New York State, we characterized the types of care that paid home care workers provided and the perceived value of that care. Results: Of 800 participants surveyed, 274 reported that they or an immediate family member received care from a paid home care worker (34.3%). Of these, the majority (73.9%) reported that paid home care workers provided emotional and/or medical care, in addition to personal care. In adjusted models, providing emotional and medical care (compared to personal care alone) was associated with nearly a two-fold greater perception of importance and experience by the care recipients. Discussion and Implications: Our findings provide additional data on how paid home care workers contribute to patient care, from the perspective of the care recipient(s). The type of care provided is associated with varying magnitudes of perceived quality. Although limited to New York, these findings have implications for paid home care workers’ training and compensation. Future studies are warranted to investigate the specific factors that mediate the association between types of care provided and their perceived value.
, Paula Byrne, Sarah E Rodgers, Michelle Maden
Background and Objectives: A systematic review was conducted to explore the use of smartphones and tablet computers as cognitive and memory aids by older adults with and without cognitive impairment, specifically the effects of smartphone and tablet use on participants’ cognition and memory, and the barriers to facilitators to smartphone and tablet use for cognitive and memory support. Research Design and Methods: A systematic search of six key databases found 11,895 citations published between 2010 and 2021. Studies were included if they involved community-dwelling older adults with or without cognitive impairment arising from acquired brain injury, mild cognitive impairment, or dementia, and if they evaluated everyday smartphone or tablet device use for cognition, memory, or activities of daily living. Results: A total of 28 papers were included in the narrative synthesis. There was some evidence that the use of smartphones and tablets could aid cognitive function in older adults without cognitive impairment, particularly executive function and processing speed. There was modest evidence that smartphone and tablet use could support memory in both older adults without cognitive impairment and those with acquired bran injury and dementia. Discussion and Implications: Smartphones and tablets were seen by users as acceptable, enjoyable, and non-stigmatising alternatives to conventional assistive technology devices; however, current use of smartphone and tablet devices is hindered by the digital literacy of older adults, a lack of accommodation for older adult users’ motor and sensory impairments, and a lack of input from clinicians and researchers. Much of the evidence presented in this review derives from case studies and small-scale trials of smartphone and tablet training interventions. Further research is needed into older adults’ use of smartphones and tablets for cognitive support before and after the onset of cognitive impairment in order to develop effective evidence-based smart technology cognition and memory aids.
, Quyen Do, Pang Du, Rachel Pruchno
Innovation in Aging, Volume 6;

Background and Objectives: Our understanding of the impact of disaster exposure on the physical health of older adults is largely based on hospital admissions for acute illnesses in the weeks following a disaster. Studies of longer-term outcomes have centered primarily on mental health. Missing have been studies examining whether exposure to disaster increases the risk for the onset of chronic diseases. We examined the extent to which 2 indicators of disaster exposure (geographic exposure and peritraumatic stress) were associated with new onset of cardiovascular disease, diabetes, arthritis, and lung disease to improve our understanding of the long-term physical health consequences of disaster exposure. Research Design and Methods: We linked self-reported data collected prior to and following Hurricane Sandy from a longitudinal panel study with Medicare data to assess time to new onset of chronic diseases in the 4 years after the hurricane. Results: We found that older adults who reported high levels of peritraumatic stress from Hurricane Sandy had more than twice the risk of experiencing a new diagnosis of lung disease, diabetes, and arthritis in the 4 years after the hurricane compared to older adults who did not experience high levels of peritraumatic stress. Geographic proximity to the hurricane was not associated with these outcomes. Analyses controlled for known risk factors for the onset of chronic diseases, including demographic, psychosocial, and health risks. Discussion and Implications: Findings reveal that physical health effects of disaster-related peritraumatic stress extend beyond the weeks and months after a disaster and include new onset of chronic diseases that are associated with loss of functioning and early mortality.
Robert Toups, Theresa J Chirles, Johnathon P Ehsani, Jeffrey P Michael, John P K Bernstein, Matthew Calamia, Thomas D Parsons, David B Carr, Jeffrey N Keller
Innovation in Aging, Volume 6;

Background and Objectives: Over 10,000 people a day turn 65 in the United States. For many older adults, driving represents an essential component of independence and is one of the most important factors in overall mobility. Recent survey studies in older adults suggest that up to 60% of older adult drivers with mild cognitive impairment, and up to 30% with dementia, continue to drive. The purpose of this review is to provide a comprehensive and detailed resource on the topics of cognition and driving for clinicians, researchers, and policymakers working on efforts related to older adult drivers. Research Design and Methods: Publications on PubMed and Medline and discussions with experts working in geriatrics, technology, driving policy, psychology, and diverse aspects of driving performance were utilized to inform the current review. Results: Research indicates that there is a complex and inverse correlation between multiple cognitive measures, driving performance, and risky driving behaviors. The fragmented nature of available peer-reviewed literature, and a reliance on correlative data, do not currently allow for the identification of the temporal and reciprocal nature of the interplay between cognition and driving endpoints. Discussion and Implications: There are currently no widely accepted definitions, conceptual models, or uniform set of analyses for conducting geriatric research that is focused on driving. Establishing conventions for conducting research that harmonizes the fields of geriatrics, cognition, and driving research is critical for the development of the evidence base that will inform clinical practice and road safety policy.
, Lauren J Parker, Roland J Thorpe
Published: 30 December 2021
Background and Objectives: Nearly 8.2 million of community-dwelling, older Medicare beneficiaries receive support from long-term services and supports (LTSS) with routine daily activities. Prior work demonstrates disability related disparities; however, it is unclear whether these patterns persist among LTSS recipients and across specific sets of activities. We examine race and gender differences in receiving help with self-care (e.g., eating), mobility (e.g., getting around the house), and household (e.g., shopping) activities in a nationally representative sample of community-dwelling Medicare Beneficiaries receiving LTSS. Research Design and Methods: Cross-sectional analysis of 1,808 White and Black older adults receiving assistance with routine daily activities in the 2015 National Health and Aging Trends Study. Bivariate statistics were used to describe the sample and provide comparisons of characteristics by race and gender. Logistic regression models examined race and gender differences in receiving assistance with self-care, mobility, and household activities after adjusting for sociodemographic and health characteristics. Results: Race and gender differences were observed across all sociodemographic and health characteristics, as well as for all forms of assistance. Relative to White men, Black men had lower odds of receiving help with self-care activities. White and black women had higher odds, and Black men had lower odds of getting help with mobility activities than White men. Black men, and White and Black women all had higher odds of receiving assistance with household tasks compared to White men. Discussion and Implications: Our findings indicate that, despite prior evidence of disability related disparities, the receipt of help with self-care, mobility, and household activities varies by race and gender. Findings reveals several target areas for future research. Future work should examine the role of cultural and social preferences for care, as well as the appropriateness of help, as evidenced by health service use and changes in quality of life.
, Derek J Hevel, Kourtney B Sappenfield, Heidi Scheer, Christine Zecca, Jaclyn P Maher
Published: 23 December 2021
Background and Objectives: Smartphone-based ecological momentary assessment (EMA) methods can provide novel insights into modeling and predicting activity-related behaviors, yet many racial and ethnic minority groups report barriers to participating in mobile health research. We aim to (1) report on strategies used to successfully recruit and retain minority older adults in a smartphone-based physical activity and sedentary behavior EMA study and (2) report on participants’ perceptions of study acceptability. Research Design and Methods: Researchers partnered with trusted individuals and community organizations serving older adults to facilitate recruitment for an 8-day EMA study of minority older adults’ physical activity and sedentary behavior. Additional strategies such as having experienced, culturally competent team members and available technical support were employed to further recruitment and retention efforts. A post study questionnaire assessed participants’ perceptions of study acceptability. Results: In total, 123 minority older adults were recruited; 102 met inclusion criteria, 91 completed the study, and 89 completed the post-study questionnaire. The sample consisted of predominantly low-income African American women with an average age of 70 years. Responses to open-ended questions revealed the most enjoyable aspects of study participation were the ability to learn more about themselves, contribute to science and/or their community, engage in a new activity, and receive financial compensation. Participants reported the least enjoyable aspects of the study included the frequency of EMA questionnaires, apprehension of missing EMA questionnaires, carrying the smartphone, and difficulty wearing the accelerometer. Most participants (97%) expressed interest in being contacted for future studies. Discussion and Implications: Low-income, older African Americans reported positive perceptions of a smartphone-based EMA study of physical activity and sedentary behavior. Findings suggest that applying demonstrated strategies to engage this population in technology-based health research can enhance recruitment and retention efforts; however, it is unclear which strategies are most effective in reducing participation barriers.
Published: 22 December 2021
Residents of rural Appalachia tend to experience poorer health and greater economic distress than rural dwellers elsewhere in the U.S. Although family is the first line of support for older adults needing care, it is unclear whether dementia caregivers in Appalachia assume these care responsibilities because of strong informal networks that support them in their caregiving role, under-resourced formal services for persons with dementia, or culture-based reluctance to accept help from outsiders. This research examines how rural residents of Appalachia manage the care of relatives with dementia. The study was grounded in the Andersen Behavioral Model, supplemented with culturally-relevant variables. Family caregivers from rural Appalachian counties in Virginia caring for community-dwelling relatives with dementia participated in a structured phone interview (N = 163). Generalized structural equation models were estimated, with predisposing, need, and enabling variables as predictors. Use of support services (e.g., meal delivery) and personal services (e.g., home health nurse) by family caregivers to care for the person with dementia were the dependent variables, and caregiver’s rural community identity and attitude toward services were moderators. Approximately half the sample utilized at least one support service and one personal service. Predisposing and need factors predicted the use of support services, whereas predisposing, need, and enabling factors predicted personal services. Caregivers who strongly identified with their cultural roots were less likely to use personal services unless they held a generally positive view of formal services. Although the extent of needs and the caregiver's economic situation were essential influences on formal service utilization, the main drivers were the caregiver's identification with rural Appalachian culture and attitude toward services. Findings point to within-group heterogeneity that requires differential approaches to delivery of community-based services accounting for varying attitudes, preferences, and family resources.
, Takashi Kusumi
Published: 17 December 2021
Background and Objectives: Focusing on the fact that older adults with positive emotions tend to spend time alone, this study aimed to examine the relationship between preference for solitude and subjective well-being among older adults. In Study 1, we developed a revised version of the Preference for Solitude Scale with a three-factor structure, unlike the single-factor structure of the original scale. In Study 2, we examined the relationship between preference for solitude and subjective well-being using the revised scale. Research Design and Methods: We conducted an Internet survey with 210 older adults in Study 1 to develop a revised Japanese scale. In Study 2, to address the possible research method bias in Study 1, we conducted a mail survey with 276 older adults. We examined the replicability of Study 1, confirming metric invariance through multi-group analysis and hypothesis model through path analysis. Results: The results of the path analysis indicated that “Productivity during solitude” (Factor 3) was positively related with positive affect and life satisfaction, and “Enjoyment of solitude” (Factor 2) was negatively related with negative affect. However, the results of the mediation analysis suggested that preference for solitude was also related to loneliness, and the indirect effect of preference for solitude on well-being was negative. Discussion and Implications: “Enjoyment of solitude” and “Productivity during solitude” were related to maintaining subjective well-being among older adults, although the effects were marginal. The impact of preference for solitude was mixed in enhancing and decreasing subjective well-being.
Matthias Hoben, Liane Ginsburg, Whitney Berta, James Dearing, Peter Norton, Malcolm Doupe, Janice Keefe, Jude Spiers
Innovation in Aging, Volume 5, pp 374-374;

Improving Nursing Home Care Through Feedback On perfoRMance Data (INFORM) was a complex, theory-based, three-arm, parallel cluster-randomized trial. In 2015–2016, we successfully implemented two theory-based feedback strategies (compared to a standard approach to feedback) to increase nursing home (NH) care aides’ involvement in formal communications about resident care (formal interactions [FI], the primary outcome). Here, we report the extent to which FI was sustained 2.5 years following withdrawal of intervention supports. We also report on several determinants of sustainability. We analyzed data from 18 NHs (46 units, 529 care aides) in the control group, 19 NHs (60 units, 731 care aides) in the basic assisted feedback group (BAF), and 14 homes (41 units, 537 care aides) in the enhanced assisted feedback group (EAF). We assessed sustainability of FI, using repeated measures, hierarchical mixed models, adjusted for care aide, care unit and facility variables. In EAF, FI scores increased from T1 (baseline) to T2 (end of intervention) (1.30–1.42, p=0.010), remaining stable at T3 (long-term follow-up) (1.39 p=0.065). FI scores in BAF increased from T1 to T2 (1.33–1.44, p=0.003) and continued to increase at T3 (1.49, p<0.001). In the control group, FI did not change from T1 to T2 (1.25–1.24, p=0.909), but increased at T3 (1.38, p=0.003). Better culture, evaluation and fidelity enactment significantly increased FI at long-term follow-up. Theory-informed feedback provides long lasting benefits in care aides' involvement in FI. Greater intervention intensity neither implies greater effectiveness nor sustainability. Modifiable context elements and fidelity enactment may facilitate sustained improvement.
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