Active ageing and quality of life: factors associated with participation in leisure activities among institutionalized older adults, with and without dementia

Factors Affecting Successful Aging of Older Adults and the Relationship Between Leisure Activities Duration and Successful Aging

The study was conducted with older adults who lived in a nursing home and applied to the geriatric outpatient clinic of a university hospital between April and August 2022. The study sample was 516 older adults and the data were collected by using the Older Information Form and Successful Aging Scale (SAS). It was determined that the mean duration of daily leisure activities was 6.61 ± 3.69 hours, and their mean SAS score was 58.31 ± 15.21. A moderate positive correlation was found between the SAS scores of the older adults and the activities of shopping; whereas a low positive correlation was found between their SAS scores and activities of walking, visiting friends and relatives, growing flowers, listening to music, reading, hand knitting, spending time on social media, exercising, and puzzles (p < .05). The main results of our study revealed that planned leisure activities that older adults engage in would contribute to their successful aging.

Urban/Rural Disparity in Quality of Life among the Older Adults in China: Mediation Effect of Leisure Activity

The current study revisits the urban/rural quality of life (QOL) disparity among the older adults in China. It aims to test the potential leisure activity mechanism. Data for this study come from the 2011 and 2014 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS). Sample is restricted to the respondents who are 65 years old and older who are alive for both waves. Ordered logistic regression model is used to test the relationship between QOL and urban/rural residency. Mediation test is used to investigate the mediation effect of leisure activities. Findings from the analysis show that urban older adults have higher QOL, as well as higher frequency of participating leisure activities compare to their rural counterparts. Results also show that leisure activities, especially the cognitive stimulation activities mediate the relationship between urban/rural residency and QOL. The current study adds the role of leisure activities as an intervening variable between urban/rural residency and QOL among older adults in China. Policy application to reduce the QOL disparity through leisure activities is also discussed.

"I Want to Do Something" - Exploring What Makes Activities Meaningful for Community-Dwelling People Living With Dementia: A Focused Ethnographic Study

Supporting ageing in place, quality of life, and activity engagement are public health priorities for people with dementia. The importance of maintaining opportunities for meaningful activities has been widely acknowledged for those with dementia in long-term care, but little is known about what makes activities meaningful for, and how they are experienced by, people with different types of dementia in their own homes. This study used focussed ethnographic methods to explore the motivations and meanings of everyday activity engagement within the homes of 10 people with memory-led Alzheimer's disease and 10 people with posterior cortical atrophy. While participants' interactions with their everyday environments were challenged by their diagnoses, they were all finding ways to continue meaning-making via various activities. The main findings are encapsulated in three themes: (1) The fun and the function of activities; (2) Reciprocities of care, and (3) The constitution and continuity of (a changing) self. Ongoing engagement with both fun and functional activities offered participants living with different dementias opportunities to connect with others, to offer care and support (as well as receive it), and to maintain a sense of self and identity. Implications are discussed regarding the development and delivery of tailored interventions and support to enable continued engagement in meaningful activities for people with different types of dementia living in the community.

Health effects of social connectedness in older adults living in congregate long-term care settings: A systematic review of quantitative and qualitative evidence

BACKGROUND

The overall impact of social connectedness on health outcomes in older adults living in nursing homes and assisted living settings is unknown. Given the unclear health impact of social connectedness for older adults in congregate long-term care settings worldwide, a comprehensive systematic review is required to evaluate the overall relationship between social connectedness and health outcomes for them.

OBJECTIVES

The purpose of this article was to synthesize the literature regarding the health impact of social connectedness among older adults living in nursing homes or assisted living settings.

METHODS

Using PRISMA guidelines, we identified eligible studies from Scopus, MEDLINE, PsycINFO, CINAHL and Cochrane databases (1990-2021). Bias and quality reporting assessment was performed using standardized criteria for cohort, cross sectional and qualitative studies. At each stage, ≥ 2 researchers conducted independent evaluations.

RESULTS

Of the 7350 articles identified, 25 cohort (follow-up range: 1 month-11 years; with two also contributing to cross sectional), 86 cross sectional, eight qualitative and two mixed methods were eligible. Despite different instruments used, many residents living in nursing homes and assisted living settings had reduced social engagement. Quantitative evidence supports a link between higher social engagement and health outcomes most studied (e.g. depression, quality of life). Few studies evaluated important health outcomes (e.g. cognitive and functional decline). Most cohort studies showed that lack of social connectedness accelerated time to death.

CONCLUSIONS

Social connectedness may be an important modifiable risk factor for adverse health outcomes for older adults living in nursing homes and assisted living facilities. Most studies were cross sectional and focused on quality of life and mental health outcomes. Longitudinal studies suggest that higher social engagement delays time to death. Evidence regarding other health outcomes important to older adults was scant and requires further longitudinal studies.

Effectiveness on Quality of Life and Life Satisfaction for Older Adults: A Systematic Review and Meta-Analysis of Life Review and Reminiscence Therapy across Settings

BACKGROUND

With the growing trend of ageing, there is an urgent need for effective interventions that enhance positive psychological functions among older adults.

OBJECTIVE

(1) To evaluate the effectiveness of life review and reminiscence therapy in enhancing the quality of life and life satisfaction among older adults. (2) To discover efficacious variables during interventions, such as form of intervention and number of sessions.

METHODS

Relevant randomized controlled trials in both English and Chinese languages were searched across eight databases. The meta-analysis was conducted by a random effects model using STATA 17. The registration number of this review is CRD42023424085.

RESULTS

Thirty-two studies with 2353 participants were included. Experimental groups of older adults significantly improved their quality of life (SMD 1.07; 95% CI 0.48 to 1.66; p < 0.001) and life satisfaction (SMD 1.12; 95% CI 0.63 to 1.60; p < 0.001). Subgroup analyses revealed that individual sessions of life review and reminiscence therapy had a more significant impact on improving quality of life and six to eight intervention sessions could enhance life satisfaction more effectively.

CONCLUSIONS

Life review and reminiscence therapy hold promise for application in medical and nursing care for older adults, suggesting the potential benefits of implementing intervention designs with effective settings for positive psychological functions.

A snapshot of social activities programs in residential aged care facilities in Victoria: A brief report

OBJECTIVES

To capture current opportunities for social participation for older people living in residential aged care in Victoria, Australia.

METHODS

A postal survey of all 766 Victorian residential aged care facilities. Respondents were asked to outline the nature of social participation opportunities available to residents, any potential barriers to inclusion and organisational commitments such as funding allocations and staff fractions.

RESULTS

Surveys were returned by 153 facilities, representing a response rate of 20%. All facilities had a dedicated social program, although just over half (57%; 87 of 153) offered the social program over the weekend, usually on a Saturday morning only (90%). Barriers to older people's opportunities for social participation included their ineligibility to continue attending external community programs once entering residential aged care (86%), their illness (71%), carer availability (50%) and lack of funding (42%). Funding for almost all programs (128 of 153; 84%) was described as internal and ad hoc, and staff allocations for the program were almost entirely fractional. Only 12 (8%) facilities reported that they had a dedicated full-time coordinator for the social participation program.

CONCLUSIONS

Social participation programs are available in Victorian residential aged care facilities. However, limited funding and staff allocations reduce the opportunities for older people to engage in meaningful social participation with others.

Determinants of active aging and quality of life among older adults: systematic review

Introduction

Population demography across the globe shows an increasing trend in the aging population due to better healthcare, improved nutrition, advanced health-related technology, and decreased fertility rate. Despite these advancements, there remains a knowledge gap in understanding the association between active aging determinants and quality of life (QoL) among older adults, particularly within diverse cultural contexts, which has not been adequately explored in previous research. Therefore, understanding the association between active aging determinants and QoL can help policymakers plan early interventions or programs to assist future older adults in both aging actively and optimizing their quality of life (QoL), as these two factors have a bidirectional relationship.

Objective

This study aimed to review evidence regarding the association between active aging and quality of life (QoL) among older adults and to determine the most widely used study designs and measurement instruments in studies conducted between 2000 and 2020.

Methods

Relevant studies were identified by a systematic search of four electronic databases and cross-reference lists. Original studies examining the association between active aging and QoL in individuals aged 60 years or older were considered. The quality of the included studies and the direction and consistency of the association between active aging and QoL were assessed.

Results

A total of 26 studies met the inclusion criteria and were included in this systematic review. Most studies reported a positive association between active aging and QoL among older adults. Active aging had a consistent association with various QoL domains including physical environment, health and social services, social environment, economic, personal, and behavioral determinants.

Conclusion

Active aging had a positive and consistent association with several QoL domains among older adults, backing the notion that the better the active aging determinants, the better the QoL among older adults. Considering the broader literature, it is necessary to facilitate and encourage the active participation of older adults in physical, social, and economic activities for the maintenance and/or improvement of QoL. Identifying other possible determinants and enhancing the methods to improve those determinants may help improve the QoL among older adults.

Predictors of Health Satisfaction in Spanish Physically Active Older Adults: A Cross-Sectional Observational Study

Studies that analyze the predictors of satisfaction with the health of the elderly are scarce. That is the reason why the objective of this study is to analyze whether the physical-psychological state, sports practice, and the use of socio-health resources are factors that predict satisfaction with health status in physically active elderly people. The Physical Activity and Quality of Life questionnaires were applied to a sample of 397 elderly people in this cross-sectional observational study. The data have been analyzed using Student's t-test chi-square test, Cohen's d, Phi Coefficient and Cramer's V. The results have shown that the lack of physical illnesses (OR = 3.920; p < 0.001) and psychological problems (OR = 1.940; p = 0.032), practicing a high level of physical activity (OR = 2.049; p = 0.001), having high scores in functional skills (OR = 8.059; p < 0.001) and using little social and health services (OR = 2.595; p < 0.001) are all predictors of being highly satisfied with one's health. In conclusion, predictors associated with high health satisfaction of active older people have been found, such as functional abilities, the existence of physical illness, psychological problems, level of physical activity, frequency of use of health and social services and satisfaction with health and social services; but it is not associated with gender or age of participants.

Relationship between specific leisure activities and successful aging among older adults

Background/Objectives

This study was designed to investigate the association between specific leisure activities and successful aging among older adults, using data from the Chinese Longitudinal Healthy Longevity Survey.

Methods

A total of 7689 older adults were involved in this study and categorized as successful aging group (n = 3989; 51.8%) or non-successful aging group (n = 3703; 48.2%). Participants were identified as successful aging if they had a score of more than 3 points, or as non-successful aging. The points were based on the following five items and each item was assigned 1 point: self-rated health, self-rated psychological status or mood, cognitive function, activities of daily life, and physical activity. Six activities including gardening work, reading newspapers or books, raising domestic animals or pets, playing cards or mahjong, watching TV or listening to radio, and participating in social activities were collected to reflect leisure activities. Chi-square tests, independent sample t-test, and logistic regression analyses were employed to explore the association between specific leisure activities and successful aging.

Results

The prevalence of successful aging was 51.8% among Chinese older adults. A significant positive relationship was found between the frequency of participation in specific leisure activities and successful aging (p < 0.05). Older adults who usually participated in leisure activities had greater odds for successful aging compared to those who never participated in leisure activities (adjusted odds ratio (OR): 1.31 (95% CI: 1.15-1.49) to 1.88 (95% CI: 1.62-2.19)). Older adults participating in one or more leisure activities had greater odds for successful aging compared to those who did not participate in leisure activities (adjusted OR: 1.51 (95% CI: 1.30-1.76) to 4.10 (95% CI: 2.44-6.89)).

Conclusions

The findings provide evidence that participating more frequently and in more leisure activities was associated with a greater probability of successful aging among Chinese older adults. Encouraging older people to participate frequently in a larger number of leisure activities may be a key to promote successful aging. Therefore, the frequency and number of participation in leisure activities should be highlighted and targeted for promoting successful aging.

The Impact of COVID-19 on Nursing Homes: Study Design and Population Description

Nursing homes for the elderly in Spain have experienced high rates of infection and mortality from COVID-19, although rates have varied from one region to another. Madrid is the region where most institutionalized older adults have died from the coronavirus. However, there is little known about the psychosocial and environmental factors involved in the high incidence of COVID-19 among the institutionalised population in this region. This article describes the protocol of a study on nursing homes during the SARS-CoV-2 pandemic in the Autonomous Community of Madrid (hereafter: Region of Madrid or Madrid Region) and provides information on the study design, measures used, and characteristics of the population studied. A questionnaire about life in nursing homes during the COVID-19 pandemic was designed and a total of 447 persons over 60 years of age without cognitive impairment-220 in private nursing homes and 227 in public nursing homes-participated by answering questions about different topics: personal situations during the pandemic, feelings and methods of coping, residential environment, health, quality of life, ageism, and self-perception of ageing. The institutionalised person profile discussed in this study was an old woman, widowed, without children, with a low level of education, with multimorbidity, and who perceived her health and quality of life positively. Most of the participants were very concerned about COVID-19 and its effects. In fact, 38% had been diagnosed with COVID-19, of whom 20% were admitted to hospital and 20% had suffered negative impacts, such as pain and neurological problems. In addition, 70% of the residents remained confined to their rooms, which increased their perceptions of loneliness and social isolation. The worst-rated aspects of the nursing home resulted from the restrictive measures imposed on nursing homes during the pandemic. This research offers useful material for understanding the pandemic and its consequences from the perspective of the older institutionalised population, which could provide insights for designing public policies.

Residential Environment Assessment by Older Adults in Nursing Homes during COVID-19 Outbreak

The most vulnerable residential settings during the COVID-19 pandemic were older adult's nursing homes, which experienced high rates of incidence and death from this cause. This paper aims to ascertain how institutionalized older people assessed their residential environment during the pandemic and to examine the differences according to personal and contextual characteristics. The COVID-19 Nursing Homes Survey (Madrid region, Spain) was used. The residential environment assessment scale (EVAER) and personal and contextual characteristics were selected. Descriptive and multivariate statistical analysis were applied. The sample consisted of 447 people (mean age = 83.8, 63.1% = women, 50.8% = widowed, 40% = less than primary studies). Four residential assessment subscales (relationships, mobility, residential aspects, privacy space) and three clusters according to residential rating (medium-high with everything = 71.5% of cases, low with mobility = 15.4%, low with everything = 13.1%) were obtained. The logistic regression models for each cluster category showed to be statistically significant. Showing a positive affect (OR = 1.08), fear of COVID-19 (OR = 1.06), high quality of life (OR = 1.05), not having suspicion of depression (OR = 0.75) and performing volunteer activities (OR = 3.67) were associated with the largest cluster. It is concluded that a better residential evaluation was related to more favourable personal and contextual conditions. These results can help in the design of nursing homes for older adults in need of accommodation and care to facilitate an age-friendly environment.

Association of leisure activity changes and reversion from mild cognitive impairment to normal cognitive function among older adults: A prospective cohort study

Background

Older adults with mild cognitive impairment (MCI) have the possibility of reverting to normal cognitive function. Leisure activity engagement (LAE) plays a critical role in the progress of the cognitive function. A better understanding of the dynamic relationship between LAE and MCI reversion would inform the implementation of preclinical dementia interventions. This study aimed to investigate the association between change patterns of LAE and MCI reversion among older adults using the Chinese Longitudinal Healthy Longevity Survey (CLHLS) database.

Study design

Longitudinal population-based study.

Methods

Older adults with MCI at the baseline were enrolled in this study. Information about cognitive function, overall, cognitively stimulating, physically active/demanding, and socially engaged LAE was collected at baseline and follow-up. Adjusted hazard ratios (HRs) for reversion and 95% confidence intervals (CIs) were calculated by Cox hazard models with time as the underlying time metric. We also assessed potential effect modifications by creating a cross-product of the stratifying variable with LAE change patterns in the fully adjusted model.

Results

The restricted cubic spline showed that the association between LAE change scores and MCI reversion rate was statistically significant and nonlinear (p<0.01). Taking participants in the low-low group as a reference, participants in the low-medium, low-high, medium-medium, medium-high, high-medium, and high-high groups had increased possibilities of MCI reversion with HRs (95% CI) of 2.19 (1.57-3.06), 2.97 (2.13-4.13), 0.87 (0.64-1.19), 2.28 (1.71-3.03), 2.78 (2.10-3.69), 1.93 (1.43-2.59), and 2.74 (2.09-3.60), respectively. Further stratified models showed that the impact of LAE change patterns on MCI reversion varied in different ages (nonagenarian, octogenarian, and younger elderly) and gender.

Conclusions

Participants who maintained the highest LAE had the greatest possibility of MCI reversion. Meanwhile, a higher level of LAE maintenance was associated with the increased possibility of MCI reversion. These results provide a practical message to older adults about how dynamic changes in LAE are associated with improved cognitive function.

A theory of change of an innovation for therapeutic care and meaningful living in a German nursing home

Background

Demographic changes are leading to growing care needs of older people and creating a challenge for healthcare systems worldwide. Nursing homes (NHs) need to provide care for growing numbers of residents while ensuring a high-quality care. We aimed to examine an innovative NH in Germany and apply a theory of change (ToC) approach to develop a best practice model (BPM) for therapeutic care in NHs.

Methods

A multimethod qualitative study conducted from February to July 2021 in Germany involved interviews with 14 staff members of an innovative NH and 10 directors and care managers of other NHs. The interview guidelines included questions on nursing practices, infrastructure, resources, interprofessional collaboration, and working culture. Additional material on the participating NH (website, promotion videos, newsletters, care documentation) were collected. Contextual literature on NH culture and therapeutic care in Germany, ToC methodology, and NH culture change were reviewed. Following a question-focused analysis of all material, we generated a ToC model towards a BPM of therapeutic care and meaningful living in NHs. Results were verified in interdisciplinary team meetings, with study participants and other stakeholders to establish consensus.

Results

The participating NH’s care concept aims to improve residents’ functional abilities and wellbeing as well as staff members’ job satisfaction. Central components of their approach include therapeutic elements such as music and movement in all nursing activities, multidisciplinary collaboration, a broad therapy and social activity offer, the continuation of therapy in everyday activities, a focus on individual life history, values, needs, and skills, social integration into the regional community, and the creation of a meaningful living environment for residents and staff.

Conclusion

The BPM we developed shows how a meaningful living environment can be created through therapeutic care and integrative activities. The ToC sheds light onto the contextual factors and cultural values which should be considered in the development of NH interventions. Research on not only biomedical aspects, but also psychosocial dynamics and narrative co-constructions in nursing practice should inform NH innovations. The ToC also highlights the importance of developing adequate political frameworks and infrastructures for implementing such innovative practices on a larger scale.

Social and private activity after retirement-substitutes or complements

BACKGROUND

Commonly observed low activity of older adults harms their well-being. We perceive the retirement as a new opening that could be utilized to fulfill previously neglected needs and involve in new activities. They can be a remedy for losing the sense of life while changing the social role and getting older. This study explores trends in activity over retirement. In particular, it verifies if different post-retirement activities: 1) formal social engagement; 2) informal help given outside the household; 3) solitary leisure or self-development activities, and 4) sociable leisure or self-development activities are mutually exclusive or supportive of each other.

METHODS

We use the data from 4 and 6th wave of Survey of Health, Ageing and Retirement in Europe, taking into consideration 2757 respondents who participated in both waves. We analyze trends in activity over retirement and verify the hypotheses regarding the relationships between engaging into different types of activities and between the activity and development of personal social networks. We conduct the descriptive analysis and utilize the Generalized Structural Equation Model.

RESULTS

Most people do not change their involvement in different activities after retirement. Among those who change, the average trend is upward. We find support that different types of activities undertaken after retirement do not crowd out each other. On the contrary, being active in one sphere goes hand in hand with activity in another. We give evidence for presence of social network mechanisms that enhance such understood complementarity. Maintaining social relationships correlates with engagement in socially-oriented activities and privately-oriented sociable pastimes. Being active, with exception of solitary forms of recreation, creates an opportunity to foster relations with other people and, thanks to their encouragement, to engage in new activities.

CONCLUSIONS

The small change in activity after retirement signifies the need to encourage non-work activity during earlier stages of life. As different types of post-retirement activities are complementary, the most active group of older adults would be the most open for social engagement and volunteering, however the least active group needs the biggest support to involve in any activities.

Active ageing profiles among older adults in Spain: A Multivariate analysis based on SHARE study

BACKGROUND

Following the active ageing model based on the Health, Lifelong Learning, Participation and Security pillars, this research has a twofold objective: i) to classify older adults according to active ageing profiles, taking into account the four pillars, and ii) to ascertain the relationship between the profiles and personal and contextual factors, as well as well-being and quality of life in old age.

METHODS

A study sample of 5,566 Spanish older adults who participated in wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE) was included. Data were analysed in different steps applying several statistical analyses (Principal Component, Cluster, Discriminant, Multiple Correspondence and bivariate analysis with Pearson chi-square and ANOVA).

RESULTS

Five older adult profiles were obtained (I: with moderate activity; II: quasi-dependents; III: with active ageing-limiting conditions; IV: with diverse and balanced activity; V: with excellent active ageing conditions). The first three profiles were characterised by subjects with a high average age, low educational level, who were retired or housewives, and who perceived a moderate level of loneliness, satisfaction with the social network and quality of life, as well as having a larger family network, but living in small households or alone. In contrast, the latter two profiles showed better personal and contextual conditions, well-being and quality of life.

DISCUSSION AND CONCLUSIONS

The multidimensional approach to active ageing followed in this article has revealed the presence of several older adult profiles, which are confined to groups with better or worse active ageing conditions. In this context, if ageing is a process that reflects the previous way of life, intervention priorities will have to consider actions that promote better conditions during the life cycle.

Barriers and enablers to leisure provision in residential aged care: personal care attendant perspectives

This exploratory descriptive study investigated barriers and enablers to the provision of leisure activities for people living in three Australian residential aged care facilities (RACFs) that operated under a household model of care. This research is unique in the international context, as few studies have explored the understandings and experiences of personal care attendants' (PCAs) perceptions of what impacts leisure provision for people living in RACFs. Qualitative data were collected from 17 PCAs via four focus groups. Barriers to leisure provision were identified as PCA–resident ratios, competing demands of the PCA role and a prioritisation of physical care tasks over leisure-related activities. The severity of residents' dementia (cognitive and functional deficits) as well as behavioural and psychological symptoms of dementia were also framed as barriers to participation in and the provision of leisure. Participants identified enablers of leisure provision as related to perceptions of leisure, the experiential knowledge of staff, organisational support and resourcing. The study findings suggest that enhancing leisure provision for people living with dementia will require attention to system issues (i.e. staffing levels, ratios, PCA role demands) as well as PCA knowledge and capability to facilitate person-centred leisure.

Ageing Perception as a Key Predictor of Self-Rated Health by Rural Older People—A Study with Gender and Inclusive Perspectives

This paper investigates positive perceptions of ageing in rural people aged 65 and over as a key predictor of the self-assessment of one’s health. Method: The sample covers a total of 3389 people from the ‘Survey of Health, Ageing and Retirement’ (SHARE), wave 6 (W6, 2015). This research analyses men and women who live in a rural environment. A linear regression model is proposed to consider the dependent variable ‘self-rated health’ and independent variables based on measures of quality of life in older adults. This study confirms that rural women perceive their health on the basis of factors different to those of their male contemporaries. The variable ‘How often do you feel/think that you can do the things that you want to do?’ is associated with women’s self-perceived health. In men, a high relationship (with p < 0.001) is obtained for the variables ‘How often do you feel/think look back on your life with a sense of happiness?’ and ‘How often do you feel/think that family responsibilities prevent you from doing what you want to do?’ Certain daily activities (e.g., leisure or care), along with a positive perception of life, influence one’s perceptions of one’s own health, especially in the case of women. In sum, rural older women make a positive evaluation of their own health and ageing, while rural older men relate self-rated health to passivity and reminiscing. There is a need for further research on psycho-social and socio-spatial issues from an intergenerational, technological and gender perspective for rural and territorial influences to attain better health and quality of life for rural older people in comparison to urban people.

Time use in elderly people at the low active aging level: a qualitative study

Abstract Introduction Thailand's population is aging rapidly. Thus, it is necessary to enable elderly people to be independent and actively participate in daily occupations. Objective To describe the time used by elderly people at the low active aging level in a suburban village, in Chiang Mai, northern Thailand. Method The study was qualitative research, using the narrative interview method. Three case studies on the low level of active aging were collected by following an interview-based guideline. The data were analyzed using qualitative content analysis. Results The results showed that elderly people at the low active aging level spent their time in varied activities, depending on personal factors and their contexts. Elderly people participate in different occupations of everyday life, which consist of activities of daily living and self-care, the instrumental activities of daily living, leisure, and work. Conclusion It was found that elderly people spent their time in four main categories: Activities of daily living, Instrumental ADL, leisure, and work. Enabling elderly people to increase active aging by continuing engagement in social participation and education is still challenging.

Active Aging Governance and Challenges at the Local Level

International and national guidelines have been promoting active aging while creating the necessary means for decision-makers and other relevant actors to work together (governance mechanisms) to implement local and active aging policies. This is especially important in the present COVID-19 pandemic context, posing greater challenges on older people who tend to be self-isolated. How are local actors conceptualizing active aging? What are their priorities related to a healthy life for older people? Which governance mechanisms are used to implement such policies? These are some of the questions addressed in this paper, targeting Portugal, a southern European country. A mixed-methods sequential explanatory design combining a survey conducted at a national level and interviews with key actors in the NUTS III Aveiro Region was employed to identify and understand the underpinning governance mechanisms. Findings confirm the ‘passive organization type’ in which European politico-territorial studies tend to place Portugal, as there are gaps in the way policies are formulated, implemented and evaluated, as well as a lack of coordination. Results of this study have important impacts on the way local governments and other stakeholders will prepare themselves in the post-pandemic period to design and implement policies addressing active aging.

Association between Participation Activities, Pain Severity, and Psychological Distress in Old Age: A Population-Based Study of Swedish Older Adults

Although chronic pain is common in old age, previous studies on participation activities in old age seldom consider pain aspects and its related consequences. This study analyses associations between participation activities, pain severity, and psychological distress in an aging population of Swedish older adults (N = 6611). We examined older adults' participation in five common leisure activities using the Multidimensional Pain Inventory (MPI), sociodemographic factors, pain severity, weight status, comorbidities, and pain-related psychological distress (anxiety, depression, insomnia severity, and pain catastrophising). We found that gender, body mass index (BMI) levels, and psychological distress factors significantly affected older adults' participation in leisure activities. Pain severity and multimorbidity were not significantly associated with older adults' participation in leisure activities nor with gender stratification in generalised linear regression models. The potentially modifiable factors, such as high levels of BMI and psychological distress, affected activity participation in men and women differently. Health professionals and social workers should consider gender and target potentially modifiable factors such as weight status and psychological distress to increase older adults' participation in leisure activities.

Prospective Study of Engagement in Leisure Activities and All-Cause Mortality Among Older Japanese Adults

Background

Engagement in leisure activities among older people is associated with a lower risk of mortality. However, no studies have been conducted focusing on the difference of associations with mortality risk among multiple types of leisure activities.

Methods

We examined prospectively the association of engagement in leisure activities with all-cause mortality in a cohort of older Japanese adults. The Japan Gerontological Evaluation Study included 48,216 participants aged 65 years or older. During a mean follow-up period of 5.6 years, we observed 5,575 deaths (11.6%). We investigated the total number of leisure activities, as well as combinations of 25 different leisure activities with Cox proportional hazards models, adjusting for potential confounding factors.

Results

We found a linear relationship between the total number of leisure activities and mortality hazard (adjusted hazard ratio, 0.93; 95% CI, 0.92–0.95). Furthermore, engagement in leisure activities involving physical activity, as well as group-based interactions, showed the strongest associations with lowered mortality. By contrast, engagement in cultural leisure activities and solitary leisure activities were not associated with all-cause mortality.

Conclusion

Although we cannot rule out residual confounding, our findings suggest that encouraging engagement in physically-active group-based leisure activities may promote longevity in older adults.

A comparison of quality of life indicators during two complementary interventions: adaptive gardening and adaptive riding for people with dementia

OBJECTIVES

We sought to provide a fine-grain description and comparison of how people living with dementia responded to adaptive gardening and adaptive riding through durations of their observed participation and emotional well-being, two dimensions of quality of life.

DESIGN

A descriptive case study design enabled in-depth description and comparison of participation and emotional well-being, two quality of life indicators, observed during four videotaped sessions of adaptive gardening and adaptive riding.

INTERVENTIONS

Eight people living with dementia self-selected into one of two complementary interventions, community-based adaptive gardening (n = 4) or adaptive riding (n = 4), in Northern Colorado. Both occurred for hour-long, weekly sessions for eight-weeks.

OUTCOME MEASURE

Durations of observed quality of life indicators of participation and apparent affect were documented using a modified version of the Activity-in-Context-in-Time on 31 hours of videotaped data. Durations for each quality of life indicator were averaged per participant and aggregated by group for comparison using a Wilcoxon Mann-Whitney U test RESULTS: Both interventions supported emotional well-being and participation. Longer durations of active participation were observed during adaptive riding with significantly higher durations of complex active participation (U = 16, p= 0.029).

CONCLUSION

Both interventions supported quality of life and merit continued development. Adaptive riding appeared to support longer durations of active participation with more complex forms when compared to adaptive gardening. Findings can inform healthcare providers' recommendations for adaptive gardening and adaptive riding for people with dementia. More research is needed with a larger sample size to further examine similarities and differences.

An ecological approach to the development of an active aging measurement in urban areas (AAMU)

BACKGROUND

An essential element in the process of "aging well" is the concept of Active Aging (AA). To propose an operational definition of Active Aging, the present study seeks to develop a new measurement tool through an ecological approach. The aim is to recognize significant indicators that play a role in assessing AA in urban areas.

METHODS

This study was conducted through a two-phase process of consensus-building: 1) identifying a set of indicators that were likely candidates for inclusion based on literature review, and 2) a two-round modified Delphi survey using an international panel of academic experts in environmental sciences and gerontology to achieve consensus on the importance of the extracted indicators and validate the items. The panelists were asked to complete a researcher-developed questionnaire with an 11-point Likert scale based on the indicators derived in phase 1. Finally, the Delphi survey's valid indicators and criteria were utilized to develop the measurement tool.

RESULTS

At the outset, a list of 111 indicators of AA was prepared through the desk study. A panel of 22 experts reviewed the extracted items and arrived at a consensus on 99 items in the first round and finalised in the second round. Thematic analysis of the panelists' open-ended responses revealed new concepts that would be explicitly considered by the consensus group. This developed measurement scale consists of five domains, i.e., individual, spatial, socio-economic, governance, and health-related, which contain 15 criteria and 99 indicators.

CONCLUSIONS

The present researchers have developed the active aging measure for urban settlements (AAMU), which can be used both by policy-makers and as an informal self-reported statement among the elderly. AAM's results in the elderly's residential environmental communities can improve policy-making to address urban design to sustain an active, healthy life among older people in urban environments.

Digital Identity Levels in Older Learners: A New Focus for Sustainable Lifelong Education and Inclusion

Identifying the digital identity of older adults entails an essential step for their effective digital inclusion grounded in a holistic and sustainable human development in hyperconnected societies. This paper proposes a theoretical framework with three levels of digital identity based on motives and practices: location, action, and significance. This framework was used for designing an ad-hoc scale, tested with a sample of senior learners (n = 659) aged 55 and over involved in active aging programs in Adult Education in Spain. Participants filled out a five-point 20-item Likert scale measuring their agreement with the digital identity factors, along with two complementary scales evaluating their internet uses and motivations, as well as other items on living arrangements and perceived social support. Exploratory and confirmatory analyses showed a factorial structure with three levels of digital identity for older adults. The results revealed that active older adults with diverse motives for using the internet and variety in digital practices recorded a higher digital identity level, as did those who felt more isolated or with less social support. As a conclusion, the educational implications according to instrumental, social, and motivational variables are key for the progressive construction of a digital identity in older adults and for their digital inclusion.

Environmental and Psychosocial Interventions in Age-Friendly Communities and Active Ageing: A Systematic Review

Background: The academic literature contains little information regarding the interventions that create age-friendly cities and communities in order to promote active ageing. Objectives: A systematic review was carried out to determine the available empirical evidence in relation to the characteristics, content and effectiveness of interventions aimed at improving environmental and psychosocial risk factors for older people, from the perspective of age-friendly communities and the promotion of active ageing. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the studies retained in this review were identified through a systematic search of the academic literature in selected electronic databases including Web of Science and Scopus. Independent critical appraisal and data extraction were conducted by two reviewers. The checklist was used to assess the quality of the articles. Findings: The search identified 1020 potentially eligible documents, of which 11 satisfied the established criteria. Non-exhaustive practices prevailed over rigorous investigations, with a high proportion of studies observed to be of low methodological quality and at high risk of bias. This reflected the predominance of uncontrolled interventions. Environmental interventions were focused on reducing risk and adapting the everyday environmental setting, while psychosocial interventions prioritised social strategies (behavioural changes, promotion of participation) and training. Interventions were more effective in certain domains of age-friendly cities and communities such as transportation and housing, followed by increased participation as a lifestyle-related behavioural change. The inferred changes were associated with providing information and enhancing skills; modifying access, barriers, exposures, and opportunities; enhancing services and support; continuity and effectiveness of changes over time; and modifying policies based on the bottom-up approach of age-friendly cities and communities (AFCC). Discussion and conclusion: Interventions focused on personal and organisational aspects might have positive effects in the longer term. However, fewer changes would be observed in interventions revolving around changing lifestyles owing to the impact of complex multi-causal factors. The relative effectiveness in terms of health calls into question the design of interventions and the supposed "friendliness" of certain communities. There is a need to encourage sound longitudinal research aimed at providing key knowledge for the implementation and evaluation of public policies, and to encourage age-friendly community programmes to promote active ageing.

Exploring the abilities of performing complex daily activities in dementia: the effects of supervision on remaining independent

Objectives: The aim of this study was to explore the remaining abilities of people with dementia (PwD) in performing daily activities.Method: Informal carers of community-residing PwD were recruited across England via mail out and carer support groups. Carers completed the revised Interview for Deteriorations in Daily Living Activities in Dementia 2 to rate the PwD's initiative and performance of daily activities. Six complex instrumental activities of daily living (IADLs) were selected: shopping, preparing a hot drink, using the telephone, preparing a cold meal, house work, and engaging in social activities, all of which were broken down into three sub-tasks. Data were analysed using Chi-square tests and linear regression analysis, assessing the contributions of hours of IADL care, hours of supervision, and dementia stage for each activity.Results: 581 carers of people with mild, moderate, and severe dementia completed the questionnaire. The ability to perform individual activities deteriorated from mild to moderate to severe dementia, with PwD remaining the most able to perform subtasks of preparing a hot drink and a cold meal. Subtask performance varied across activities, with some better maintained than others across severity stages. Linear regression models showed that hours of supervising PwD explained a greater proportion of the variance of each IADL than IADL care hours.Conclusion: PwD should be supervised to continue engaging in activities, thereby avoiding performing everything for the PwD. Findings can have implications for PwD living in nursing homes, and future research should explore the remaining IADL abilities of nursing home residents.

The WHO active ageing pillars and its association with survival: Findings from a population-based study in Spain

BACKGROUND

The World Health Organization's active ageing model is based on the optimisation of four key "pillars": health, lifelong learning, participation and security. It provides older people with a policy framework to develop their potential for well-being, which in turn, may facilitate longevity. We sought to assess the effect of active ageing on longer life expectancy by: i) operationalising the WHO active ageing framework, ii) testing the validity of the factors obtained by analysing the relationships between the pillars, and iii) exploring the impact of active ageing on survival through the health pillar.

METHODS

Based on data from a sample of 801 community-dwelling older adults, we operationalised the active ageing model by taking each pillar as an individual construct using principal component analysis. The interrelationship between components and their association with survival was analysed using multiple regression models.

RESULTS

A three-factor structure was obtained for each pillar, except for lifelong learning with a single component. After adjustment for age, gender and marital status, survival was only significantly associated with the physical component of health (HR = 0.66; 95% CI = 0.47-0.93; p = 0.018). In turn, this component was loaded with representative variables of comorbidity and functionality, cognitive status and lifestyles, and correlated with components of lifelong learning, social activities and institutional support.

CONCLUSION

According to how the variables clustered into the components and how the components intertwined, results suggest that the variables loading on the biomedical component of the health pillar (e.g. cognitive function, health conditions or pain), may play a part on survival chances.

Relationship Between Mental Health and the Education Level in Elderly People: Mediation of Leisure Attitude

Purpose

The present study intends to explore the influence of education on the mental health of retired people and the mediating role of a leisure attitude in this relationship.

Design/Methodology

The sample was simple random, and a confidentiality agreement was established. The sample was composed of 403 Portuguese participants (37.2% male; 62.8% female). The participants completed the MHI and the LAS.

Findings

The hypothesized mediation model showed that a leisure attitude mediated the association between education and well-being. In addition, higher levels of distress were found in participants with higher levels of education.

Scientific Contribution

Our results suggest that old-aged people with high education and a more positive leisure attitude have a better psychological adjustment concerning well-being. Also, a higher level of education can lead to a better perception of aging changes (physical, life, profession).

Influence of pre-admission factors on quality of life and adaptation in nursing home residents with dementia: the QOL-EHPAD study protocol

Background

In 2015 in France, 585,560 people were nursing home residents. A large body of studies has identified predictors of poor quality of life and poor adaptation in institution, mostly for residents without dementia. With 42 to 72% of these residents diagnosed with dementia, it is crucial to identify what factors prior to admission might have an impact on quality of life once the admission is finalized, in order to target specific domains of intervention, while the person still lives at home and after his/her admission.

Methods

QOL-EHPAD is a prospective, multi-centred, observational cohort study. At baseline, we will collect retrospective data on the life of 150 persons with dementia and their caregivers. These data will refer to the conditions of admission to a nursing home (emergency admission, involvement in the decision, admission from home or from the hospital) and to the 6 months prior to the admission of the person with dementia: sociodemographic and medical data, psychological tests, information on quality of life, satisfaction, behaviour, and nutrition. Similar data about life in the nursing home will be collected after 6 months, along with information on adaptation of the person with dementia to his/her new living environment. We will use univariate regression analyses followed by stepwise linear regression models to identify which factors pertaining to life at home are associated with quality of life and adaptation after 6 months.

Discussion

This study will provide data on the impact of institutionalization on quality of life and the determinants of a successful institutionalization in people with dementia. This could be helpful in setting up targeted interventions to prepare admission into a nursing home before the actual admission and to accompany both the caregiver and the person with dementia throughout this process.

Independent Older Adult's IADL and Executive Function According to Cognitive Performance

Participation in Instrumental Activities of Daily Living (IADL) is essential in occupational therapy aiming to improve the life situation of elderly. Effective executive function (EF) is important to successful functioning in IADL. The purpose of this study was to examine EF and IADL performance differences according to cognitive levels as measured by the Montreal Cognitive Assessment (MoCA), age, and gender. In all, 80 elderly (49% female; age M = 73.4) were assessed at home, with Weekly Calendar Planning Activity (WCPA-10), IADL scale, and MoCA as a cognitive screening tool for dividing into normal cognitive (NC) level and mild cognitive impairment (MCI). The comparison between the MoCA groups on the WCPA-10 and IADL shows significant differences between the groups; gender and age differed only in IADL. IADL and WCPA-10 performance among independent elderly relates to their cognitive level. We suggest that intervention that will focus on EF may assist in improving performance and maintaining participation in occupation.

Satisfaction with Life, Subjective Well-Being and Functional Skills in Active Older Adults Based on Their Level of Physical Activity Practice

Studies about the influence of physical activity on life satisfaction, functional ability and subjective well-being in physically active older adults without cognitive impairment are very few for the moment. Therefore, the aim of this research was to evaluate the life satisfaction, functional skills and subjective well-being of physically active older adults based on the level of activity practiced. The IPAQ (International Physical Activity), CUBRECAVI and LSIA (Life Satisfaction Index) scales were tested for a sample of 397 Spanish older adults between 61 and 93 years of age (M = 69.65; SD = 4.71). The results showed that those who performed high physical activity obtained higher scores in functional skills (p < 0.01) and in the activities of daily living (p < 0.01). In addition, subjective well-being (p < 0.01) and the functional autonomy of older adults (p < 0.01) were related to the level of physical activity that they practiced. In conclusion, it could be said that the older adults with a high level of physical activity have more functional skills and less difficulties performing the activities of daily living, and that they value their autonomy and health better.

Multilevel Effects of Community Capacity on Active Aging in Community-Dwelling Older Adults in South Korea

PURPOSE

This study aimed at identifying the level of active aging in older adults and the influence of the individual and community levels of community capacity on active aging.

METHODS

A cross-sectional survey was conducted on a stratified sample of 380 older adults living in 35 neighborhoods of five regions in Seoul, the capital of South Korea. The structured questionnaire included the Korean version of instruments that measure active aging and community capacity at the individual level. Secondary data including metropolitan statistical information, a public data portal, and a city plan were used to acquire community-capacity factors at the community level. Data were analyzed with multilevel models.

RESULTS

The overall active aging mean score was 3.00 ± 0.55 out of 5; the highest mean score was in the security domain (3.46 ± 0.65) and the lowest one was in the participation domain (2.71 ± 0.66). Individual factors associated with active aging included age, education, income, and community capacity at the individual level. At the community level, two community-capacity factors (senior leisure welfare facilities and cooperative unions) were significantly associated with active aging. In active aging, 6.4% and 4.1% of total variance could be explained by 35 neighborhoods, after considering individual and community level variables, respectively.

CONCLUSION

This study showed that community capacity is important for active aging among older adults. Appropriate strategies that consider both individual and community factors, such as contextual indicators of community capacity, are necessary to improve active aging.

Effects of selected leisure activities on preventing loneliness among older Chinese

This study examined three types of leisure activities (playing cards/mahjong, watching TV/listening to the radio, and participation in social activities) among the older segment of the Chinese population, and the effects of these activities in preventing the feelings of loneliness. Data came from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), conducted in 2005, 2008, and 2011. The males, those who were educated, the young-old (aged between 65 and 74 years), urban dwellers, and living in institutions were more likely to participate in all three activities frequently. Frequent or occasional participation in these three activities was negatively associated with feelings of loneliness. The longitudinal study from 2005 to 2011 showed that respondents who frequently played cards/mahjong at baseline were less likely to feel persistent loneliness at the end of the 2011 wave. Instead, frequently watching TV/listening to the radio in 2008 was associated with lower odds in feeling persistent loneliness at the end of 2011. Hence, active participation in playing cards/mahjong and TV/radio entertainment can be effective treatment intervention against persistent loneliness among older Chinese. For the Chinese, a leisure activity steeped in a nation's culture and heritage, such as playing mahjong, may be used as an intervention strategy to prevent and alleviate chronic loneliness among older adults.

Virtual reality among the elderly: a usefulness and acceptance study from Taiwan

BACKGROUND

Virtual reality (VR) has several applications in the medical domain and also generates a secure environment to carry out activities. Evaluation of the effectiveness of VR among older populations revealed positive effects of VR as a tool to reduce risks of falls and also improve the social and emotional well-being of older adults. The decline in physical and mental health, the loss of functional capabilities, and a weakening of social ties represent obstacles towards active aging among older adults and indicate a need for support. Existing research focused on the effects of VR among older populations, and its uses and benefits. Our study investigated the acceptance and use of VR by the elderly.

METHODS

This pilot study was conducted on 30 older adults who voluntarily participated during March to May 2018. Nine VR applications that promote physical activities, motivate users, and provide entertainment were chosen for this study. Participants were asked to use any one of the applications of their choice for 15 min twice a week for 6 weeks. At the end of 6 weeks, participants were asked to fill out a questionnaire based on the Technology Acceptance Model and a literature review, to evaluate their acceptance of VR technology. Cronbach's alpha reliability analysis was used to test the internal consistency of the questionnaire items. Pearson's product moment correlation was used to examine the validity of the questionnaire. A linear regression and mediation analysis were utilized to identify relationships among the variables of the questionnaire.

RESULTS

In total, six male and 24 female participants aged 60~95 years volunteered to participate in the study. Perceived usefulness, perceived ease of use, social norms, and perceived enjoyment were seen to have had significant effects on the intention to use VR. Participants agreed to a large extent regarding the perceived usefulness, perceived enjoyment, and their experience of using VR. Thus, VR was seen to have high acceptance among this elderly population.

CONCLUSIONS

Older people have positive perceptions towards accepting and using VR to support active aging. They perceived VR to be useful, easy to use, and an enjoyable experience, implying positive attitudes toward adopting this new technology.

When technology cares for people with dementia: A critical review using neuropsychological rehabilitation as a conceptual framework

Clinicians and researchers have become increasingly interested in the potential of technology in assisting persons with dementia (PwD). However, several issues have emerged in relation to how studies have conceptualized who the main technology user is (PwD/carer), how technology is used (as compensatory, environment modification, monitoring or retraining tool), why it is used (i.e., what impairments and/or disabilities are supported) and what variables have been considered as relevant to support engagement with technology. In this review we adopted a Neuropsychological Rehabilitation perspective to analyse 253 studies reporting on technological solutions for PwD. We analysed purposes/uses, supported impairments and disabilities and how engagement was considered. Findings showed that the most frequent purposes of technology use were compensation and monitoring, supporting orientation, sequencing complex actions and memory impairments in a wide range of activities. The few studies that addressed the issue of engagement with technology considered how the ease of use, social appropriateness, level of personalization, dynamic adaptation and carers' mediation allowed technology to adapt to PWD's and carers' preferences and performance. Conceptual and methodological tools emerged as outcomes of the analytical process, representing an important contribution to understanding the role of technologies to increase PwD's wellbeing and orient future research.

Social and leisure activity profiles and well-being among the older adults: a longitudinal study

OBJECTIVES

Studies highlight the beneficial effects of social and leisure activities on the well-being of aging people. Our aims were: to investigate activity profiles among older adults living in their own homes, to highlight potential changes in profiles over a period of five years and to examine effects of differences between these profiles on well-being variables.

METHODS

Three waves were considered in this longitudinal study, with 550, 410 and 374 people (76, 79, 82 years on average), respectively. We used cluster analysis to obtain activity profiles of social and leisure activities, ANOVAs with age and external variables (satisfaction with life, time occupation satisfaction, self-esteem and depression) to explore differences between cluster groups, and chi-square tests of association to explore whether the same individual belonged to the same activity profile over time.

RESULTS

The number of clusters decreased strongly from the first wave to the other two waves (n = 7 to n = 2 and 3). Two main types of activity differentiated the profiles: social activities (voluntary work and associations) and recreational activities outside the home/at home. The activities showed no systematic or strong effects on external variables, nevertheless for the oldest subjects when comparing the less active to the more active (recreational profile and social profile) the latter expressed a greater satisfaction of time occupation and self-esteem, and lower scores of depressive symptoms.

CONCLUSIONS

Such activities could be an indicator of a certain independence (physical and mental availability) which plays a strong role in the well-being of older adults.

Extraversion personality, perceived health and activity participation among community-dwelling aging adults in Hong Kong

Activity participation is essential to the wellbeing of aging adults. Divergent levels of activity participation within aging populations have been explained from diverse perspectives, but the interaction effects of key determinants, such as personality and health, are often ignored. This study examines the effects of extravert personality on aging adults' activity levels by addressing its interaction with perceived physical health and mental health. A sample of 304 adults aged 50 and older was selected using systematic sampling from participants of an institute for promoting active aging at a university in Hong Kong in 2017. Data on socio-demographic characteristics, perceived physical and mental health, extraversion personality traits, and level of activity participation were collected using a telephone survey. Most participants (46.7%) reported moderate activity levels and over a quarter (26.6%) reported high or low activity levels. Multi-nominal logistic regression analyses show that extraversion was associated with an increased likelihood of reporting moderate (OR = 1.85, p = .036) but not high (p > .05) activity levels when adjusted for perceived physical and mental health and socio-demographics, with low activity levels being the constant comparison. Meanwhile, extraversion predicted both moderate (OR = 3.84, p = .014) and high (OR = 5.06, p = .032) activity levels for participants with poor or average perceived mental health. However, the interaction effects of extraversion with perceived physical health or mental health were not significant in predicting either moderate or high activity levels (p > .05). The implications for enhancing activity participation among aging adults are discussed in view of both personality and perceived health status.

An ethnographic study in nursing homes in Iran

BACKGROUND:

The approach of death is an undeniable part of ageing and death is the most important concern for elderly people who live in nursing homes. This study examines describes how care home residents feel when they recognise that they are close to death.

AIMS:

The aim of this study was to explore the experiences of elderly residents who are dying in nursing homes as well as their caregivers toward death in an Iranian context.

METHODS:

A focused ethnographic research design was chosen. The research sample consisted of 25 nursing home staff-three nurses, 18 healthcare assistants, two administrators, a social worker and a psychologist-and 10 elderly people in two nursing homes in Iran. Data was collected through field notes, observations and semistructured, in-depth interviews. Data was analysed using thematic analysis.

FINDINGS:

There were two main themes of: seeking the embrace of a calm death; and waiting for death. Within these, four subthemes were identified.

CONCLUSION:

The perceptions of the participants originated from the nursing home culture and their beliefs in eternal life. Training staff about the cultural needs of dying people and end-of-life care would be the most effective way to improve the experience of dying for nursing home residents.

StraightenUp+: Monitoring of Posture during Daily Activities for Older Persons Using Wearable Sensors

Monitoring the posture of older persons using portable sensors while they carry out daily activities can facilitate the process of generating indicators with which to evaluate their health and quality of life. The majority of current research into such sensors focuses primarily on their functionality and accuracy, and minimal effort is dedicated to understanding the experience of older persons who interact with the devices. This study proposes a wearable device to identify the bodily postures of older persons, while also looking into the perceptions of the users. For the purposes of this study, thirty independent and semi-independent older persons undertook eight different types of physical activity, including: walking, raising arms, lowering arms, leaning forward, sitting, sitting upright, transitioning from standing to sitting, and transitioning from sitting to standing. The data was classified offline, achieving an accuracy of 93.5%, while overall device user perception was positive. Participants rated the usability of the device, in addition to their overall user experience, highly.

From Active Aging to Active Citizenship: The Role of (Age) Friendliness

The concept of ‘Active Aging’ emerged in the 1990s, reflecting a growing emphasis on the relationships between health, participation, aging, and independence. The concept focuses on encouraging the participation of older adults in society and it recognizes the competence and knowledge that older people possess. The Active Aging discourse developed as a broad political response to demographic aging, one which promotes a cultural shift in what ‘old age’ may mean, by providing older people with new roles. The initiative “Age-Friendly Cities and Communities”, which was launched by the WHO in 2007, was developed with the aim of applying this paradigm into practice at the local level. Its purpose was to promote a movement of citizen participation where older people have a leading role as generators of well-being, and tackling the barriers of Active Aging. This paper provides a theoretical reflection concerning the development of the concept of Active Aging and how this has led to new ways of active citizenship in later life. New generations of older people demand a space where they can develop and contribute to society, regardless of their age. The aging of the population poses challenges and opportunities, which we can and must take advantage of in order to build a better and more egalitarian society, one that recognizes the value of diversity.

Social support for elderly people over 65 years in Spain

AIMS

To determine what social support is available in Spain to people over 65 who also dedicate hours of their time to the care of others who are older.

BACKGROUND

Demographic and social changes are leading to growth of the population. The social support available to older people in the final stage of life affects their health.

METHODS

A cross-sectional study was conducted involving the records of older, non-institutionalized individuals residing in Spain, obtained from the European Health Survey of 2014. The method of collecting information used in the European Survey was personal interviews assisted by a computer.

RESULTS

The records of 6520 older people were studied; 40.1% of the participants studied had expressed the possibility of having three to five people available in case of a serious problem, and 83.6% reported that the rest of the people around them were very interested in what happens to them. With respect to care, only 7% of the older people studied mentioned performing care tasks.

CONCLUSIONS

Social support is beneficial to older people, regardless of whether they perform care tasks, because it acts as a protective factor against problems such as loneliness, stress and depression. The profile of a primary caregiver in this age range is a married, middle-class woman with primary schooling who is caring for a first-degree relative.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

These data suggest that it is necessary for nurses to know about the needs of older people to implement societal measures of health promotion, prevention and education that favour social cohort. In addition, health policymakers should establish programmes that improve the social support of non-institutionalized older people.

Assessment of Cognitively Stimulating Activity in a Spanish Population

Theoretical models of active ageing and cognitive reserve emphasize the importance of leading an active life to delay age-related cognitive deterioration and maintain good levels of well-being and personal satisfaction in the elderly. The objective of this research was to construct a scale to measure cognitively stimulating activities (CSA) in the Spanish language. The sample consisted of a total of 453 older persons. The scale was constructed from a list of 28 items and validated using structural equation models. The scale obtained showed a negative correlation with age and a positive correlation with education and physical activity. Using hierarchical regression models, CSAs were found to have a significant effect on attention when controlling for the effect of age and education. Likewise, a significant interaction between age and CSA was found on the measure of episodic memory. The validated CSA scale will enable the relationships between changes in cognitive functions and stimulating activities to be studied.

Could age and aging change the host response to systemic parasitic infections? A systematic review of preclinical evidence

The impact of age and aging in the evolution of systemic parasitic infections remains poorly understood. We conducted a systematic review from preclinical models of Chagas disease, leishmaniasis, malaria, sleeping sickness and toxoplasmosis. From a structured and comprehensive search in electronic databases, 29 studies were recovered and included in the review. Beyond the characteristics of the experimental models, parasitological and immunological outcomes, we also discussed the quality of current evidence. Our findings indicated that throughout aging, parasitemia and mortality were consistently reduced in Chagas disease and malaria, but were similar or increased in leishmaniasis and highly variable in toxoplasmosis. While a marked humoral response in older animals was related to the anti-T. cruzi protective phenotype, cellular responses mediated by a polarized Th1 phenotype were associated with a more effective defense against Plasmodium infection. Conversely, in leishmaniasis, severe infections and high mortality rates were potentially related to attenuation of humoral response and an imbalance between Th1 and Th2 phenotypes. Due to the heterogeneous parasitological outcomes and limited immunological data, the role of aging on toxoplasmosis evolution remains unclear. From a detailed description of the methodological bias, more controlled researches could avoid the systematic reproduction of inconsistent and poorly reproducible experimental designs.

Social participation among older adults (55+): Results of a survey in the region of South Limburg in the Netherlands

Social participation may improve the health and well-being of older adults, and may increase the social and human capacity of their communities. This study investigates the level and forms of social participation among older adults (aged 55 years or older) in the region of South Limburg, the Netherlands, and their association with socio-demographic and health-related characteristics. The study provides evidence that can be used by policy makers to enhance social participation in the region. We use cross-sectional data collected in a survey in 2012 among a sample of older adults (aged 55 years or older) representative for the region of South Limburg. The results indicate that 56% (N = 16,291/weighted sample N = 213,332) of the older adults in the region participate in social activities. Specifically, 25.5% perform paid labour, 20% give informal care and 25% participate in volunteer work. Older adults with a higher education (OR = 2.49 for the highest education group) or higher income (OR = 1.70 for the highest income group) are significantly more likely to participate in social activities compared with the respective reference categories. Increased age (OR = 0.23 for the oldest age group), female gender (OR = 0.83), loneliness (OR = 0.75 for severe loneliness) and restrictions (OR = 0.78 for restrictions on the OECD scale, OR = 0.68 for restrictions on the HDL scale, OR = 0.52 for transportation restrictions) significantly hinder social participation. The lower social participation rate among older adults that we observe compared with the national statistics can be explained by the relatively higher proportion of people with low or average socioeconomic status in South Limburg. And as South Limburg is the unhealthiest region of the Netherlands, this also contributes to the low social participation. Prevention of poor physical and mental health, and provision of care services are important to encourage social participation among the older adults in South Limburg.