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Li L, Rosenwohl-Mack A, Dzeng E. Web Exclusive. Annals Graphic Medicine - A Graphical Abstract Examining Moral Distress and Coping Practices Among Clinicians During the COVID-19 Pandemic. Ann Intern Med 2023; 176:eG220054. [PMID: 37429032 DOI: 10.7326/g22-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Affiliation(s)
- Lingsheng Li
- University of California, San Francisco, San Francisco, California (L.L., A.R., E.D.)
| | - Amy Rosenwohl-Mack
- University of California, San Francisco, San Francisco, California (L.L., A.R., E.D.)
| | - Elizabeth Dzeng
- University of California, San Francisco, San Francisco, California (L.L., A.R., E.D.)
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Abstract
BACKGROUND Homeless street sweeps are frequent operations in many cities in the USA in which government agencies move unhoused people living in public outdoor areas. Little research exists on the health impact of street sweeps operations. OBJECTIVE This study was created at the request of community advocacy groups to investigate and document the health impacts of street sweeps from the perspective of healthcare providers. DESIGN This is a qualitative study using data gathered from open-ended questions. PARTICIPANTS We recruited 39 healthcare providers who provided health and wellness services in San Francisco for people experiencing homelessness (PEH) between January 2018 and January 2020. INTERVENTIONS We administered a qualitative, open-ended questionnaire to healthcare providers using Qualtrics surveying their perspectives on the health impact of street sweeps. APPROACH We conducted qualitative thematic analysis on questionnaire results. KEY RESULTS Street sweeps may negatively impact health through two outcomes. The first outcome is material loss, including belongings and medical items. The second outcome is instability, including geographic displacement, community fragmentation, and loss to follow-up. These outcomes may contribute to less effective management of chronic health conditions, infectious diseases, and substance use disorders, and may increase physical injuries and worsen mental health. Providers also reported that sweeps may negatively impact the healthcare system by promoting increased usage of emergency departments and inpatient hospital care. CONCLUSIONS Sweeps may have several negative consequences for the physical and mental health of the PEH community and for the healthcare system.
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Affiliation(s)
- Diane Qi
- UCSF School of Medicine, San Francisco, CA, USA.
| | - Kamran Abri
- UCSF School of Medicine, San Francisco, CA, USA
| | | | | | - Lina Khoeur
- UCSF School of Medicine, San Francisco, CA, USA
| | - Lily Barnard
- UCSF Department of Family Medicine, San Francisco, CA, USA
| | - Kelly Ray Knight
- UCSF School of Medicine, San Francisco, CA, USA.,UCSF Department of Humanities and Social Sciences, San Francisco, CA, USA
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Hoffmann CM, Nianogo RA, Yaffe K, Rosenwohl-Mack A, Carrasco A, Barnes DE. Importance of Accounting for Regional Differences in Modifiable Risk Factors for Alzheimer's Disease and Related Dementias: The Case for Tailored Interventions. J Alzheimers Dis 2022; 89:563-570. [PMID: 35938249 DOI: 10.3233/jad-220278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We recently estimated that 36.9% of Alzheimer's disease and related dementias (ADRD) cases in the US may be attributable to modifiable risk factors, but it is not known whether national estimates generalize to specific states or regions. OBJECTIVE To compare national estimates of modifiable risk factors of ADRD to California, overall and by sex and race/ethnicity, and to estimate number of cases potentially preventable by reducing the prevalence of key risk factors by 25%. METHODS Adults ≥18 years who participated in the Behavioral Risk Factor Surveillance Survey in California (n = 9,836) and the US (n = 378,615). We calculated population attributable risks (PARs) for eight risk factors (physical inactivity, current smoking, depression, low education, diabetes mellitus, midlife obesity, midlife hypertension, and hearing loss) and compared estimates in California and the U.S. RESULTS In California, overall, 28.9% of ADRD cases were potentially attributable to the combination of risk factors, compared to 36.9% in the U.S. The top three risk factors were the same in California and the U.S., although their relative importance differed (low education [CA:14.9%; U.S.:11.7% ], midlife obesity [CA:14.9%; U.S.:17.7% ], and physical inactivity [CA:10.3%; U.S.:11.8% ]). The number of ADRD cases attributable to the combined risk factors was 199,246 in California and 2,287,683 in the U.S. If the combined risk factors were reduced by 25%, we could potentially prevent more than 40,000 cases in California and 445,000 cases in the U.S. CONCLUSION Our findings highlight the importance of examining risk factors of ADRD regionally, and within sex and race/ethnic groups to tailor dementia risk reduction strategies.
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Affiliation(s)
- Coles M Hoffmann
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Roch A Nianogo
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.,California Center for Population Research, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kristine Yaffe
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology & Biostatistics 550, University of California, San Francisco, San Francisco, CA, USA.,San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Amy Rosenwohl-Mack
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Anna Carrasco
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Deborah E Barnes
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology & Biostatistics 550, University of California, San Francisco, San Francisco, CA, USA.,San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
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Nianogo RA, Rosenwohl-Mack A, Yaffe K, Carrasco A, Hoffmann CM, Barnes DE. Risk Factors Associated With Alzheimer Disease and Related Dementias by Sex and Race and Ethnicity in the US. JAMA Neurol 2022; 79:584-591. [PMID: 35532912 PMCID: PMC9086930 DOI: 10.1001/jamaneurol.2022.0976] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Previous estimates suggested that 1 in 3 cases of Alzheimer disease and related dementia (ADRDs) in the US are associated with modifiable risk factors, the most prominent being physical inactivity, depression, and smoking. However, these estimates do not account for changes in risk factor prevalence over the past decade and do not consider potential differences by sex or race and ethnicity. Objective To update estimates of the proportion of ADRDs in the US that are associated with modifiable risk factors and to assess for differences by sex and race and ethnicity. Design, Setting, and Participants For this cross-sectional study, risk factor prevalence and communality were obtained from the nationally representative US Behavioral Risk Factor Surveillance Survey data from January 2018 to December 2018, and relative risks for each risk factor were extracted from meta-analyses. Data were analyzed from December 2020 to August 2021. Respondents included 378 615 noninstitutionalized adults older than 18 years. The number before exclusion was 402 410. Approximately 23 795 (~6%) had missing values on at least 1 of the variables of interest. Exposures Physical inactivity, current smoking, depression, low education, diabetes, midlife obesity, midlife hypertension, and hearing loss. Main Outcomes and Measures Individual and combined population-attributable risks (PARs) associated with ADRDs, accounting for nonindependence between risk factors. Results Among 378 615 individuals, 171 161 (weighted 48.7%) were male, and 134 693 (weighted 21.1%) were 65 years and older. Race and ethnicity data were self-reported and defined by the US Behavioral Risk Factor Surveillance System Data; 6671 participants (weighted 0.9%) were American Indian and Alaska Native, 8043 (weighted 5.1%) were Asian, 29 956 (weighted 11.7%) were Black, 28 042 (weighted 16.0%) were Hispanic (any race), and 294 394 (weighted 64.3%) were White. Approximately 1 in 3 of ADRD cases (36.9%) in the US were associated with 8 modifiable risk factors, the most prominent of which were midlife obesity (17.7%; 95% CI, 17.5-18.0), physical inactivity (11.8%; 95% CI, 11.7-11.9), and low educational attainment (11.7%; 95% CI, 11.5-12.0). Combined PARs were higher in men (35.9%) than women (30.1%) and differed by race and ethnicity: American Indian and Alaska Native individuals, 39%; Asian individuals, 16%; Black individuals, 40%; Hispanic individuals (any race), 34%; and White individuals, 29%. The most prominent modifiable risk factors regardless of sex were midlife obesity for American Indian and Alaska Native individuals, Black individuals, and White individuals; low education for Hispanic individuals; and physical inactivity for Asian individuals. Conclusions and Relevance The findings suggest that risk factors associated with ADRDs have changed over the past decade and differ based on sex and race and ethnicity. Alzheimer risk reduction strategies may be more effective if they target higher-risk groups and consider current risk factor profiles.
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Affiliation(s)
- Roch A Nianogo
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles.,California Center for Population Research, University of California, Los Angeles
| | | | - Kristine Yaffe
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco.,Department of Neurology, University of California, San Francisco.,Department of Epidemiology & Biostatistics, University of California, San Francisco.,San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Anna Carrasco
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco
| | - Coles M Hoffmann
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco
| | - Deborah E Barnes
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco.,Department of Epidemiology & Biostatistics, University of California, San Francisco.,San Francisco Veterans Affairs Health Care System, San Francisco, California
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Rosenwohl-Mack A, Dubbin L, Chodos A, Dulaney S, Fang ML, Merrilees J, Portacolone E. Use of Services by People Living Alone With Cognitive Impairment: A Systematic Review. Innov Aging 2021; 5:igab004. [PMID: 33796795 PMCID: PMC7990060 DOI: 10.1093/geroni/igab004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Formal supports and social services are essential to people living alone with cognitive impairment (PLACI) because they are at risk of negative health outcomes and lack cohabitants who may support them with cognitively demanding tasks. To further our understanding of this critical and worldwide issue, we conducted a systematic review to understand whether, and how, PLACI access and use essential formal supports and services. RESEARCH DESIGN AND METHODS We searched 6 databases (PubMed, Embase, PsycINFO, CINAHL, Web of Science, and Sociological Abstracts) to identify quantitative and mixed-method literature on formal service use among PLACI. The initial search was conducted in 2018 and updated in 2020. RESULTS We identified 32 studies published between 1992 and 2019, representing 13 countries, that met our criteria: 16 reported on health services and 26 on social services. Most studies compared PLACI with people with cognitive impairment living with others. Health service use was lower or similar among PLACI, as opposed to counterparts living with others. Most studies reported a higher use of social services (e.g., home services) among PLACI than those living with others. Overall use of essential home service among PLACI was higher in Europe than in the United States, a country where large portions of PLACI were reported receiving no formal services. DISCUSSION AND IMPLICATIONS We identified wide variability among countries and major gaps in service use. Results for use of health services were mixed, although our findings suggest that PLACI may have fewer physician visits than counterparts living with others. Our findings suggest that varying policies and budgets for these services among countries may have affected our findings. We encourage researchers to evaluate and compare the influence of social policies in the well-being of PLACI. We also encourage policy makers to prioritize the needs of PLACI in national dementia strategies.
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Affiliation(s)
- Amy Rosenwohl-Mack
- Department of Social and Behavioral Sciences, School of Nursing, University of California San Francisco, USA
| | - Leslie Dubbin
- Department of Social and Behavioral Sciences, School of Nursing, University of California San Francisco, USA
| | - Anna Chodos
- Division of Geriatrics, University of California San Francisco, USA
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, USA
| | - Sarah Dulaney
- Memory and Aging Center, University of California San Francisco, USA
| | - Min-Lin Fang
- Library, University of California San Francisco, USA
| | | | - Elena Portacolone
- Institute for Health & Aging, University of California San Francisco, USA
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Rosenwohl-Mack A, Schumacher K, Fang ML, Fukuoka Y. A new conceptual model of experiences of aging in place in the United States: Results of a systematic review and meta-ethnography of qualitative studies. Int J Nurs Stud 2019; 103:103496. [PMID: 31884333 DOI: 10.1016/j.ijnurstu.2019.103496] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The purpose of this systematic review was to synthesize the evidence on experiences of aging in place in the United States. DESIGN Systematic review and meta-ethnography of qualitative studies. DATA SOURCES We searched six bibliographic databases (PubMed, Embase, PsycINFO, CINAHL, Web of Science, Sociological Abstracts), with no limits on publication date. Eligible studies reported peer-reviewed qualitative research on experiences of aging in place in the United States with full-text available in English. REVIEW METHODS Three reviewers independently used Covidence software to screen titles and abstracts followed by full texts. We assessed quality and risk of bias using a modified version of the Joanna Briggs Institute Checklist for Qualitative Research. Qualitative data analysis was conducted using meta-ethnography, following Noblit and Hare's seven-step method of translation and synthesis to generate a novel conceptual model. RESULTS Of 2659 papers screened, 37 unique studies were eligible for inclusion, reported in 38 publications. The studies were conducted in 16 states and published between 1994 and 2018. The included samples represented 1199 participants in total, with mean ages ranging from 48 to 91 years. The gender of the samples ranged from 20% to 100% female, with a median of 77%. One-third of the included studies did not report participants' race/ethnicity, and half of the remaining study samples were at least 90% white; however, 20% of the studies focused exclusively on experiences of racial/ethnic minority older adults. Using meta-ethnography, we developed a new conceptual model of aging in place in the United States as a dynamic process of balancing threats and agency in relation to experiences of identity, connectedness, and place. We found that people aging in place were engaged in significant work to cope with unpredictable needs and challenges by changing their mindset, adapting their home environment to accommodate new needs, and finding different ways to connect with important people in their lives. Agency was shaped by resources and restrictions on choice, and where threats to aging in place outweighed an individual's sense of agency, the consequences included feelings of uncertainty, isolation, and dislocation. CONCLUSIONS To the best of our knowledge, this is the first systematic review of qualitative studies to evaluate experiences of aging in place in the United States. The findings of our meta-ethnographic synthesis led to the development of a new conceptual model of aging in place highlighting the dynamic tensions involved in balancing threats and agency.
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Affiliation(s)
- Amy Rosenwohl-Mack
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco (UCSF), 3333 California St, Suite 455, San Francisco, CA 94118, United States.
| | - Karen Schumacher
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, 2 Koret Way, N631, San Francisco CA 94143, United States.
| | - Min-Lin Fang
- Education and Research Services, UCSF Library, University of California, San Francisco, 530 Parnassus Ave, San Francisco, CA 94143, United States.
| | - Yoshimi Fukuoka
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, 2 Koret Way, N631, San Francisco CA 94143, United States.
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Rosenwohl-Mack A, Chodos A, Dulaney S, Fang ML, Merrilees J, Dubbin L, Portacolone E. USE OF SERVICES BY PEOPLE LIVING ALONE WITH COGNITIVE IMPAIRMENT: A SYSTEMATIC REVIEW. Innov Aging 2019. [PMCID: PMC6845436 DOI: 10.1093/geroni/igz038.3312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
At least one third of older adults with dementia live alone in the United States. Living alone may represent an opportunity to maintain independence and autonomy, while remaining in a familiar home environment. However, living alone with cognitive impairment is also associated with health risks and unmet needs. No systematic reviews on this population have been published. We systematically reviewed research on use of healthcare and long-term services and supports (LTSS) by people living alone with cognitive impairment. Following PRISMA guidelines, we searched six electronic databases for studies reporting quantitative findings on use of services by people living alone with cognitive impairment; 33 studies met inclusion criteria. Nine countries were represented, all high-income economies. Race/ethnicity data was reported in just five studies, and only one included a majority of racial/ethnic minorities. Overall, people living alone with cognitive impairment appear to use health services at similar or lower rates compared to those living with others; however, LTSS use is higher among people living alone. Representation of non-white participants was poor, but the evidence available suggests that among racial/ethnic minorities with cognitive impairment, there is no difference in LTSS use between those living alone and living with others. Findings highlight inconsistencies in access to and use of essential services by older adults living alone with cognitive impairment. As the populations of the US and other high-income countries become both older and more diverse, with increasing numbers living alone, researchers and service providers must consider the specific needs and preferences of this population.
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Affiliation(s)
- Amy Rosenwohl-Mack
- University of California, San Francisco, San Francisco, California, United States
| | - Anna Chodos
- University of California, San Francisco, San Francisco, California, United States
| | - Sarah Dulaney
- Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States
| | - Min-Lin Fang
- Education and Research Services, UCSF Library, University of California, San Francisco, San Francisco, California, United States
| | - Jennifer Merrilees
- Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States
| | - Leslie Dubbin
- Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, United States
| | - Elena Portacolone
- University of California, San Francisco, San Francisco, California, United States
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Rosenwohl-Mack A, Beld M, Greene M, Skultety K, Dubbin L, Deutsch MB, Flatt JD. BUILDING H.O.U.S.E. (HEALTHY OUTCOMES USING A SUPPORTIVE ENVIRONMENT) FOR LGBTQ OLDER ADULTS. Innov Aging 2019. [PMCID: PMC6845445 DOI: 10.1093/geroni/igz038.3528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults face unique challenges in finding affordable, inclusive, and supportive housing. These challenges may be due to discrimination, income disparities, and higher rates of health problems compared to cisgender heterosexual seniors. To our knowledge, this is the first longitudinal study of the health and wellbeing of older adults who move into LGBTQ-welcoming, affordable senior housing. Participants completed a brief baseline survey at the time of their housing lottery application. Questions focused on physical, psychological, and social health and current health service use. We calculated descriptive statistics on health status at baseline. 184 participants completed the baseline survey, mean age was 68 years (SD 5.2), and nearly 75% reported an annual income under $30,000. Almost half reported a diagnosis of hypertension, 40% depression, 27% anxiety, and 25% HIV/AIDS. Around 70% reported their health as good to excellent, 21% fair, and 9% poor or very poor. However, 58% reported their physical activities were at least somewhat limited by their physical health, 43% reported difficulties with balance or walking, and 32% reported memory problems. Nearly 3% had been admitted into the hospital and 10% had visited the emergency room in the past 30 days. In terms of social wellbeing, 63% felt isolated from others at least some of the time. In summary, LGBTQ older adults seeking affordable senior housing report relatively good health, although they also experience functional and social difficulties. New forms of housing that are explicitly LGBTQ-welcoming may help address these health challenges.
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Affiliation(s)
- Amy Rosenwohl-Mack
- University of California, San Francisco, San Francisco, California, United States
| | - Matt Beld
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, San Francisco, California, United States
| | - Meredith Greene
- School of Medicine, University of California, San Francisco, San Francisco, California, United States
| | | | - Leslie Dubbin
- Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, United States
| | - Madeline B Deutsch
- Center of Excellence for Transgender Health, University of California, San Francisco, San Francisco, California, United States
| | - Jason D Flatt
- University of California, San Francisco, San Francisco, California, United States
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Rosenwohl-Mack A, Schumacher K, Fang ML, Fukuoka Y. Experiences of aging in place in the United States: protocol for a systematic review and meta-ethnography of qualitative studies. Syst Rev 2018; 7:155. [PMID: 30292236 PMCID: PMC6173904 DOI: 10.1186/s13643-018-0820-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND By 2035, older adults will outnumber children for the first time in the United States (US). In light of its aging population, the US has supported services focused on enabling older adults to continue living in their current homes, a model commonly described as "aging in place." The lived experience of aging in place is not well documented in existing systematic reviews. The aims of this systematic review are to synthesize and evaluate the existing qualitative evidence on experiences of aging in place in the US and identify knowledge gaps and directions for future studies. METHODS Six electronic bibliographic databases (PubMed, PsycINFO, CINAHL, Web of Science, EMBASE, and Sociological Abstracts) will be searched. Studies presenting qualitative data on the experiences of older adults currently aging in place in the US will be included. Covidence software will be used to screen studies and extract data. The Joanna Briggs Institute checklist for qualitative research will be used to assess quality and risk of bias of included studies. We will use meta-ethnography, following the method described by Noblit and Hare, to synthesize and evaluate the results of the included studies. DISCUSSION To the best of our knowledge, this is the first systematic review to integrate and synthesize the findings of qualitative studies of aging in place focusing on older adults in the US. The findings of this review will provide in-depth knowledge on lived experiences of aging in place and address important gaps in existing work. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO): CRD42018102847.
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Affiliation(s)
- Amy Rosenwohl-Mack
- Department of Social & Behavioral Sciences, School of Nursing, University of California, San Francisco (UCSF), CA USA
| | - Karen Schumacher
- Department of Physiological Nursing, School of Nursing, UCSF, CA, USA
| | - Min-Lin Fang
- Education and Research Services, UCSF Library, UCSF, CA, USA
| | - Yoshimi Fukuoka
- Department of Physiological Nursing, School of Nursing, UCSF, CA, USA
- Institute for Health & Aging, School of Nursing, UCSF, CA, USA
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