ISSN / EISSN : 0016-9013 / 1758-5341
Published by: Oxford University Press (OUP) (10.1093)
Total articles ≅ 16,216
Latest articles in this journal
The Gerontologist; https://doi.org/10.1093/geront/gnac068
Non-pharmacologic interventions have demonstrated benefits for people living with dementia and their caregivers. Few studies have evaluated their implementation in real-world settings. Using Normalization Process Theory (NPT), an implementation science framework, this study evaluated acceptability of the Care of Persons with Dementia in their Environments (COPE) intervention by care managers and interventionists implemented in a Medicaid and state-revenue funded home and community-based services (HCBS) program. NPT and data from nine care manager focus groups (n=61) and two interventionist focus groups (n=8) were utilized to understand COPE acceptability to program care managers and interventionists. NPT’s four criteria, coherence, cognitive participation, collective action, and reflexive monitoring, framed the research questions used to evaluate the intervention’s implementation. Care managers and interventionists demonstrated a shared understanding of COPE aims and the value of practices implemented (coherence). Training by national experts facilitated program buy-in to meet COPE goals and was demonstrated by care managers and interventionists as they used the training to broaden their program involvement (cognitive participation). Operational work done by care managers and interventionists to implement the intervention (collective action) and their shared perceptions of program benefits (reflexive monitoring) contributed to program implementation, families’ positive responses to COPE and enhanced sustainability. Introducing evidence-based dementia care interventions into HCBS programs strongly depends upon building shared understandings between care managers and interventionists and valuing the contributions of all stakeholders involved in delivering care innovations to people living with dementia and their caregivers.
The Gerontologist; https://doi.org/10.1093/geront/gnac067
Background and Objectives: A substantial portion of the service sector workforce is middle aged or older, but little is known about the scheduling conditions of these older workers. This study describes the quality of work schedules in the service sector by age and tests associations of unpredictable schedules with well-being and job retention among workers ages 50-80. Research Design and Methods: The Shift Project collected survey data on detailed working conditions and health from 121,408 service sector workers, recruited in 2017-2020 using social media advertisements. Survey weights aligned sample demographics with the American Community Survey, and multiple imputation addressed missingness. Ordinary least squares regression models were used to examine associations between age and schedule stability, and ordinary least squares, ordinal logit, and logit regression models tested associations between schedule stability and well-being and job retention outcomes for older workers. Results: Scheduling conditions were more stable and predictable for older compared to younger workers; however, more than 80% of workers ages 50-80 experienced one or more types of routine schedule instability. Among workers ages 50-80, unpredictable schedules were associated with psychological distress, poor quality sleep, work-family conflict, economic insecurity, job dissatisfaction, and intentions to look for a new job. Canceled and back-to-back closing and opening (“clopening”) shifts were most strongly associated with negative outcomes. Discussion and Implications: Policies aimed at improving scheduling conditions hold promise to benefit older service workers’ well-being. As the population ages, improving work schedules in the years approaching retirement may be important to longer working lives.
The Gerontologist; https://doi.org/10.1093/geront/gnac066
Background and Objectives: Refusals of care in dementia can be a source of distress for people with dementia and their caregivers. Informant-based measures to examine refusals of care are limited and often measure other behaviours such as agitation. We aimed to assess the validity and reliability of the newly developed, 14-item, Refusal of Care Informant Scale (RoCIS) and then use the scale to verify the most common refusal behaviours. Research Design and Methods: Data from 129 dyads were analysed. Dyad was defined as a person with advanced dementia either living in a care home or supported in their own home and their caregiver. Data about the person with dementia were gathered using informant-based questionnaires. The psychometric properties of the RoCIS were investigated using Rasch analysis to determine validity and reliability. Results: Following Rasch analysis, the item ‘upset’ was removed from the RoCIS. The reduced 13-item RoCIS is unidimensional and achieved a reliability index of 0.85 (Cronbach’s alpha 0.88). 68% of people with dementia had refused care in the last month, with ‘verbally refused’ the most common type of refusal behaviour. People in the ‘very severe/profound’ stage of dementia showed more refusal behaviours than those in the ‘severe’ stage. Discussion and Implications: Results provide initial evidence that the RoCIS is a valid and reliable informant-based scale measuring refusals of care in advanced dementia. Results indicate a need to develop new approaches and techniques to make assistance with personal care more acceptable to people with dementia.
The Gerontologist; https://doi.org/10.1093/geront/gnac065
Studies have shown that neighborhood environment shapes older Americans’ aging experience and health. However, it remains largely unknown whether and how neighborhood environment influences the wellbeing of older Asian Immigrants. Guided by the neighborhood stress process model, this study aims to investigate 1) the associations between neighborhood environmental stressors and depression among Chinese older immigrants, and 2) the potential mediation effects of intrapersonal (sense of mastery, sense of hopefulness) and interpersonal coping (social engagement) resources in such associations. This study analyzed data collected from 2,801 Chinese older immigrants in the greater Chicago area. Structural equation modeling (SEM) with bootstrap resampling was used to fit path models on neighborhood environmental stressor, intra- and interpersonal coping resources, and depression. Findings showed that neighborhood social disintegration and physical disorder were associated with more depressive symptoms directly and indirectly via lower intra- and inter-personal coping resources. Specifically, older immigrants living in neighborhoods with greater social disintegration reported lower sense of mastery and social engagement, which in turn were associated with more depressive symptoms (partial mediation). Older immigrants living in neighborhoods with greater physical disorder reported lower sense of hopefulness and mastery, which subsequently were associated with more depressive symptoms (full mediation). The findings showed that neighborhood environmental stressors are risk factors for mental health of older Chinese immigrants and coping resources may serve as pathways of the associations. The implications for future research and practice were discussed.
The Gerontologist; https://doi.org/10.1093/geront/gnac064
This is a correction to: Courtney S Thomas Tobin, PhD, Ángela Gutiérrez, PhD, MPH, Caryn N Bell, PhD, Roland J Thorpe, PhD, Early Life Racial Discrimination, Racial Centrality, and Allostatic Load Among African American Older Adults, The Gerontologist, 2021;, gnab185, https://doi.org/10.1093/geront/gnab185 In the originally published version of this manuscript, there were errors in placement of superscripts in Table 2. Specific notes should be added to “Adolescent ELRD” to indicate significant differences from “None” and “Adult”; and to “Adult ELRD” to indicate a significant difference from “Adolescent”. These errors have been corrected.
The Gerontologist; https://doi.org/10.1093/geront/gnac069
Background and Objectives: Suboptimal medication adherence is prevalent in older adults with multimorbidity. However, intervention programs for enhancing adherence in this population are limited. This study describes the development process of a medication self-management program for older adults with multimorbidity. Research Design and Methods: We adopted the first four steps of the Intervention Mapping to develop the program: (1) needs assessment, including a literature review, a systematic review, and a cross-sectional study, (2) development of program outcomes and objectives, (3) selection of theory-based intervention methods and practical applications, and (4) development of the program. Results: We conducted a needs assessment to identify factors affecting medication adherence among older adults with multimorbidity and created a logic model of the adherence problem in Step 1. In Step 2, we developed the specific program outcomes and objectives and then selected adherence information, personal motivation, social motivation, behavioral skills, and treatment experiences as modifiable and important targets that needed to change in this program. In Step 3, we chose several theory-based methods and strategies for practical applications. We finally created a nurse-led medication self-management program in Step 4. Feedback from relevant stakeholders refined the intervention protocol and materials. Discussion and Implications: The newly developed medication self-management program incorporated theory and evidence from literature and empirical studies with the engagement of multiple stakeholders, making it a contextually and culturally appropriate intervention. This study provides insights into strategies for geriatrics healthcare professionals to support medication self-management among older adults with multimorbidity.
The Gerontologist; https://doi.org/10.1093/geront/gnac063
Background and Objectives: Previous studies have linked COVID-19 to a rise in ageism. While a growing body of research examined hostile ageism during the pandemic, benevolent ageism received less attention. Drawing on the stereotype content theory and the classic tripartite model of attitudes, the current study explored how benevolent and hostile ageism are reflected in the cognitive, affective, and behavioural dimensions of attitudes towards older adults in German COVID-19 related tweets. The study examined the most prevalent attitudes as well as changes in prevalence between the first and second lockdown period in Germany. Research Design and Methods: 792 German tweets concerning COVID-19 and ageing were collected and coded using Mayring’s qualitative content analysis with a dominantly inductive approach. Quantitative methods were used to identify the most prevalent subthemes as well as changes in prevalence. Results: The coding resulted in 21 subthemes. Most tweets (60.73%) contained either hostile or benevolent ageist attitudes, with benevolent ageism being more prevalent. The top 5 subthemes in terms of prevalence and reach contained several opposing attitudes, such as devaluation and opposing devaluation. The chi-square tests revealed a shift from a promotion to an evaluation of COVID-19 related policies between the two lockdowns. Discussion and Implications: Results highlight social media’s polarising effect and its potential contribution to both hostile and benevolent ageism in the context of COVID-19 in Germany. Results indicate the need to consider the adverse effects of benevolent ageism and use of chronological age as risk factor, when designing COVID-19 related policies.
The Gerontologist; https://doi.org/10.1093/geront/gnac062
There is no theoretical framework to guide society to enhance social capital among older adults in the Decade of Healthy Aging. This paper aims to advance scholarship by providing a theoretical framework for promoting social capital for healthy aging using timebanking as a case illustration. We provide an integrated theoretical framework to enhance social capital for healthy aging by incorporating three core elements: (1) facilitating emotional meaningfulness via social participation for older adults, (2) incorporating older adults as co-producers in community development, and (3) nurturing an inclusive and equitable society. We further demonstrate the utility of the integrated theoretical framework for gerontologists by conceptualizing timebanking as an intervention for enhancing social capital in an aging society.
The Gerontologist; https://doi.org/10.1093/geront/gnac055
Background and Objectives: Although reputed for being the virtual playground of teenagers, TikTok has since made its way to older adults, some of whom have become content creators with millions of followers. Despite their immense sway over audiences, as well as their potential to reconfigure socially constructed notions of aging, these older TikTok personalities have been given scant attention in gerontological literature. We fill this gap by exploring how older adults use TikTok to engage in discourses on old age. Research Design and Methods: We compiled the most viewed videos of users aged 60 and above with at least 100,000 followers, generating 1,382 videos with over 3.5 billion views. Videos which did not feature older adults engaging in discourses on aging were excluded, resulting in 348 videos for content analysis. Both inductive and deductive approaches guided the qualitative analysis. Results: Three themes emerged: Nearly 3 in 4 videos featured older adults ‘Defying Age Stereotypes’ (71%; Theme 1). 18% featured them ‘Making Light of Age-Related Vulnerabilities’ (Theme 2). 11% involved older adults ‘Calling out Ageism’ (Theme 3). Discussion and Implications: This is the first known study exploring how older adults consciously engage in discourses of aging through their participation on TikTok. Our findings highlight the potential for older adults to be put at the vanguard of a movement aimed at challenging socially constructed notions of old age.
The Gerontologist; https://doi.org/10.1093/geront/gnac060
Background and Objectives: The rapidly aging and diversifying U.S. population is challenged by increases in prevalence of Alzheimer’s disease (AD) and aging-related disorders. We conducted a scoping review to assess equitable inclusion of diverse older adult populations in aging research focused on National Institutes of Health (NIH)-sponsored research. Research Design and Methods: The scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-Scr) Protocol. The search was limited to NIH-funded studies focusing on aging, AD and Alzheimer’s disease-related dementias (ADRD) and included adults aged 55+. The priority populations and health disparities put forth by the NIA Health Disparities Framework serve as a model for guiding inclusion criteria and for interpreting the representation of these underrepresented groups, including racial ethnic minorities, socioeconomically disadvantaged, rural populations, groups with disabilities, and LGBTQ communities. Results: Our search identified 1,177 records, of which 436 articles were included in the analysis. Inclusion of individuals with ADRD and mild cognitive impairment, racial ethnic minorities, rural populations, socioeconomically disadvantaged, groups with disabilities, and LGBTQ communities were poorly specified in most studies. Studies used multiple recruitment methods, conducting studies in community settings (59%) and hospitals/clinics (38%) most frequently. Incentives, convenience factors, and sustained engagement via community-based and care partners were identified as key strategies for improved retention. Discussion and Implications: This scoping review identified gaps in existing literature and aims for future work, including stronger research focus on, better inclusion of, and improved data collection and reporting of older adults from underrepresented groups.