A culturally and linguistically tailored Community-Engaged Dementia Education Program (CEDEP) for the Houston Vietnamese American community

Data from the Vietnamese Aging and Care Survey (VACS) showed the high prevalence of disability, depressive symptoms, and cognitive impairment in older Vietnamese immigrants and refugees. We proposed a Community-Engaged Dementia Education Program to examine the Houston Vietnamese American community's literacy on dementia and develop a one-pager educational material. This is a cross-sectional, qualitative study (interviews and focus groups) using the Cultural Exchange Model as a conceptual framework. We interviewed fourteen Vietnamese key informants and assessed the community's knowledge of dementia based on Edwards' 9-stage Community Readiness Model. The community's low literacy on dementia (Stages 2-3: Denial/resistance to vague awareness) was revealed. Approaches to introducing dementia conversations to the community and what to include in the one-pager were discussed. Based on the key informants' insight, we developed a dementia one-pager tailored to the community by using lay language with a representative image of the target population, indicating warning signs of dementia, and encouraging them to see their doctors for cognitive check-ups. The plan for the next steps includes utilizing the local ethnic media, collaborating with the existing pillars of the Cultural Exchange model, leveraging the university students' learning opportunities, and disseminating the culturally and linguistically tailored one-pager.

Multiple Chronic Conditions and Disability among Vietnamese Older Adults: Results from the Vietnamese Aging and Care Survey (VACS)

Using data from Vietnamese-origin older immigrants/refugees in the Houston, Texas area, we assessed their overall health, chronic conditions, disability, depressive symptoms, and cognitive impairment, and examined the association between their chronic conditions and disability by comorbidity clusters. The mean age of the sample was 76 years old. The majority were married in fair/poor health with several chronic conditions and disabilities and lived with families in low-income households. Hypertension and arthritis were the most common health conditions, but cognitive impairment had the most significant impact on their disability. They experienced similar health conditions to other older Americans but had higher rates of depressive symptoms and cognitive impairment possibly due to cultural factors that may have delayed mental health treatment. Culturally and linguistically tailored services created by policymakers, healthcare professionals, and local social service agencies are recommended for the well-being of immigrants/refugees who migrated to the U.S. for a better life.

Characteristics of Asian American Family Caregivers of Older Adults Compared to Caregivers of Other Racial/Ethnic Groups: Behavioral Risk Factor Surveillance System 2015-2020

Asian Americans (AAs) are the fastest-growing racial/ethnic minority group in the United States. While otherwise highly heterogeneous, AAs overall value filial piety and eldercare. This study compared the health and caregiving experiences of AA caregivers of older adults to AA non-caregivers and caregivers of older adults across racial/ethnic groups. We used 2015-2020 Behavioral Risk Factor Surveillance System data for 315 AA caregivers and 3822 AA non-caregivers, plus 395 American Indian/Alaska Native, 1883 Black, 1292 Hispanic, and 20,321 non-Hispanic White caregivers. Among AAs, 4.3% were caregivers, a lower proportion than in other racial/ethnic groups. Most AA caregivers were female (59%), married (71%), in excellent/very good/good health (76%), and with at least one chronic health condition (66%). Other than relationship to care recipients, caregivers' experiences were similar across racial/ethnic groups: most cared for <20 hours/week and provided household and personal care. Efforts to support AA caregivers should be attentive to cultural practices.

Feasibility and Efficacy of Life Review Delivered by Virtually-Trained Family Caregivers

BACKGROUND

Due to the high prevalence of depressive symptoms and Alzheimer's disease and related dementias in older Americans (≥65 years), we developed a six-week depression intervention, Caregiver-Provided Life Review (C-PLR) for care recipients (CRs) with early-stage dementia and mild depression.

OBJECTIVE

The objective of the study was to examine the feasibility and efficacy of C-PLR delivered by virtually-trained caregivers (CGs) on CRs who live with dementia and depression in community and long-term care settings (N = 25 CG-CR dyads).

METHODS

We used fidelity scores as a measure of CG's feasibility to provide C-PLR. We collected the pre- and post-measures on CRs' depression (primary outcome), life satisfaction, CGs' burden, positive aspects of caregiving, and CG-CR relationship quality (secondary outcomes) and compared them using paired t-tests. We evaluated if the effect differed by race/ethnicity, residential setting, or living alone.

RESULTS

The average fidelity check-in score was 14.8±0.78 indicating high feasibility. CGs were 52 years old (mean), 88% female, 64% working, 72% college-educated, and 72% in good-excellent health. CRs were 81 years old (mean), 84% female, and 56% in poor-fair health. CRs' depression significantly improved (p < 0.001), and this effect was found in CRs who were Asian (p = 0.017), White (p = 0.040), community-dwelling (p < 0.001), lived alone (p = 0.045), or with others (p = 0.002).

CONCLUSION

This study demonstrated that the C-PLR can be successfully taught to CGs virtually and is effective in reducing CR's depressive symptoms. C-PLR could be implemented more broadly to improve symptoms among CRs in community and residential settings, as well as among a diverse population of CRs.

The bidirectional relationship between homebound status and falls among older adults: a longitudinal study

BACKGROUND

Previous research has shown an association between homebound status and falls among older adults. However, this association was primarily drawn from cross-sectional studies. This study aimed to determine the bidirectional relationship between homebound status and falls among older adults in the community.

METHODS

We used data of the community-dwelling older adults from 2011 to 2015 of the National Health and Aging Trends Study, a nationally representative survey of Medicare Beneficiaries in the United States (Sample 1 [No falls at baseline]: N = 2,512; Sample 2 [Non-homebound at baseline]: N = 2,916). Homebound status was determined by the frequency, difficulty, and needing help for outdoor mobility. Falls were ascertained by asking participants whether they had a fall in the last year. Generalized estimation equation models were used to examine the bidirectional association between homebound status and falls longitudinally.

RESULTS

Participants with no falls at baseline (n = 2,512) were on average, 76.8 years old, non-Hispanic whites (70.1%), and female (57.1%). After adjusting for demographics and health-related variables, prior year homebound status significantly contributed to falls in the following year (Odds ratio [OR], 1.28, 95% CI: 1.09-1.51). Participants who were non-homebound at baseline (n = 2,916) were on average, 75.7 years old, non-Hispanic white (74.8%), and female (55.8%). Previous falls significantly predicted later homebound status (OR, 1.26, 95% CI: 1.10-1.45) in the full adjusted model.

CONCLUSION

This is the first longitudinal study to determine the bidirectional association between homebound status and falls. Homebound status and falls form a vicious circle and mutually reinforce each other over time. Our findings suggest the importance of developing programs and community activities that reduce falls and improve homebound status among older adults.

Feasibility Study of Caregiver-Provided Life Review: Implementation, Adaptation, and Effects on Care Recipients' Depressive Symptoms

OBJECTIVES

This study aimed to examine the feasibility of unpaid, family/friend caregivers conducting life reviews with people with dementia in long-term care and community settings and reported on how we adapted the intervention modality under the COVID-19 pandemic.

METHODS

Twenty-one caregiver-care recipient dyads completed 6 weekly life review sessions. The intervention format was modified to accommodate COVID-19 restrictions. Primary and secondary outcome measures were analyzed based on repeated measures at baseline and post-intervention.

RESULTS

Due to the changing nature of the pandemic, we iterated the caregiver training intervention four times to accommodate caregivers' needs while having faced multiple recruitment challenges with care facility residents. Care recipients' depression appeared to have improved (p = .001).

CONCLUSIONS

Although the COVID-19 pandemic created unique recruitment challenges, all the care recipients seemed to enjoy the life review activities supported by the positive outcomes in gaining socialization opportunities. It may be beneficial to offer a more self-paced intervention modality to ease the burden on caregivers.

CLINICAL IMPLICATIONS

It appears that unpaid family/friend caregivers can provide life reviews to their loved ones with dementia. Training the caregivers on how to provide life reviews can be an easy, low-risk activity that might ameliorate depressive symptoms in the care recipients.

Mediating role of homebound status between depressive symptoms and cognitive impairment among community-dwelling older adults in the USA: a cross-sectional analysis of a cohort study

OBJECTIVE

Depressive symptoms are known modifiable factors of cognitive impairment in older adults. However, the pathway through which depressive symptoms lead to cognitive impairment is not well understood. This study aimed to investigate whether homebound status (defined as usually unable to leave home unassisted) mediates the association between depressive symptoms and cognitive impairment in community-dwelling older adults in the USA.

DESIGN

A secondary analysis of cross-sectional data.

SETTINGS

Communities in the USA.

PARTICIPANTS

Community-dwelling older adults (N=7537) from the 2011 National Health and Aging Trends Study, a nationally representative survey of Medicare Beneficiaries in the USA.

MAIN OUTCOME MEASURES

Participants' cognitive impairment status was classified using a composite measure. Depressive symptoms were assessed using Patient Health Questionnaire-2. Homebound status was determined by the frequency, difficulty and needing help in getting outdoors. We used logistic regression and the Paramed command in STATA to analyse whether homebound mediated the association between depressive symptoms and cognitive impairment.

RESULTS

Participants were on average, 77.7 years old, female (58.3%) and non-Hispanic white (68.1%). About 26% of the participants were classified as having cognitive impairment, 16% reported depressive symptoms and 25% were homebound. Depressive symptoms (adjusted OR, 1.60; 95% CI 1.36 to 1.89) and homebound status (adjusted OR, 1.58; 95% CI 1.34 to 1.86) were independently associated with cognitive impairment. Homebound significantly mediated 12.5% of the total effect between depressive symptoms and cognitive impairment, with significant indirect effect (OR, 1.07; 95% CI 1.04 to 1.10), direct effect (OR, 1.61; 95% CI 1.36 to 1.91) and total effect (OR, 1.72; 95% CI 1.46 to 2.03).

CONCLUSIONS

This study supports a mediating role of homebound status in the relationship between depressive symptoms and cognitive impairment. Interventions to promote outdoor mobility should be studied for their ability to delay cognitive impairment for older adults with depressive symptoms.

Recruitment and Data Collection Challenges of Research Focused on Older Adults and Family Caregivers from Asian American Communities: A Case Study Series

OBJECTIVES

The purpose of this case study series was to present recruitment and data collection strategies used for Asian American ethnic groups by documenting challenges experienced by researchers in the field of aging.

SUMMARY

We compiled four case studies investigating Asian American older adults and/or family caregivers (i.e., Vietnamese, South Asians, Chinese, and Koreans). Each case study employed unique research methods to overcome experienced challenges associated with recruitment and data collection.

DISCUSSION

Three constructs were organized for effective recruitment and data collection strategies of this racial group and included (1) forming a bilingual and bicultural research team (research-centered); (2) establishing reciprocal partnerships between researchers and community partners (community-centered); and (3) understanding the historical and cultural backgrounds of targeted ethnic groups (participant-centered). Approaches taken to address the range of challenges and limitations identified in this case study series may also help increase the representation of Asian-American older adults and family caregivers in research.

CLINICAL IMPLICATIONS

Successfully including racial and ethnic minority groups in research, especially Asian Americans, may reduce existing racial disparities in mental and physical health. Any barriers and facilitators affecting the research regarding Asian American ethnic groups should continue to be discussed.

Health of Vietnamese Older Adults and Caregiver's Psychological Status in the United States: Result from the Vietnamese Aging and Care Survey

Objective: We examined the association between care recipient's physical, mental, and cognitive health conditions and caregivers' psychological distress in Vietnamese older care recipients and their caregivers.Methods: The Vietnamese Aging and Care Survey was developed for care recipients, and adult-child and spousal caregivers, and inquired about their sociodemographics and health-related variables.Results: Data were collected on 58 caregiver-care recipient dyads. Adult-child and spousal caregivers were on average 43 and 70 years-old respectively. The vast majority were female (76%) and born in Vietnam (97%). Adult-child caregivers reported more caregiver burden than spousal caregivers. Care recipients were on average 75 years-old. Care recipients of adult-child caregivers reported more depressive symptoms than care recipients of spousal caregivers and were more likely to have mild dementia. Care recipients' health had no effect on caregiver depressive symptoms but their educational attainment was associated with caregiver burden and depressive symptoms.Conclusions: This study showed care recipients and caregivers' years of education were positively associated with caregivers' psychological distress. Vietnamese families lived in ethnic enclaves and shared caregiving responsibilities within the family. However, using available outside resources may alleviate psychological distress of not only caregivers but also families as a whole.Clinical Implications: Healthcare professionals should encourage educated caregivers and educated care recipients to use outside resources to ease caregiving duties.

Symptoms of anxiety and depression predicting fall-related outcomes among older Americans: a longitudinal study

Background

Anxiety and depressive symptoms are associated with fear of falling and fear of falling-related activity restrictions. However, it remains unknown whether anxiety or depressive symptoms alone could predict fear of falling and activity restrictions in older adults. We sought to determine if anxiety and depressive symptoms alone could be an independent predictor of fear of falling and activity restrictions in community-dwelling older adults.

Methods

This longitudinal analysis used waves 5 (time 1, [T1]) and 6 (time 2, [T2], 1 year from T1) data (N = 6376) from the National Health and Aging Trends Study. The Generalized Anxiety Disorder Scale 2 and Patient Health Questionnaire 2 were used to assess anxiety and depressive symptoms, respectively. Interview questions included demographics, health-related data, and fall worry levels (no fear of falling, fear of falling but no activity restrictions, and activity restrictions). Using multinomial logistic regression models, we examined whether anxiety and depressive symptoms (T1) predicted fear of falling and activity restrictions (T2).

Results

In wave 5 (T1, mean age: 78 years, 58.1% female), 10 and 13% of participants reported anxiety and depressive symptoms. About 19% of participants experienced fear of falling but not activity restrictions, and 10% of participants developed activity restrictions in wave 6 (T2), respectively. Participants with anxiety symptoms at T1 had a 1.33 times higher risk of fear of falling (95% CI = 1.02–1.72) and 1.41 times higher risk of activity restrictions (95% CI = 1.04–1.90) at T2. However, having depressive symptoms did not show any significance after adjusting for anxiety symptoms.

Conclusions

Anxiety symptoms seemed to be an independent risk factor for future fear of falling and activity restrictions, while depressive symptoms were not. To prevent future fear of falling and activity restrictions, we should pay special attention to older individuals with anxiety symptoms.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03406-8.

Association between caregivers' characteristics and older care recipients' well-being among Vietnamese immigrant families in the United States

AIMS

We examined the association between caregivers' psychological status and their older family members' (care recipients) mental health in the Vietnamese American community (N = 58 dyads).

METHODS

Logistic regression models were used.

RESULTS

Caregivers and care recipients were on average 53 and 75 years old, immigrated at ages 32 and 51, and had 10 and 6 years of formal education, respectively. Approximately two-thirds of caregivers provided care for 20+ h/week for 7 years with the majority of care recipients reporting fair or poor health. Care recipients' physical and cognitive health had a significant association with their depressive symptoms. However, care recipients acting as burdened caregivers' "company" helped themselves and felt less depressed (OR = 0.89, 95% CI: 0.80, 0.99).

CONCLUSION

Leveraging the tradition of Vietnamese multigeneration households, we should promote being a good company to each other that will help the caregiver-care recipient dyad, as well as their family unit when planning future interventions.

Longitudinal association between personality traits and homebound status in older adults: results from the National Health and Aging Trends Study

Background

Personality is associated with predictors of homebound status like frailty, incident falls, mobility, and depression. However, the relationship between personality traits and homebound status is unclear. This study aims to examine the longitudinal association between personality traits and homebound status among older adults.

Methods

Using data of non-homebound community-dwelling adults aged 65 years and older in the 2013 and 2014 waves (baseline) of the National Health and Aging Trends Study (N = 1538), this study examined the association between personality traits and homebound status. Homebound status (non-homebound, semi-homebound, and homebound) was determined by the frequency of going outside, difficulty in going outside, and whether there was help when going outside. Personality traits, including conscientiousness, extraversion, neuroticism, openness, and agreeableness were assessed using the 10-item Midlife Development Inventory on a rating scale from 1 (not at all) to 4 (a lot). Ordered logistic regression models were used to examine whether personality traits predicted homebound status in later 3 years with and without adjusting covariates.

Results

The sample was on average 77.0 ± 6.70 years old, and 55% were female. The majority were non-Hispanic whites (76%), and received some college or vocational school education or higher (55%). Homebound participants tended to be less educated older females. Three years later, 42 of 1538 baseline-non-homebound participants (3%) became homebound, and 195 participants (13%) became semi-homebound. Among these five personality traits, high conscientiousness (adjusted odds ratio [OR] = 0.73, p < 0.01) was associated with a low likelihood of becoming homebound after adjusting demographic and health-related covariates.

Conclusions

These findings provided a basis for personality assessment to identify and prevent individuals from becoming homebound.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02771-8.

Unmet needs for assistance related to subjective cognitive decline among community-dwelling middle-aged and older adults in the US: prevalence and impact on health-related quality of life

OBJECTIVES

To estimate the prevalence of unmet needs for assistance among middle-aged and older adults with subjective cognitive decline (SCD) in the US and to evaluate whether unmet needs were associated with health-related quality of life (HRQOL).

DESIGN

Cross-sectional.

SETTING

US - 50 states, District of Columbia, and Puerto Rico.

PARTICIPANTS

Community-dwelling adults aged 45 years and older who completed the Cognitive Decline module on the 2015--2018 Behavioral Risk Factor Surveillance System reported experiencing SCD and always, usually, or sometimes needed assistance with day-to-day activities because of SCD (n = 6,568).

MEASUREMENTS

We defined SCD as confusion or memory loss that was happening more often or getting worse over the past 12 months. Respondents with SCD were considered to have an unmet need for assistance if they sometimes, rarely, or never got the help they needed with day-to-day activities. We measured three domains of HRQOL: (1) mental (frequent mental distress, ≥14 days of poor mental health in the past 30 days), (2) physical (frequent physical distress, ≥14 days of poor physical health in the past 30 days), and (3) social (SCD always, usually, or sometimes interfered with the ability to work, volunteer, or engage in social activities outside the home). We used log-binomial regression models to estimate prevalence ratios (PRs). All estimates were weighted.

RESULTS

In total, 40.2% of people who needed SCD-related assistance reported an unmet need. Among respondents without depression, an unmet need was associated with a higher prevalence of frequent mental distress (PR = 1.55, 95% CI: 1.12-2.13, p = 0.007). Frequent physical distress and social limitations did not differ between people with met and unmet needs.

CONCLUSIONS

Middle-aged and older adults with SCD-related needs for assistance frequently did not have those needs met, which could negatively impact their mental health. Interventions to identify and meet the unmet needs among people with SCD may improve HRQOL.

Bidirectional relationship between subjective age and frailty: a prospective cohort study

Background

Subjective age refers to how young or old individuals experience themselves to be and is associated with health status, behavioral, cognitive, and biological processes that influence frailty. However, little research has examined the relationship between subjective age and frailty among older adults. This study examined the bidirectional association between subjective age and frailty among community-dwelling older adults.

Methods

We used data from the 2011 to 2015 waves of the National Health and Aging Trends Study. Our sample consists of 2,592 community-dwelling older adults with complete data on main outcome variables. Subjective age was measured by asking participants, “What age do you feel most of the time?” Based on the five phenotypic criteria: exhaustion, unintentional weight loss, low physical activity, slow gait, and weak grip strength, frailty was categorized into robust = 0, pre-frailty = 1 or 2; frailty = 3 or more criteria met. Generalized estimating equation models were used to examine the concurrent and lagged association between subjective age and frailty.

Results

Participants were, on average, 75.2 ± 6.8 years old, non-Hispanic whites (76 %), female (58 %). 77 % of the participants felt younger, 18 % felt the same, and 5 % felt older than their chronological age. About 45 %, 46 %, and 9 % of the participants were robust, pre-frailty and frailty in the first wave, respectively. Generalized estimating equations revealed that an “older” subjective age predicted a higher likelihood of pre-frailty and frailty (OR, 95 % CI = 1.93, 1.45–2.56).

Conclusions

These findings suggest that people with older subjective age are more likely to be pre-frail/frail. Subjective age could be used as a quick and economical screening for those who are potentially frailty or at risk for frailty.

The Association Between Personality and Homebound Status in Older Adults: Results From the NHATS

Personality is associated with predictors of homebound status like frailty, incident falls, and depression. It has been rarely investigated whether personality predicts homebound status among older adults. Using the combining cross-sectional data of the Year 2013 and Year 2014 data from the National Health and Aging Trends Study (NHATS), this study examined the association between personality traits and homebound status in a sample of community-dwelling older adults aged 65 years and older (N=2,788). Homebound status (non-homebound, semi-homebound, and homebound) was determined by the frequency, difficulty, and help of outdoor mobility. Personality traits, including conscientiousness, agreeableness, openness, extraversion, and neuroticism were assessed using the 10-item Midlife Development Inventory on a rating scale from 1 (not at all) to 4 (a lot). Each personality trait was included as a predictor in an ordinal logistic regression model to examine its association with homebound status after adjusting demographic and health-related covariates. The sample was on average 79±7.53 years old, non-Hispanic White (72.0%), female (58.6%), living alone (35.4%) or with spouse/partner only (37.4%). Seventy-four percent, 18%, and 8% of participants were non-homebound, semi-homebound, and homebound, respectively. Homebound participants tended to be less-educated older females. The average scores of conscientiousness, agreeableness, openness, extraversion, and neuroticism were 3.19±0.75, 3.57±0.56, 2.81±0.83, 3.13±0.75, and 2.22±0.86, respectively. Among these five personality traits, high conscientiousness (OR=1.34, p<0.001) and extraversion (OR=1.16, p=.03) were associated with a reduced likelihood of being homebound. These findings provided a basis for potential personality assessment to identify and protect individuals with high homebound risk.

Favorite Activity Patterns Among Older Adults With and Without Dementia: Findings From the NHATS

Favorite activities are usually meaningful and valuable to older adults. However, information on favorite activity patterns and their relationship with cognitive function from large samples is still limited. Using Round 1 data from the National Health and Aging Trends Study, we examined favorite activity patterns among community-dwelling older adults with and without dementia (N=6,565). Based on the 8-item Ascertain Dementia (AD8) dementia screening interview, participants were classified into no dementia, possible dementia, and probable dementia. Favorite activity was assessed by asking participants, “What their favorite activity they are currently able to do?” Multinomial logistic regression models were used to examine the association between each of the top three favorite activities and the cognitive impairment categories, controlling for demographics and general health. The sample was on average, 77±7.45 years old, non-Hispanic White (69.8%), female (57.3%), and 35.0% had high school education. The three most popular favorite activities among probable dementia participants were watching TV, walking, and outdoor maintenance. Participants who liked watching TV most were more likely associated with possible dementia (Relative Risk Ratio [RRR] = 1.49, p=0.044) compared to participants without favorite activities. Participants who liked walking most were less associated with possible dementia (RRR=0.58, p=0.003) and probable dementia (RRR=0.39, p<0.001) compared to those without favorite activities. Similarly, participants who liked outdoor maintenance most were less likely to develop possible dementia (RRR=0.48, p<0.001) and probable dementia (RRR=0.27, p<0.001) than participants without favorite activities. Researchers may use older adults’ “active” favorite activities to create tailored interventions to slow dementia progression.

Bidirectional Relationship Between Subjective Age and Fear of Falling: Findings From the NHATS

Subjective age refers to how young or old people experience themselves to be. It is associated with health status, physical function, and mental processes that influence the occurrence of fear of falling, which is a severe problem in older adults. The present study aims to contribute to existing knowledge by examining the relationships between subjective age and fear of falling. Participants were community-dwelling adults aged 65 years and older drawn from the 2011 (T1) - 2015 (T5) waves of the National Health and Aging Trends Study. Subjective age was measured by asking, “What age do you feel most of the time?” Fear of falling was measured with the question: “In the last month, did you worry about falling down?” The analyses included 1,984 participants without fear of falling at baseline, on average, 74.9±6.6 years old, female (53%), and non-Hispanic whites (76%). Eighty percent of the participants felt younger, and 4% felt older than their chronological age, but 21% of them had a fear of falling. Participants who experienced fear of falling at T5 tended to be female, non-Hispanic whites, and live alone. Generalized estimating equations revealed that an “older” subjective age independently predicted fear of falling (OR, 95%CI= 1.02, 1.01-1.02) controlling for demographics and health conditions. Fear of falling predicted an “older” subjective age (OR, 95%CI= 3.38, 1.72-6.66) after adjustment. These findings indicated bidirectional relationships between subjective age and fear of falling. Subjective age may help identify individuals who are at risk for fear of falling in older adults.

Baby Boomers as Caregivers: Results From the Behavioral Risk Factor Surveillance System in 44 States, the District of Columbia, and Puerto Rico, 2015-2017

INTRODUCTION

Baby boomers, people born from 1946 through 1964, represent a substantial portion of the US population. Generally, baby boomers have more chronic disease and disability than those in the previous generation. Frequently, they also provide informal care to others. The objective of our study was to estimate the prevalence of informal caregiving among baby boomers and compare the health of baby boomer caregivers and noncaregivers.

METHODS

Using data from the Behavioral Risk Factor Surveillance System (2015-2017) for 44 states, the District of Columbia, and Puerto Rico, we classified 109,268 baby boomers as caregivers or noncaregivers and compared their general health (poor or fair vs good, very good, or excellent), chronic health conditions, and frequent mental distress (FMD). FMD was defined as 14 days or more of poor mental health in the past month. We used log-binomial regression to calculate prevalence ratios, adjusted for age and sex (aPRs), and to separately estimate aPRs for fair or poor health and FMD or at least one chronic health condition.

RESULTS

One in 4 baby boomers (24.2%) were caregivers. In adjusted models, male caregivers had a higher prevalence of fair to poor health than noncaregivers (aPR = 1.17; 95% confidence interval [CI], 1.06-1.29; P = .001). More caregivers than noncaregivers had at least 1 chronic health condition (aPR = 1.10, 95% CI, 1.07-1.13; P < .001) and more often had FMD (aPR = 1.39; 95% CI, 1.26-1.53; P < .001).

CONCLUSION

Our study showed these caregivers had more chronic health conditions and more often had FMD than noncaregivers. The health of baby boomer caregivers is a public health priority, as these caregivers might need support to maintain their own physical and mental health.

Terms and Measures of Cognitive Health Associated With Dementia and Alzheimer's Disease: A Scoping Review

The Healthy Brain Initiative: National Public Health Road Map to Maintaining Cognitive Health (2007) called on the research community to disseminate its work on cognitive aging and cognitive health. The purpose of this scoping review was to (1) identify terminology that cognitive, social, and behavioral scientists use to describe cognitive aging and cognitive health, in association with dementia and Alzheimer's disease, among older adults; (2) demonstrate how such terms are defined; and (3) illustrate how these constructs are measured in research settings. Empirical studies published 2007-2018 were examined for terminology, definitions, disciplinary orientation, and measurement mechanisms. Analysis of the corpus and a detailed review of the terms "cognitive impairment" and "mild cognitive impairment" reveal that formal definitions are provided infrequently and measurement of constructs ranges widely. Overall, the variability in terminology, definitions, and measures reflects a need for greater specificity in research communication, such that cross-disciplinary collaboration can be facilitated.

Can Family Caregivers Provide Life Review to Reduce Depression in Older Adults With Dementia?

Life review (LR) therapy has received considerable support as an effective treatment for depression among older adults. Researchers believe that providing LR does not require extensive training and can be done by family members who are not psychiatric professionals. If so, then training family caregivers to provide LR is a potential strategy for alleviating the shortage of resources for treating depression among the growing population of older adults experiencing depression. A pilot study that explored the feasibility of that strategy had mixed results. Seventeen (89%) of 19 caregiver-care recipient dyads completed the current study, and caregivers provided the LR with self-reported fidelity. However, there was lack of statistically significant improvement in this convenience sample. Implications are provided for future assessments of this strategy with a larger study of caregiver and care recipient dyads. [Journal of Gerontological Nursing, 46(2), 41-48.].

Vietnamese Adult-Child and Spousal Caregivers of Older Adults in Houston, Texas: Results from the Vietnamese Aging and Care Survey (VACS)

Vietnamese are the largest Asian ethnic group in Houston, Texas; however, research on this population is scarce. To address this dearth of knowledge, we developed the Vietnamese Aging and Care Survey. The objective of the study was to explore the sociodemographic and health characteristics of Vietnamese adults aged 65 years and older (n = 132) and their family caregivers (n = 64). Adult-child caregivers (n = 41) were aged between 21 and 65 years old. The majority were married, working, female, and in good to excellent health. Spousal caregivers (n = 23) were between 57 and 82 years old, retired, female, and in fair to good health. Adult children received more caregiving-related help from others compared to spousal caregivers; however, they felt more caregiver burden, had more perceived stress, and were in challenging relationships with care recipients. Differences in life stages of adult-child versus spousal caregivers may contribute to these results. Implications are discussed.

"It May Be a Bit Uncertain But It's Never Boring": Thematic Analysis of a Blog About Engaging With Aging

Online blogs about healthy aging written by health care professionals and others are increasing. The purpose of the current study was to analyze a first-person narrative blog about engaging with aging (EWA), with a goal of better understanding the process used to manage daily life and inform healthy aging for older adults. Using a thematic analysis approach, 67 blog posts written by a nonagenarian, retired nursing professor were analyzed. Emergent themes revealed the identification of age-related changes (e.g., physical, cognitive, functional, social, societal, psychological), characteristics of the age-related changes process, responses to age-related changes (e.g., feelings, attitudes), approaches and strategies to addressing age-related changes (i.e., the use of internal and external resources), and the outcomes of the approaches. The EWA blog posts help understand the aging experience from the perspective of an older adult, especially functional changes and how they affect daily life, as well as strategies used to adapt to changes. [Journal of Gerontological Nursing, 45(12), 21-27.].

HEALTH STATUS OF OLDER VIETNAMESE REFUGEES: RESULTS FROM THE VIETNAMESE AGING AND CARE SURVEY (VACS)

Over 1.3 million Vietnamese including refugees migrated to the U.S., after the Vietnam War. Vietnamese are the 4th largest Asian ethnic group in the U.S. Despite the number, little is known about their health conditions. To fill this gap, the Vietnamese Aging and Care Survey (VACS) was developed, and sociodemographic and health data on 132 refugees (≥65 years) were collected in Houston, Texas. They were on average 75.4 years-old, retired (77%), married (58%), female (55%) with less than high school education (86%) in poor/fair health (76%). They immigrated around age 49 years-old, and have hypertension (74%), arthritis (48%), and diabetes (41%). They manage their lives by living in a multi-generation tightly-knit enclaves, and show resilience to their low sociodemographic status (≤25K, 94%). Findings suggest healthcare professionals to introduce more social services such as adult daycare programs in culturally-sensitive ways to ease their transition to new lives in the U.S.

TERMS AND MEASURES OF COGNITIVE AGING AND COGNITIVE HEALTH: A SCOPING REVIEW

The Healthy Brain Initiative: National Public Health Road Map to Maintaining Cognitive Health (2007) called on the research community to more widely disseminate its work on cognitive aging and cognitive health. However, communication beyond individual disciplines is complex. We identified terminology that social scientists use to describe cognitive aging and cognitive health among older adults, demonstrated how such terms are defined, and illustrated how these constructs are being measured. We searched terms such as Alzheimer* and dementia in studies between 2007 and 2018 (n=209). Geriatrics (n=95), neurology (n=81), psychiatry (n=65), and psychology (n=30) were most common disciplines; however, there was no consistency in how terms were used within and across disciplines. A detailed review of “cognitive impairment” and “mild cognitive impairment” demonstrated that formal definitions were provided infrequently and measurement of constructs ranged widely. The variability in terminology, definitions and measures reflects a need for greater specificity in research communication.

Gender differences in cognitive impairment among the old and the oldest-old in China

AIM

To examine gender differences in the prevalence of cognitive impairment across two age cohorts in China: the old (aged 65-79 years) and the oldest-old (aged 80-116 years).

METHODS

The Chinese Longitudinal Healthy Longevity Survey with waves from 2008 to 2011 was used (N = 13 586). Regression analysis was used to model the gender effects on baseline cognitive function and onset of cognitive impairment. Independent variables included demographics, socioeconomic status (SES), social network, leisure activities and functional disabilities.

RESULTS

Among the oldest-old, women (32.9%) were twice as likely as men (15.7%) to have cognitive impairment. For the old, women (2.2%) were only slightly more likely than men (1.9%). Regression models showed the oldest-old women having a significantly higher risk of cognitive impairment than men (P < 0.001), even after adjusting for independent variables. No significant gender differences were found among the old cohort. SES, social network and leisure activities appeared to affect gender differences, especially among the oldest-old. Of the independent variables examined, the gender effects were reduced the most when incorporating SES for both age cohorts.

CONCLUSIONS

For the oldest-old, gender differences in cognitive impairment could be due to differences in SES between men and women. The old cohort showed no statistically significant gender difference at this time; however, we should follow this old cohort for their future potential gender differences in the prevalence of cognitive impairment. Geriatr Gerontol Int 2019; 19: 586-592.

Benchmarks for Evaluating Life Review and Reminiscence Therapy in Alleviating Depression among Older Adults

The efficacy of reminiscence and life review (LR) therapy in alleviating depression among older adults is well established. However, providers in nonresearch settings might implement these interventions inadequately, and such settings rarely can evaluate their outcomes using control groups. Alternatively, evaluators in such settings can calculate a within-group effect size and then compare it with average within-group effect size benchmarks derived from the randomized clinical trials (RCTs) supporting the intervention's effectiveness. This study developed these within-group effect size benchmarks. A search of RCTs from five systematic reviews and meta-analyses, and more recent RCTs published through 2016, yielded 25 studies that met inclusion criteria. Hedge's g for LR recipients and waitlist controls were .598 and -.20, respectively, and .568 and -.012 for reminiscence theory. These benchmarks offer an approach for evaluating the implementation of LR and reminiscence therapy when control groups are infeasible.

Acceptability of Fitbit for physical activity tracking within clinical care among men with prostate cancer

Prior research has not examined the acceptability of commercially available fitness tracking devices in men with prostate cancer, many of whom are at risk for conditions that physical activity could alleviate. We conducted an exploratory 3-week field study to examine acceptability of the Fitbit Zip and attitudes towards integrating fitness tracking into clinical care among men with prostate cancer. Twenty-six men used the Fitbit Zip for a one-week baseline phase followed by a 2-week optional use phase and then completed in-depth interviews. Interview data was analyzed using inductive thematic analysis. Participants found the device comfortable and easy to wear. Barriers to use included health and technology difficulties. Participants expressed value in sharing Fitbit data with their health care team. Findings support the use of easy to use and simple fitness trackers among men with prostate cancer and there could be opportunities to integrate fitness tracker data into clinical care.

Associations between Physical Activity and Cognitive Functioning among Middle-Aged and Older Adults

OBJECTIVES

To describe aerobic physical activity among middle-aged and older adults by their self-reported cognitive decline and their receipt of informal care for declines in cognitive functioning and most common type of physical activity.

DESIGN

Cross-sectional study using data from the 2011 Behavioral Risk Factor Surveillance System.

SETTING

Landline and cellular telephone survey.

PARTICIPANTS

93,082 respondents aged 45 years and older from 21 US states in 2011.

MEASUREMENTS

Subjective cognitive decline (SCD) was defined as experiencing confusion or memory loss that was happening more often or getting worse during the past 12 months. Regular care was defined as always, usually, or sometimes receiving care from family or friends because of SCD. Using the 2008 Physical Activity Guidelines for Americans, respondents were classified as being inactive, insufficiently active, or sufficiently active based on their reported aerobic exercise. We calculated weighted proportions and used chi-square tests for differences across categories by SCD status and receipt of care. We estimated the prevalence ratio (PR) for being inactive, insufficiently active, and sufficiently active using separate log-binomial regression models, adjusting for covariates.

RESULTS

12.3% of respondents reported SCD and 23.1% of those with SCD received regular care. 29.6% (95%CI: 28.9-30.4) of respondents without SCD were inactive compared to 37.1% (95%CI: 34.7-39.5) of those with SCD who did not receive regular care and 50.2% (95%CI: 45.2-55.1) of those with SCD who received regular care. 52.4% (95%CI: 51.6-53.2) of respondents without SCD were sufficiently active compared to 46.4% (95%CI: 43.8-49.0) of respondents with SCD and received no regular care and 30.6% (95%CI: 26.1-35.6) of respondents with SCD who received regular care. After adjusting for demographic and health status differences, people receiving regular care for SCD had a significantly lower prevalence of meeting aerobic guidelines compared to people without SCD (PR=0.80, 95%CI: 0.69-0.93, p=0.005). The most prevalent physical activity was walking for adults aged ≥ 45 years old (41-52%) regardless of SCD status or receipt of care.

CONCLUSION

Overall, the prevalence of inactivity was high, especially among people with SCD. These findings suggest a need to increase activity among middle-aged and older adults, particularly those with SCD who receive care. Examining ways to increase walking, potentially by involving informal caregivers, could be a promising way for people with SCD to reduce inactivity and gain the health benefits associated with meeting physical activity guidelines.

Association of Filial Responsibility, Ethnicity, and Acculturation Among Japanese American Family Caregivers of Older Adults

Challenges of filial caregiving practices by 1st-generation immigrants due to differences in caregiving values between their home and host countries are well documented. This study explored the filial responsibility of later generation Japanese American caregivers of older adults. Acculturation and filial responsibility were measured using the Suinn-Lew Asian Self Identity Acculturation scale and Filial Values Index, respectively. A qualitative interview guide was developed using Gordon's assimilation theory, and 21 caregivers ( M age = 68 years, 86% female, seven in each generation) were interviewed. Despite the 3rd-generation caregivers' high acculturation level, their filial responsibility scores remained high. Qualitative interviews also revealed later generation caregivers' strong filial responsibility and continued caregiving involvement. Unexpectedly, caregivers' own future expectancy of care included placement in mainstream residential facilities rather than ethnic-specific settings. Findings point to the need to develop caregiver services that consider later generation caregivers' culture and level of assimilation.

Champions of an Older Adult Exercise Program: Believers, Promoters, and Recruiters

Champions, who support, market, and promote programs, are a vital part of successful program adoption, implementation, and maintenance. Enhance®Fitness (EF) is an evidence-based, community-delivered group exercise program for older adults. Using semistructured phone interviews with 20 participants, 17 instructors, and 15 staff, we explored the roles of champions in adopting, implementing, and maintaining EF at YMCA-affiliated sites. Interviews revealed EF champions play critical roles in program dissemination. Champions are outgoing, passionate, and enthusiastic about EF. They believe in the program and its benefits (believers), are "walking advertisements" (promoters), and have magnetic personalities, persuading newcomers to join (recruiters). EF champions were not purposefully selected but naturally arose during the course of program delivery. Community sites adopting evidence-based programs can foster and support champions by engaging with them, and capitalizing on their energy as an emerging resource throughout the adoption, implementation, and maintenance of programs.

Association of social isolation and health across different racial and ethnic groups of older Americans

Social isolation is a social and public health problem that affects people of all ages, especially elders. Previous studies have found that social isolation across numerous industrialised countries is associated with negative health outcomes. However, it is unknown whether and how this association differs by race/ethnicity and age. To begin to address this gap, this study examines the association of social isolation and physical and mental health among Black, White and Hispanic elders in the United States of America. Building on Cornwell and Waite's perceived isolation and social disconnectedness dimension model of social isolation, the author used multi-stage survey data from a nationally representative sample of 3,005 community-residing adults aged 57-85 from the National Social Life, Health, and Aging Project. Tests for association were conducted on health by age, gender, marital status, education and race/ethnicity separately. Multivariate logistic regressions were used to test the association of social isolation and health exclusively and separately among these three groups. Results showed that social isolation is strongly associated with physical and mental health. Both perceived isolation and social disconnectedness had a significant negative association with physical and mental health among White elders. For Blacks, social disconnectedness is negatively associated with their physical health while perceived isolation had a negative association with mental health. Among Hispanic elders, there seemed to be no association between social isolation and physical health, but a significant negative association was found with their mental health. Despite various associated patterns, however, social isolation overall was associated with health outcomes that were similar across three elder groups. By identifying factors influencing social isolation and health among minority older Americans, this study has relevance to the development of culturally sensitive health-care practice and services, which may be applicable to minority elders in different countries.

Beyond Strength

This study examines the expected and experienced benefits among participants in Enhance®Fitness (EF), an evidence-based group physical activity program for older adults. We also describe the implications for program dissemination (reach, implementation, and maintenance) within the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Twenty semistructured interviews were conducted with EF participants enrolled from 2005 to 2012. Interviews were digitally recorded, professionally transcribed, and analyzed using a deductive approach. Participants were motivated to join EF for expected physical benefits and the social environment of a group-based class. Actualized benefits of participation included physical, social, functional, and improved self-image/sense of well-being. Participants valued the practical application of class exercises to daily activities that support independent living, such as lifting objects and completing household chores. Organizations looking to implement EF or improve existing EF classes can improve program reach, implementation, and maintenance by incorporating participants’ expressed motivations and valued benefits in program marketing and by improving organizational support to meet participant needs. EF class instructors can tailor their classes to engage participants based on their motivations. Understanding participants’ motivations and valued benefits can improve EF dissemination by meeting participant needs with tailored class offerings and organizational needs informed by participant insights that aid program sustainability.

Adoption of Evidence-Based Health Promotion Programs: Perspectives of Early Adopters of Enhance(®)Fitness in YMCA-Affiliated Sites

Purpose

To identify facilitators and barriers among early adopters of Enhance^®Fitness (EF), in Young Men’s Christian Association-affiliated (Y-affiliated) sites from the perspective of program staff. EF is an evidence-based group exercise program for seniors.

Methods

This qualitative study used semi-structured phone interviews with 15 staff members representing 14 Y-affiliated sites. Interviews were digitally recorded, transcribed, and analyzed using qualitative content analysis informed by the RE-AIM framework.

Findings

Staff were, on average, 48.7 years old (SD 13.5) and had been involved with EF for 5.2 years (SD 3.1). Key themes related to facilitating adoption of EF were: match with the Y mission, support from different organizational levels, match between the target population need and EF, initial and on-going financial support, presence of champions, novelty of EF, an invitation to partner with a community-based organization to offer EF, and program-specific characteristics of EF. Key themes related to barriers interfering with EF adoption included competing organizational programs and space limitations, limited resources and expertise, and costs of offering the program.

Implications

Our findings identify the types of organizational support needed for adoption of evidence-based health promotion programs like EF. Recommendations for practice, research, and policy based on the findings, including assessing organizational readiness, researching late adopters, and developing revenue streams, may help facilitate program adoption. Packaging and sharing these practical recommendations could help community-based agencies and nationally networked organizations facilitate adoption of EF and other evidence-based programs.

A Review of Ethnicity, Culture, and Acculturation Among Asian Caregivers of Older Adults (2000-2012)

This review identified domains of care experiences among studies of Chinese, Filipino, Japanese, Korean, and Vietnamese caregivers in the United States and Canada between 2000 and 2012. Using a narrative approach, 46 peer-reviewed journal articles were found through electronic databases and references. Considering caregivers' assimilation to host countries, attention was given to their culture, socioeconomic resources, immigrant status, filial responsibility, generation, and acculturation. Three primary domains were identified across subgroups. The caregivers' experiences domain was a strong sense of filial responsibility and its varied effects on caregiving experience; in the cultural values domain, reciprocity, and familism. In the acculturation domain, caregivers' generations influenced their experiences. Because our society is rapidly changing demographically and culturally, studies of older adults and their caregivers that are not only inclusive of all racial/ethnic groups but also sensitive to specific racial/ethnic and cultural subgroup differences are necessary to inform policy and practice.

Generational differences in Japanese Americans' preferred senior service environments

Japanese American social service agencies and senior centers were created during the 1970s based on the needs of the first (Japanese-speaking) and second (bilingual) generations of Japanese Americans. In 2011, the oldest baby boomers turned 65. Acculturated, English-speaking Japanese American baby boomers may have different preferences about types of services and activities. This study compared the preferences of 230 Japanese American baby boomers and 183 seniors regarding ethnic-specific and nonethnic-specific social service and senior center environments. Despite acculturation, the baby boomers preferred the mixed service environment that included both Japanese-specific and nonethnic-specific activities, suggesting the importance of maintaining Japanese culture.