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- Dual Caregivers of Persons Living with Dementia: The Added Stress of COVID-19 PandemicAtkinson, Emily; Savla, Jyoti S.; Roberto, Karen A.; Blieszner, Rosemary; McCann, Brandy R.; Knight, Aubrey L. (SAGE, 2022-02-17)Serving in dual caregiving roles presents challenges and has consequences for caregivers’ physical and mental health. Forty-six dual caregivers in rural southwest Virginia participated in one semi-structured telephone interview pre-pandemic. Of these caregivers, nine dual caregivers of multiple older adults (MOA) and six caregivers of multiple generations (MG) participated in two telephone interviews during the COVID-19 pandemic. Pre-pandemic health, stress, and support data were used to compare dual caregivers of MOA and MG; differences were minimal. Responses to interviews conducted during the pandemic highlighted the effects of social restrictions on MOA and MG caregivers, revealing five themes (1) Increased isolation, (2) Increased need for vigilance, (3) Negative impact on mental health, (4) Tendency to “do it all,” and (5) Increased informal help. MOA and MG caregivers differed on managing care responsibilities and ensuring the health of care recipients. In general, dual caregivers experienced decreased mental health, increased social isolation, and increased caregiving responsibilities. Antecedents of the pandemic experiences differentiated MOA and MG caregiver. Findings suggest that programs and services should target dual caregivers’ unique needs.
- Dynamical Properties of Postural Control in Obese Community-Dwelling Older AdultsFrames, Christopher W.; Soangra, Rahul; Lockhart, Thurmon E.; Lach, John; Ha, Dong Sam; Roberto, Karen A.; Lieberman, Abraham (MDPI, 2018-05-24)Postural control is a key aspect in preventing falls. The aim of this study was to determine if obesity affected balance in community-dwelling older adults and serve as an indicator of fall risk. The participants were randomly assigned to receive a comprehensive geriatric assessment followed by a longitudinal assessment of their fall history. The standing postural balance was measured for 98 participants with a Body Mass Index (BMI) ranging from 18 to 63 kg/m2, using a force plate and an inertial measurement unit affixed at the sternum. Participants’ fall history was recorded over 2 years and participants with at least one fall in the prior year were classified as fallers. The results suggest that body weight/BMI is an additional risk factor for falling in elderly persons and may be an important marker for fall risk. The linear variables of postural analysis suggest that the obese fallers have significantly higher sway area and sway ranges, along with higher root mean square and standard deviation of time series. Additionally, it was found that obese fallers have lower complexity of anterior-posterior center of pressure time series. Future studies should examine more closely the combined effect of aging and obesity on dynamic balance.
- Extended Family Caregivers for Persons Living With DementiaRoberto, Karen A.; Savla, Jyoti S. (SAGE, 2022-11-01)Despite changes in the structure of contemporary families, little is known about extended family members—siblings, grandchildren, nieces/nephews, stepkin—who are primary caregivers for a relative living with dementia. Information about these caregivers is needed to help ensure their needs are understood by providers in health care and social service settings. The focus of this research was on the care situations of extended family caregivers and the impact of caregiving on their health and well-being. In Study 1, data from the National Study of Caregiving were used to describe the experiences of 107 extended family caregivers. In Study 2, case study techniques elicited additional information about the experiences of 10 extended family caregivers. Collectively, these caregivers provide care with little or no formal support and occasional help from a small informal network. Caregiving affected their physical and emotional health, depending on the strength of the relationship between the caregiver and the person living with dementia and the type of care provided. Findings contribute new knowledge about extended family caregivers and highlight the important role extended family dementia caregivers play and the challenges they face.
- Extended parallel process model (EPPM) in evaluating lung Cancer risk perception among older smokersZarghami, Fatemeh; Allahverdipour, Hamid; Jafarabadi, Mohammad Asghari (2021-10-17)Background There is a lack of scientific literature on the application of fear appeals theories to evaluate lung cancer risk perception among smokers. The aim of the present study is to apply the Extended Parallel Process Model (EPPM) to discover the perception of the smokers about their lifetime risk of developing lung cancer (perceived susceptibility), their perception of lung cancer survival (perceived severity), response efficacy, self-efficacy, and readiness to quit. Methods In this cross-sectional study, 215 eligible smokers (aged 45 years and over who have smoked at least 1 pack per day in the last 5 years) were recruited. The data collection tool was designed using validate self-report questionnaires and it was contained items on the perceived risk of a smoker contracting lung cancer and perceived lung cancer survival rate. It also had questions to measure the main constructs of the EPPM and Readiness to quit (“Low_Readiness”, and “High_Readiness”). To test how the data support conceptual EPPM to data, Generalized Structural Equation Modeling (GSEM) was used. Results Findings showed a significant relationship between Perceived_Susceptibility and Perceived_Response Efficacy; (B = 1.16, P < 0.001); between Perceived_Susceptibility and Perceived_Self Efficacy, (B = -0.93, P < 0.001), Perceived_Severity, and Perceived_Response Efficacy (B = 1.07, P < 0.001). There was also a significant relationship between Perceived_Threat and Perceived_Response Efficacy; between Perceived_Threat and Perceived_Self Efficacy. The relationship between High_Readiness and Perceived_Self Efficacy, and between High_Readiness and Perceived_Severity also were significant. However, the relationships between High_Readiness and Perceived_Threat were not significant (P > 0.05). Conclusion Perceived_threat and Perceived_efficacy were important for smokers with low readiness to quit, while Perceived_efficacy was most important for smokers with high readiness to quit. These findings could be used in promoting lung cancer awareness and designing smoking cessation programs based on smokers’ stages of change.
- Family Caregivers in Rural Appalachia Caring for Older Relatives With Dementia: Predictors of Service UseSavla, Jyoti S.; Roberto, Karen A.; Blieszner, Rosemary; Knight, Aubrey L. (Oxford University Press, 2022-01-01)Background and Objectives Residents of rural Appalachia tend to experience poorer health and greater economic distress than rural dwellers elsewhere in the United States. 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, underresourced 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. Research Design and Methods 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. Results 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. Discussion and Implications 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.
- Friendship in Later Life: A Research AgendaBlieszner, Rosemary; Ogletree, Aaron M.; Adams, Rebecca G. (Oxford University Press, 2019-01-01)Friendship is a relationship that can endure across the entire lifespan, serving a vital role for sustaining social connectedness in late life when other relationships may become unavailable. This article begins with a description of the importance of studying friendship in late life and the benefits of friendship for older adults, pointing to the value of additional research for enhancing knowledge about this crucial bond. Next is discussion of theoretical approaches for conceptualizing friendship research, followed by identification of emerging areas of late-life friendship research and novel questions that investigators could explore fruitfully. We include a presentation of innovative research methods and existing national and international data sets that can advance late-life friendship research using large samples and cross-national comparisons. The final section advocates for development and assessment of interventions aimed at improving friendship and reducing social isolation among older adults.
- The impact of interventions on appointment and clinical outcomes for individuals with diabetes: a systematic reviewNuti, Lynn; Turkcan, Ayten; Lawley, Mark A.; Zhang, Lingsong; Sands, Laura P.; McComb, Sara (2015-09-02)Background Successful diabetes disease management involves routine medical care with individualized patient goals, self-management education and on-going support to reduce complications. Without interventions that facilitate patient scheduling, improve attendance to provider appointments and provide patient information to provider and care team, preventive services cannot begin. This review examines interventions based upon three focus areas: 1) scheduling the patient with their provider; 2) getting the patient to their appointment, and; 3) having patient information integral to their diabetes care available to the provider. This study identifies interventions that improve appointment management and preparation as well as patient clinical and behavioral outcomes. Methods A systematic review of the literature was performed using MEDLINE, CINAHL and the Cochrane library. Only articles in English and peer-reviewed articles were chosen. A total of 77 articles were identified that matched the three focus areas of the literature review: 1) on the schedule, 2) to the visit, and 3) patient information. These focus areas were utilized to analyze the literature to determine intervention trends and identify those with improved diabetes clinical and behavioral outcomes. Results The articles included in this review were published between 1987 and 2013, with 46 of them published after 2006. Forty-two studies considered only Type 2 diabetes, 4 studies considered only Type 1 diabetes, 15 studies considered both Type 1 and Type 2 diabetes, and 16 studies did not mention the diabetes type. Thirty-five of the 77 studies in the review were randomized controlled studies. Interventions that facilitated scheduling patients involved phone reminders, letter reminders, scheduling when necessary while monitoring patients, and open access scheduling. Interventions used to improve attendance were letter reminders, phone reminders, short message service (SMS) reminders, and financial incentives. Interventions that enabled routine exchange of patient information included web-based programs, phone calls, SMS, mail reminders, decision support systems linked to evidence-based treatment guidelines, registries integrated with electronic medical records, and patient health records. Conclusions The literature review showed that simple phone and letter reminders for scheduling or prompting of the date and time of an appointment to more complex web-based multidisciplinary programs with patient self-management can have a positive impact on clinical and behavioral outcomes for diabetes patients. Multifaceted interventions aimed at appointment management and preparation during various phases of the medical outpatient care process improves diabetes disease management.
- The Impacts of the Neighborhood Built Environment on Social Capital for Middle-Aged and Elderly KoreansHwang, Eunju; Brossoie, Nancy; Jeong, Jin Wook; Song, Kimin (MDPI, 2021-01-14)The purpose of this study was to investigate the relationship between the neighborhood built environment (NBE) aspects of age-friendly cities and communities (AFCCs) and social capital in the Korean context. We described and compared age differences when analyzing misfits of AFCC NBE and impacts on social capital. We collected the data (N = 1246) from two Korean communities; our multiple and binary logistic regression outcomes show that AFCC NBE aspects such as outdoor spaces, transportation, and housing are significant predictors of different subcategories of social capital. For the older group, the outdoor spaces misfit was significant for all three subcategories of social capital, but transportation and housing misfits were significant for the social trust and reciprocity index scores. For the middle-aged group, the outdoor spaces misfit was significant for social networking and participation, and a transportation misfit was significant for participation and social trust and reciprocity. Fewer misfits or better fits of outdoor spaces and transportation encouraged more networking, participation, social trust, and reciprocity. Dwelling type was important to predict social capital, especially for the older group. The present study confirmed the importance of AFCC NBE in predicting social capital and unique factors in the Korean context.
- Incapacitated and Alone: Prevalence of Unbefriended Residents in Alberta Long-Term Care HomesChamberlain, Stephanie A.; Duggleby, Wendy; Fast, Janet; Teaster, Pamela B.; Estabrooks, Carole A. (2019-10)The objective of this study was to assess the prevalence of residents who are incapacitated and have no surrogate decision maker, known as the "unbefriended" in Alberta long-term care (LTC) homes. Using cross-sectional online survey methods, data were collected from 123 staff (i.e., directors of care/nursing, administrators) from Alberta LTC homes. Information was collected on survey respondents' demographic characteristics, number of unbefriended residents, and on organizational characteristics. The overall prevalence of unbefriended residents in LTC homes was 4.14% in Alberta (SD = 6.28%, range: 0%-34.6%). Homes with the highest prevalence (nearly 15%) of unbefriended residents had >135 beds and were public not-for-profit and located in large urban centers. Fifty-three percent of unbefriended residents were male. The highest prevalence of unbefriended residents lived in homes located in large urban centers and public not-for-profit operators. Population level and LTC home level prevalence data are needed to assess the scope of unmet needs.
- A Long and Winding Road: Dementia Caregiving With Grit and GraceRoberto, Karen A.; McCann, Brandy R.; Blieszner, Rosemary; Savla, Jyoti S. (Oxford University Press, 2019)Background and Objectives: Many dementia caregivers provide care for numerous years. Exhibiting grit, or commitment and persistence in the face of adversity, may bolster their ability to manage caregiving challenges. We explored grit in relationship to memory and behavior problems and response to stressors among women engaged in long-term dementia care. Research Design and Methods: Informed by a life course perspective, and guided by stress-process theory, we interviewed 10 women with a spouse or parent initially diagnosed with mild cognitive impairment 4 times over 10 years. Using Charmaz’s analysis methods and grit as a sensitizing concept, we employed an unfolding analytic strategy involving (a) thematic analysis to identify expressions of grit in response to caregiving stressors across interviews and (b) case-by-case comparisons to assess associations of grit with the use of care strategies across caregivers over time. Results: Dementia caregivers experienced unrelenting and changing psychosocial and physical challenges. Over time, most women exhibited a sustained commitment to the relationship through the ways in which they protected the identity of the person with dementia, modified their expectations for emotional intimacy, and managed their financial affairs. They persevered as their roles and relationships fluctuated, often finding purpose and relief through employment and leisure pursuits. As care intensified, women who took charge and consciously made decisions in the best interest of the care recipient and themselves minimized stress. Discussion and Implications: While some caregivers exhibited grit from the outset, all showed enhanced perseverance and commitment to the ways they managed memory-related changes over time. Developing confidence in their ability to manage and provide care helped the caregivers respond to stressors with purpose and sustain their roles and responsibilities. Enhancing grit in long-term dementia caregivers may result in better individual and relational outcomes.
- Peritraumatic Stress From a Disaster Increases Risk for Onset of Chronic Diseases Among Older AdultsSands, Laura P.; Do, Quyen; Du, Pang; Pruchno, Rachel (Oxford University Press, 2022-01-01)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.
- Perturbation-based balance training targeting both slip- and trip-induced falls among older adults: a randomized controlled trialAllin, Leigh J.; Brolinson, Per Gunnar; Beach, Briana M.; Kim, Sunwook; Nussbaum, Maury A.; Roberto, Karen A.; Madigan, Michael L. (2020-06-12)Background Falls are the leading cause of injuries among older adults. Perturbation-based balance training (PBT) is an innovative approach to fall prevention that aims to improve the reactive balance response following perturbations such as slipping and tripping. Many of these PBT studies have targeted reactive balance after slipping or tripping, despite both contributing to a large proportion of older adult falls. The goal of this randomized controlled trial was to evaluate the effects of PBT targeting slipping and tripping on laboratory-induced slips and trips. To build upon prior work, the present study included: 1) a control group; 2) separate training and assessment sessions; 3) PBT methods potentially more amenable for use outside the lab compared to methods employed elsewhere, and 4) individualized training for older adult participants. Methods Thirty-four community-dwelling, healthy older adults (61–75 years) were assigned to PBT or a control intervention using minimization. Using a parallel design, reactive balance (primary outcome) and fall incidence were assessed before and after four sessions of BRT or a control intervention involving general balance exercises. Assessments involved exposing participants to an unexpected laboratory-induced slip or trip. Reactive balance and fall incidence were compared between three mutually-exclusive groups: 1) baseline participants who experienced a slip (or trip) before either intervention, 2) post-control participants who experienced a slip (or trip) after the control intervention, and 3) post-PBT participants who experienced a slip (or trip) after PBT. Neither the participants nor investigators were blinded to group assignment. Results All 34 participants completed all four sessions of their assigned intervention, and all 34 participants were analyzed. Regarding slips, several measures of reactive balance were improved among post-PBT participants when compared to baseline participants or post-control participants, and fall incidence among post-PBT participants (18%) was lower than among baseline participants (80%). Regarding trips, neither reactive balance nor fall incidence differed between groups Conclusions PBT targeting slipping and tripping improved reactive balance and fall incidence after laboratory-induced slips. Improvements were not observed after laboratory-induced trips. The disparity in efficacy between slips and trip may have resulted from differences in dosage and specificity between slip and trip training. Trial registration Name of Clinical Trial Registry: clinicaltrials.gov Trial Registration number: NCT04308239. Date of Registration: March 13, 2020 (retrospectively registered).
- Prediction of fall risk among community-dwelling older adults using a wearable systemLockhart, Thurmon E.; Soangra, Rahul; Yoon, Hyunsoo; Wu, Teresa; Frames, Christopher W.; Weaver, Raven; Roberto, Karen A. (2021-10-25)Falls are among the most common cause of decreased mobility and independence in older adults and rank as one of the most severe public health problems with frequent fatal consequences. In the present study, gait characteristics from 171 community-dwelling older adults were evaluated to determine their predictive ability for future falls using a wearable system. Participants wore a wearable sensor (inertial measurement unit, IMU) affixed to the sternum and performed a 10-m walking test. Measures of gait variability, complexity, and smoothness were extracted from each participant, and prospective fall incidence was evaluated over the following 6-months. Gait parameters were refined to better represent features for a random forest classifier for the fall-risk classification utilizing three experiments. The results show that the best-trained model for faller classification used both linear and nonlinear gait parameters and achieved an overall 81.6 +/- 0.7% accuracy, 86.7 +/- 0.5% sensitivity, 80.3 +/- 0.2% specificity in the blind test. These findings augment the wearable sensor's potential as an ambulatory fall risk identification tool in community-dwelling settings. Furthermore, they highlight the importance of gait features that rely less on event detection methods, and more on time series analysis techniques. Fall prevention is a critical component in older individuals' healthcare, and simple models based on gait-related tasks and a wearable IMU sensor can determine the risk of future falls.
- Reading Self-Perceived Ability, Enjoyment and Achievement: A Genetically Informative Study of Their Reciprocal Links Over TimeMalanchini, Margherita; Wang, Zhe; Voronin, Ivan; Schenker, Victoria J.; Plomin, Robert; Petrill, Stephen A.; Kovas, Yulia (2017-04)Extant literature has established a consistent association between aspects of reading motivation, such as enjoyment and self-perceived ability, and reading achievement, in that more motivated readers are generally more skilled readers. However, the developmental etiology of this relation is yet to be investigated. The present study explores the development of the motivation-achievement association and its genetic and environmental underpinnings. Applying cross-lagged design in a sample of 13,825 twins, we examined the relative contribution of genetic and environmental factors to the association between reading enjoyment and self-perceived ability and reading achievement. Children completed a reading comprehension task and self-reported their reading enjoyment and perceived ability twice in middle childhood: when they were 9-10 and 12 years old. Results showed a modest reciprocal association over time between reading motivation (enjoyment and perceived ability) and reading achievement. Reading motivation at age 9-10 statistically predicted the development of later achievement, and similarly, reading achievement at age 9-10 predicted the development of later motivation. This reciprocal association was observed beyond the stability of the variables and their contemporaneous correlation and was largely explained by genetic factors.
- Subjective Memory Decline Predicts Incident Cognitive Impairment among White -- but Not Black or Hispanic -- Older AdultsFerraro, Kenneth F.; Sauerteig-Rolston, Madison R.; Barnes, Lisa L.; Friedman, Elliot; Sands, Laura P.; Thomas, Patricia A. (Oxford University Press, 2022-06-18)Background and objectives: This study investigates whether subjective memory decline in a racially diverse sample of older adults without cognitive impairment at baseline is associated with incident cognitive impairment during a 12-year follow-up period. Research design and methods: With panel data from a national sample (N=9,244) of cognitively-intact Black, White, and Hispanic Americans 65 years or older in 2004, we examine if subjective memory decline is associated with the loss of normal cognition by 2016. Cognitive status was assessed every two years with a modified version of the Telephone Interview for Cognitive Status to identify the transition from normal cognition to cognitive impairment. Results: Estimates from Weibull accelerated failure-time models reveal that subjective memory decline is associated with earlier incident cognitive impairment (time ratio = 0.96, p<.05). In subsequent models stratified by race-ethnicity, this association was evident among White respondents (time ratio = 0.95, p<.01) but not among Black, US-born Hispanic, or foreign-born Hispanic respondents. Discussion and implications: Given that the prognostic validity of subjective memory decline differs by race and ethnicity, caution is warranted when using it as a screening or clinical tool in diverse populations.
- Understanding and Addressing Older Adults’ Needs During COVID-19Sands, Laura P.; Albert, Steven M.; Suitor, Jill J. (Oxford University Press, 2020-06-02)Four months have passed since the World Health Organization (WHO) identified coronavirus disease 2019 (COVID-19) as a public health emergency, and 3 months since it declared the outbreak of COVID-19 a pandemic. WHO posted guidelines to reduce the spread of COVID- 19, including isolating those with the virus, quarantining those exposed to the virus, and social distancing. These guidelines have been adopted across the globe, and there is evidence that following these guidelines slows transmission of the disease. Some have suggested that cases have reached a plateau, yet these conclusions are based on data drawn from reports of identified cases, which are not necessarily representative of all cases of COVID-19. This is problematic for designing guidelines and policies that are intended to protect the health of the entire population and the health of those who may be particularly vulnerable to COVID-19, including older adults. The pandemic has created difficulties for all, so we must be thoughtful about our pathway for returning to a life that is not threatened by COVID-19. Guidelines and policies for charting that pathway should be based on high-quality data, scientific knowledge, and ethical decision making.