Innovation in Aging
EISSN : 2399-5300
Current Publisher: Oxford University Press (10.1093)
Total articles ≅ 15,935
Latest articles in this journal
Innovation in Aging; doi:10.1093/geroni/igab004
Background and Objectives Formal supports and social services are essential to people living alone with cognitive impairment (PLACI) because they are at risk of negative health outcomes and lack cohabitants who may support them with cognitively demanding tasks. To further our understanding of this critical and worldwide issue, we conducted a systematic review to understand whether, and how, PLACI access and use essential formal supports and services. Research Design and Methods We searched six databases (PubMed, Embase, PsycINFO, CINAHL, Web of Science, and Sociological Abstracts) to identify quantitative and mixed-method literature on formal service use among PLACI. The initial search was conducted in 2018 and updated in 2020. Results We identified 32 studies published between 1992 and 2019, representing 13 countries, that met our criteria: 16 reported on health services and 26 on social services. Most studies compared PLACI with people with cognitive impairment living with others. Health service use was lower or similar among PLACI, as opposed to counterparts living with others. Most studies reported a higher use of social services (e.g., home services) among PLACI than those living with others. Overall use of essential home service among PLACI was higher in Europe than in the US, a country where large portions of PLACI were reported receiving no formal services. Discussion and Implications We identified wide variability among countries and major gaps in service use. Results for use of health services were mixed, although our findings suggest that PLACI may have fewer physician visits than counterparts living with others. Our findings suggest that varying policies and budgets for these services among countries may have affected our findings. We encourage researchers to evaluate and compare the influence of social policies in the wellbeing of PLACI. We also encourage policy makers to prioritize the needs of PLACI in national dementia strategies.
Innovation in Aging; doi:10.1093/geroni/igab001
Background and Objectives Medication exposure is a potential risk factor for falls and subsequent death and functional decline among older adults. However, controversy remains on the best way to assess medication exposure and which approach best predicts falls. The objective of the current study was to examine the association between different measures of medication exposure and falls risk among community-dwelling older adults. Research Design and Methods This retrospective cohort study was conducted using Falls Free PA program data and a linked prescription claims data from Pennsylvania’s Pharmaceutical Assistance Contract for the Elderly program. Participants were community-dwelling older adults living in Pennsylvania, U.S.A. Three measures of medication exposure were assessed: i) total number of regular medications (polypharmacy); ii) counts of potentially inappropriate medications (PIMs) derived from current prescription guidance tools (Fall Risk-Increasing Drugs (FRIDs), Beers criteria); and iii) medication burden indices based on pharmacologic mechanisms (Anticholinergic Cognitive Burden, Drug Burden Index) all derived from claims data. The associations between the different medication risk measures and self-reported falls incidence were examined with univariate and multivariable negative binomial regression models to estimate incidence rate ratios (IRRs). Results Overall 343 older adults were included and there were 236 months with falls during 2,316 activity adjusted person-months (10.2 falls per 100 activity-adjusted person-months). Of the six measures of medication risk assessed in multivariate models, only the use of two or more FRIDs (adjusted IRR 1.67 (95% CI: 1.04-2.68)) independently predicted falls risk. Among the 13 FRID drug classes, the only FRID class associated with an increased fall risk was antidepressants. Discussion and Implications The presence of multiple FRIDs in a prescription is an independent risk factor for falls, even in older adults with few medications. Further investigation is required to examine whether deprescribing focused on FRIDs effectively prevents falls among this population.
Innovation in Aging, Volume 5; doi:10.1093/geroni/igab002
In the original article, “A GIS APPROACH TO IDENTIFYING SERVICE ACCESS DISPARITIES IN RURAL APPALACHIA,” DOI: 10.1093/geroni/igy023, the spelling of co-author R Blieszner’s surname was incorrect. The name should read: “R. Blieszner, PhD” in full, instead of “R. Bliezner, PhD”.
Innovation in Aging, Volume 5; doi:10.1093/geroni/igaa064
I am honored to take the reins of Innovation in Aging (IA) as its second Editor-in-Chief. In its first 4 years, IA has already made its mark in aging science. We have published more than 135 papers and put together highly cited special issues and sections in caregiving dynamics, Latinx health, public health and aging, and mental health among older adults in minority groups. IA is indexed in PubMed, the Emerging Sources Citation Index (Web of Science), the Directory of Open Access Journals, and SCOPUS. We continue to see submissions at an expanding pace and, on average, get first decisions back to authors within 25 days. With increasing citations, we are on track to receive an impressive journal impact factor.
Innovation in Aging; doi:10.1093/geroni/igaa066
Background and Objectives Many older adults remain inactive despite the known positive health implications of physical activity (improved mood, reduced mortality risk). Physical inactivity is an interdependent phenomenon in couples, but most research examines physical inactivity at the individual level. We estimated the average amount of prolonged physical inactivity for older adult couples and, using dyadic analysis, identified physical and mental health determinants thereof. Research Design and Methods Forty-six heterosexual older adult couples (age=70.61±6.56) from the Veterans Integrated Service Network 20 cohort of the Collaborative Aging Research using Technology (CART) initiative were included. The average number per day of prolonged inactive periods (no step counts or sleep activity for ≥ 30 minutes) was estimated using actigraphy data collected over a month. Results Multilevel modeling revealed that, within couples, there was no significant difference between partners in the average amount of inactive periods (p=.28). On average across couples, males and females had an average of 6.90±2.02 and 6.56±1.93 inactive periods per day, respectively. For males, older age was the only variable associated with more inactive periods (β=0.15, p=.002). For females, having more depressive symptoms in both dyad members was associated with fewer inactive periods (female: β=-0.30,p=.03; male: β=-0.41,p<.001), and more dependence in completing their own instrumental activities of daily living predicted more inactive periods (β=2.58, p<.001). Discussion and Implications Viewing couples’ activity as an interdependent phenomenon, rather than individual, provides a novel approach to identifying pathways to reduce inactivity in older adults, especially when focusing on the mental health and level of independence within the couple.
Innovation in Aging, Volume 5; doi:10.1093/geroni/igaa065
Background and Objectives Screening for functional disability is a promising strategy to identify high-need older adults. We compare 2 disability measures, activities of daily living (ADLs), and life space constriction (LSC), in predicting hospitalization and mortality in older adults. Research Design and Methods We used the nationally representative National Health and Aging Trends Study of 30,885 observations of adults aged 65 years and older. Outcomes were 1-year mortality and hospitalization. Predictors were ADLs (receiving help with bathing, eating, dressing, toileting, getting out of bed, walking inside) and LSC (frequency of leaving home). Results Of respondents, 12.4% reported 3 or more ADLs and 10.8% reported rarely/never leaving home. ADL disability and LSC predicted high rates of 1-year mortality and hospitalization: of those with 3 or more ADLs, 46.4% died and 41.0% were hospitalized; of those who never/rarely left home, 40.7% died and 37.0% were hospitalized. Of those with both 3 or more ADLs and who never/rarely left home, 58.4% died. ADL and LSC disability combined was more predictive of 1-year mortality and hospitalization than either measure alone. ADL disability and LSC screens identified overlapping but distinct populations. LSC identified more women (72.6% vs 63.8% with ADL disability), more people who live alone (40.7% vs 30.7%), fewer who were White (71.7% vs 76.2%) with cancer (27.6% vs 32.4), and reported pain (67.1% vs 70.0%). Discussion and Implications LSC and ADLs both independently predicted mortality and hospitalization but using both screens was most predictive. Routine screening for ADLs and LSC could help health systems identify those at high risk for mortality and health care use.
Innovation in Aging, Volume 4, pp 381-381; doi:10.1093/geroni/igaa057.1226
Long-term care residents with and without cognitive impairment may experience undertreatment of persistent pain (Fain et. al, 2017). Certified nursing assistants (CNAs) are important sources of information about resident pain as they provide the majority of residents’ hands-on care. Therefore, assessing the accuracy of CNAs’ pain assessments and potential influencing factors may provide insight regarding the undertreatment of pain. Informed by prior research, this study examined resident pain catastrophizing and cognitive status as predictors of CNAs’ pain assessment accuracy. CNA empathy was examined as a moderating variable. Analyses confirmed a relationship between pain catastrophizing and CNA pain rating accuracy (R^2 = .205, p < .01), reflecting lower accuracy of ratings for residents higher in catastrophizing. Hypotheses predicting a relationship between resident cognitive status and CNA pain rating accuracy and moderating effects of empathy were disconfirmed. Challenges of conducting research in long-term care are discussed.
Innovation in Aging, Volume 4, pp 625-625; doi:10.1093/geroni/igaa057.2130
This individual symposium abstract will focus on the epidemiology of suicide in older adults, with particular focus on risk factors, changing demographics, and population shifts with the baby-boomers aging. Epidemiologically, older men aged 75 and older have a suicide rate of 39.7 deaths per 100,000 in 2017, compared to the general population of 14.0 deaths per 100,000. Risk factors for suicide in older adults include functional disability, multiple chronic physical conditions, and social isolation. In addition, older adults often face stressors such as relationship issues, life crises (loss of spouse), and social factors (employment and financial challenges, housing stress, and legal issues). Limited mobility, physical and mental health conditions, and lack of social support can affect healthcare access and utilization. Many older adults do not routinely seek behavioral health treatment, with reported under-detection of mental health conditions such as depression, substance use disorders, and suicidal ideation.
Innovation in Aging, Volume 4, pp 190-191; doi:10.1093/geroni/igaa057.617
Inactivity levels among community-dwelling adults 50 years and older is a healthcare concern, particularly when examining the association between increasing age, inactivity, and risk of non-communicable diseases. To confront this concern, healthcare providers need to address the reasons for inactivity. Unfortunately, limited tools exist to address barriers of physical activity (PA). The purpose of our study was to develop and psychometrically evaluate a PA barrier scale for adults 50 years and older. The scale is called the Inventory of Physical Activity Barriers (IPAB) and it was developed, refined, and evaluated using a cross-sectional and a modified Delphi study. We had two groups of participants: 39 adults (50 years and older) provided survey pilot data for psychometric evaluation, and nine interprofessional PA experts assisted with finalizing the scale. Participants completed a demographic questionnaire, Physical Activity Vital Sign questionnaire, and IPAB. The IPAB’s refinement was guided by item-scale correlations, descriptive statistics, and consensus among the PA experts. Construct validity was examined by comparing mean IPAB scores of inactive and active participants via independent t-test. Internal consistency was assessed via Cronbach Alpha. The IPAB was refined from 172 items to 40 items and found to be internally consistent (α=.97) and able to differentiate individuals who do and do not meet the recommended 150 minutes of weekly PA (p=0.01). These preliminary results show the IPAB is a reliable assessment of PA barriers for adults 50 years and older, and are promising for the scale’s construct validity and support further psychometric evaluation of the tool.
Innovation in Aging, Volume 4, pp 258-258; doi:10.1093/geroni/igaa057.828
Transitioning from hospital to home is an important healthcare system priority. This paper reports on the qualitative findings from a larger mixed methods study designed to examine the implementation and effectiveness of a new transitional care intervention (Community Assets Supporting Transitions [CAST]). The goal of the CAST intervention is to improve the quality and experience of hospital-to-home transitions for older adults (≥ 65 years) with depressive symptoms and multimorbidity. Semi-structured interviews were completed with a sub-set of intervention group trial participants including 11 older adult participants and 1 caregiver, as well as 4 intervention nurses. A qualitative descriptive design was used to explore the perceived impacts of the CAST intervention on participants and their caregivers. Audio-recorded interviews were transcribed verbatim, with descriptive codes and themes generated using conventional content analysis. Patient participants indicated that the intervention resulted in improved access to information (e.g., medication review) and services (e.g., care coordination) that enhanced their self-management. Participants felt that the home visits and phone visits were valuable and helped to improve their mental health. Intervention nurses described advocating for patients to help achieve their needs. For example, nurses advocated for physiotherapy services to provide additional education to support patient mobility. Understanding patient, caregiver, and provider perceptions of the impact of the CAST intervention will help to identify how to improve the delivery of this transitional care intervention, to bridge the gap between hospital and community care, and to positively impact patient health outcomes.