Mason Caregivers Aiming for Resilience, Empowerment, and Support Study: Assessing Family Caregiver Burden Post-Intervention

Background: Family caregivers of older adults living with dementia are known to experience higher burden levels. Methods: This empirical study conducted a sub-group analysis of burden levels of 97 family caregivers by the dementia severity of care recipients. Family caregivers were assessed before and after the 9-week Stress-Busting Program for Family CaregiversTM (SBP). Results: Family caregivers of older adults living with severe dementia had the highest baseline Zarit Burden Interview (ZBI) score of 27.7 which decreased to 25.0 (p < .05); family caregivers of those living with moderate dementia had a baseline ZBI score of 24.3 which decreased to 20.4 (p < .01); and family caregivers of those living with mild dementia had the lowest baseline ZBI score of 21.0, which decreased to 18.0 (p < .01). Conclusion: The SBP intervention was associated with a 15% reduction in burden scores for family caregivers of older adults living with dementia.

Ageism, Racism, Sexism, and Work With Older Healthcare Clients: Why an Intersectional Approach Is Needed in Practice, Policy, Education, and Research

Women are subject to health disparities across the life course, owing to multiple factors, including sexism, ageism, and other forms of structural discrimination and mistreatment which have been linked with greater risks for sexual violence and related trauma as well as resulting problems with physical and mental health as well as overall wellbeing. Thus, a more intersectional approach to healthcare and social service delivery for older women is expressly needed, particularly since the COVID-19 pandemic, to address UN Global goals of advancing health and wellness, gender equality, less disparities altogether, and with this, greater justice. As such, in this article, timely needs for practice, policy, research, and education will be explored, to address intersectional prejudice and discrimination, chiefly among older women who are members of nondominant populations, to improve healthcare and social services and social justice, principally in later life.

Association of Social Isolation With Hospitalization and Nursing Home Entry Among Community-Dwelling Older Adults

Importance

Social isolation is associated with adverse health outcomes, yet its implications for hospitalization and nursing home entry are not well understood.

Objective

To evaluate whether higher levels of social isolation are associated with overnight hospitalization, skilled nursing facility stays, and nursing home placement among a nationally representative sample of community-dwelling older adults after adjusting for key health and social characteristics, including loneliness and depressive symptoms.

Design, Setting, and Participants

This observational cohort study included 7 waves of longitudinal panel data from the Health and Retirement Study, with community-dwelling adults aged 65 years or older interviewed between March 1, 2006, and June 30, 2018 (11 517 respondents; 21 294 person-years). Data were analyzed from May 25, 2022, to May 4, 2023.

Main Outcomes and Measures

Social isolation was measured with a multidomain 6-item scale (range, 0-6, in which a higher score indicates greater isolation). Multivariate logistic regressions were performed on survey-weighted data to produce national estimates for the odds of self-reported hospitalization, skilled nursing facility stays, and nursing home placement over time.

Results

A total of 57% of this study's 11 517 participants were female, 43% were male, 8.4% were Black, 6.7% were Hispanic or Latino, 88.1% were White, 3.5% were other ("other" includes American Indian or Alaska Native, Asian or Pacific Islander, and other race, which has no further breakdown available because this variable was obtained directly from the Health and Retirement Study), and 58.2% were aged 65 to 74 years. Approximately 15% of community-dwelling older adults in the US experienced social isolation. Higher social isolation scores were significantly associated with increased odds of nursing home placement (odds ratio, 2.01; 95% CI, 1.21-3.32) and skilled nursing facility stays (odds ratio, 1.16; 95% CI, 1.06-1.28) during 2 years. With each point increase in an individual's social isolation score, the estimated probability of nursing home placement or a skilled nursing facility stay increased by 0.5 and 0.4 percentage points, respectively, during 2 years. Higher levels of social isolation were not associated with 2-year hospitalization rates.

Conclusions and Relevance

This cohort study found that social isolation was a significant risk factor for nursing home use among older adults. Efforts to deter or delay nursing home entry should seek to enhance social contact at home or in community settings. The design and assessment of interventions that optimize the social connections of older adults have the potential to improve their health trajectories and outcomes.

Community arts engagement supports perceptions of personal growth in older adults

PURPOSE

The effects of arts engagement on older adults have been well-documented. However, the ways older adults overcome common situational and dispositional barriers to enhance personal growth and well-being are less known.

METHODS

Fifty-six community dwelling older adults (71.3 ± 4.6 years) took part in dance, music, or a control workshop two times/week for ten weeks. Participants' personal growth was examined through focus groups and surveys in this mixed-methods study.

RESULTS

Focus group and survey results revealed participants experienced personal growth through engaging in the dance and music arms of the experiment. Participants, especially those in arts workshops, described personal growth experiences aligning with four themes: increased social connections, developed new skills, utilized a growth mindset, and used creativity to overcome situational and dispositional barriers to participation. The barriers included musculoskeletal challenges, hearing impairments, and difficulty retaining new information.

CONCLUSIONS

The study yielded high adherence and retention rates, and participants reported increased engagement within their communities. Our observations provide avenues for future practitioners and facilitators to create programming that empowers older adults and utilizes participants' ongoing feedback to support access, inclusion, and sense of community.

Characteristics of Nursing Facilities and Staff Willingness to Implement a Non-Pharmacological Intervention

While non-pharmacological interventions could positively impact mood and behaviors of nursing-home residents who are living with dementia, some facilities are more willing to adopt such interventions than others. This study investigated the characteristics of Medicaid-funded nursing facilities that were associated with their willingness to implement a non-pharmacological intervention, personalized music. Using the publicly-available dataset (aka LTCfocus) from Brown University, this study examined characteristics of nursing homes in Virginia that have implemented or are in the process of implementing a personalized music intervention (n = 59) and that have decided not to implement it (n = 216). The findings indicate that nursing facilities with a higher proportion of long-term residents are more likely to implement the intervention. The findings can inform future research recruitment strategies. In addition, a greater understanding of the use of non-pharmacological interventions in relation to the characteristics of nursing facilities offers insight to policymakers and public health officials regarding resource allocations to facilities.

Dance, Music, and Social Conversation Program Participation Positively Affects Physical and Mental Health in Community-Dwelling Older Adults: A Randomized Controlled Trial

INTRODUCTION

As the world population ages, practitioners use community-engaged interventions to help older adults stay healthy. Engaging in arts programs (e.g., dance or music) reportedly improves physical and mental health, but little research exists examining these effects in community-dwelling older adults. Our purposes were to examine how taking part in 10-week, twice per week community arts programs (dance and music) and control (social conversation) affected physical and mental health in community-dwelling older adults and their perceptions after program participation.

METHODS

In this randomized controlled trial, 64 older adults over 65 years of age (71.3 ± 4.6 years, 166.9 ± 8.3 cm, 78.1 ± 18.1 kg) took part in community-engaged arts programs: ballroom dance (n = 23), music (ukulele-playing, n = 17), or control (social conversation n = 24), two times per week for 10 weeks. Participants' physical health using the Short Physical Performance Battery (SPPB; score 0 = worst to 12 = best) and mental health using the Montreal Cognitive Assessment (MoCA; score = 0 to 30, where less than 26 = normal) were tested three times: 1. before (pre), 2. at the end of 10 weeks (post-1), and 3. 1 month after intervention (post-2). Separate 3 (group) x 3 (time) ANOVAs and adjusted Bonferroni pairwise comparisons as appropriate examined changes across groups and time. Focus group interviews and surveys were audio recorded, transcribed, and analyzed using inductive thematic analyses to examine participants' perceptions.

RESULTS

Across all groups, participants had an 87.8% attendance and an 87.5% retention rate. Participants' SPPB performance improved over time (pre = 10.5 ± 1.4, post-1 = 10.7 ± 1.3, post-2 = 11.3 ± 1.0; p < 0.001), but similarly across groups (p = 0.40). Post-hoc analyses revealed that performance improved from pre to post-1 (p = 0.002) and pre to post-2 (p < 0.001). Participants' cognition improved over time (pre = 26.3 ± 2.8, post-1 = 27.3 ± 2.6, post-2 = 27.5 ± 2.5, p < 0.001), and similarly across groups (p = 0.60). Post-hoc analyses revealed that cognition improved from pre- to post-1 (p = 0.002), and pre- to post-2 (p = 0.001). Participants consistently mentioned increased social engagement as the major reason for participation.

CONCLUSIONS

Overall, taking part in community-engaged arts (dance and music) and social conversation programs positively influenced physical and mental health in older adults. Still, as all groups improved equally, the results may partly be due to participants having normal physical and mental function pre-participation and due to them learning the test over time. These study findings imply that providing fun and free community-engaged programs that empower participants to be more engaged can positively influence physical and mental health and promote successful aging in older adults.

A web-based training program for direct care workers in long-term care communities: Providing knowledge and skills to implement a music and memory intervention

As dementia increases and the availability of at-home caregivers decreases, the need grows for effective training for direct care workers. Direct care workers have demanding schedules with restrictive availability and lack professional incentives to pursue specialized training. This study explored the impact of the Mason Music & Memory Initiative (M³I), a web-based, micro-learning training for direct care workers, combined with the implementation of the Music & Memory intervention. The training provided a foundational understanding of dementia and the person-centered music intervention. Twenty-five direct care workers, across two long-term care communities, completed the training modules over four weeks. All participants completed a pre- and posttest, determining their knowledge and understanding of dementia and the Music & Memory intervention adopted by their facilities. Many workers found the training to be informative and inspiring, noting improved behaviors in residents during the implementation of the M³I.

TWO STEPS FORWARD AND THREE STEPS BACK: STUDENTS’ PERSPECTIVES ON LIVING AND WORKING WITHIN AN AGING SOCIETY

Each day, 10,000 Americans celebrate a 65th birthday, but there are still many young adults not choosing to enter a field that focuses on working with the older population. As part of a continued effort to understand low enrollments in a minor in aging studies and a graduate certificate program in gerontology, focus groups were held with students to explore why they are not choosing to learn more about one of the fastest growing sectors of the U.S. population. A total of 21 students participated in two focus groups. Students’ majors varied but included social work, public health, nursing and communications. All of the students were between the ages of 18 and 22 except for one student who was 68 years old. Only 6 students had taken an aging class, but every student indicated that they were close to a family member, 60 years old or older. Two researchers coded and analyzed the focus group data for themes. Examples of the themes about older adults included being unwilling to change, having negative views toward millennials, and being hampered by technology. Themes relative to student perspectives included needing empathy and patience to work with older adults, assuming decline and lacking opportunities within their majors to take gerontology courses. Comparing views and perspectives of older adults decades ago by traditional college-aged students to current day perspectives resulting from this data will be discussed as well as successful strategies for increasing enrollments in gerontology programs.

Results from a person-centered music intervention for individuals living with dementia

AIM

Dementia is a chronic, costly disease affecting millions of people worldwide. Effective, affordable person-centered interventions are required to improve the lived experiences of individuals with dementia and their caregivers in various care settings. The present study examined the effects of a person-centered music listening intervention on mood, agitation and social engagement for individuals living with dementia.

METHODS

This quasi-experimental study was carried out with participants at five community-based adult day health centers (n = 51). Standardized instruments were used to measure mood and agitation, and in-person and video-recorded observations of participant behavior were used to analyze changes before, during and after the intervention across four domains: mood, agitation, connecting to music and engaging socially. Within-person differences were examined using the Wilcoxon signed rank test, and between-group differences were examined using the Mann-Whitney U-test.

RESULTS

Although standardized instruments did not yield statistically significant results, the behavioral observations showed a positive change in mood and a decrease in agitation. From pre- to post-intervention, there were statistically significant increases in joy, eye contact, eye movement, being engaged and talkativeness, and a decrease in sleeping and moving or dancing.

CONCLUSIONS

Behavioral observations show the positive impact a person-centered music listening intervention might have on individuals living with dementia and attending adult day health centers. This affordable intervention provides a useful tool for caregivers that might improve the day-to-day experience of individuals living with dementia. Geriatr Gerontol Int 2019; 19: 30-34.

"Maintaining connections but wanting more": the continuity of familial relationships among assisted-living residents

Social support is a key component of well-being for older adults, particularly for those who have moved from independent living to assisted living involving a transformation of roles, relationships, and responsibilities. Twenty-nine assisted-living facility residents were interviewed to understand the perceived continuity of relationships with family and friends. An inductive approach to thematic analysis revealed 1 main theme and 3 subthemes. The main theme that emerged was: maintaining connections but wanting more. Residents appreciated maintaining connections with family and friends, but often expressed feelings of discontentment with the continuity of former relationships. The subthemes included: appreciating family and friends, waiting for more, and losing control. Implications for research and practice are discussed.

Quality of life and life skill baseline measures of urban adolescents with disabilities

Many gaps exist in the understanding of how adolescents with disabilities successfully transition to adulthood and the services contributing to this success. This study attempts to fill one gap by establishing quality of life baseline measures for low-income urban adolescents. We compared baseline data for a representative sample of adolescents with disabilities in the District of Columbia to national norms using three instruments-the Pediatric Quality of Life Inventory 4.0, the Ansell-Casey Life Skills Assessment, and the Career Maturity Inventory-Attitude Scale. The sample for this study was primarily African American and had a higher level of disability as measured by receipt of Supplemental Security Income (SSI). The baseline scores of the adolescents in DC may be lower than the normed scores of their peers with disabilities in the U.S. because of socioeconomic and racial inequities and because the population has to contend with greater levels of disabilities.