Aging in place and the places of aging: A longitudinal study

Does Neighborhood Socioeconomic Status Alter Memory Change Associated with a Cancer Diagnosis? Preliminary Evidence from the US Health and Retirement Study

BACKGROUND

Neighborhood disadvantage has been linked to cognitive impairment, but little is known about the effect of neighborhood disadvantage on long-term cancer-related memory decline.

METHODS

Incident cancer diagnosis and memory (immediate and delayed recall, combined with proxy-reported memory) were assessed at biennial interviews in the US Health and Retirement Study (N = 13,293, 1998-2016). Neighborhood disadvantage was measured using the National Neighborhood Data Archive disadvantage index, categorized into tertiles (T1: least disadvantaged-T3: most disadvantaged). Linear mixed-effects models estimated the standardized memory trajectories in participants with or without cancer, by neighborhood disadvantage.

RESULTS

Living in more disadvantaged neighborhoods was associated with worse mean memory function and steeper memory declines, regardless of cancer status. An incident cancer diagnosis was associated with an acute memory drop for those living in least disadvantaged neighborhoods but not more disadvantaged neighborhoods [T1: -0.05, 95% confidence interval (CI): -0.08, -0.01; T3: -0.13, 95% CI: -0.06, 0.03]. Cancer survivors in the least disadvantaged neighborhoods had a slight memory advantage in the years prior to diagnosis (T1: 0.09, 95% CI: 0.04, 0.13) and after diagnosis (T1: 0.07, 95% CI: 0.01, 0.13).

CONCLUSIONS

An incident cancer diagnosis among those living in the least disadvantaged neighborhoods was associated with an acute memory drop at the time of diagnosis and a long-term memory advantage before and after diagnosis compared with cancer-free individuals in similar neighborhoods.

IMPACT

These findings could inform interventions to promote cancer survivor's long-term aging. Future studies should investigate the social and biological pathways through which neighborhood socioeconomic status could influence cancer-related memory changes.

'It's where I belong': what does it mean to age in place from the perspective of people aged 80 and above? A longitudinal qualitative study (wave one)

BACKGROUND

Most people want to remain at home as they age. Ageing in place - remaining at home and connected to the community - is a national and international policy priority; however, to better understand how policy might be implemented, a more nuanced understanding is required about older adults' lived experiences of ageing in place, especially the experiences of those aged 80 and above.

OBJECTIVE

To describe and explore the social processes which enable ageing in place from the perspective of community-dwelling older people (80+).

METHODS

Forty-six respondents (80-100+ years) participated in the first wave of a longitudinal qualitative study set in North East England. Semi-structured interviews were conducted in participants' homes between June 2022 and January 2023. Interviews were analysed using reflexive thematic analysis.

RESULTS

Participants positioned their homes as a place of freedom and as the antithesis of a 'care home'. Remaining in place was important for all participants; a key priority for them was to remain physically active to enable this. However, many participants faced significant hurdles to remaining in place. These were primarily related to health and mobility issues. Some participants were able to overcome such barriers by drawing on financial resources and available social networks.

CONCLUSION

The home is central to understanding older peoples' (80+) experiences of ageing. In a socio-political context which promotes ageing in place, the social factors shaping experiences of ageing in place must be considered. This involves attending to the challenges of later life, particularly health and especially mobility and physical function. Currently, those with resources (social and economic) are better equipped to respond to such challenges, thus potentially exacerbating widening inequalities in ageing. By foregrounding the perspectives of those ageing in place alongside social factors shaping their experiences, our study has important implications for policy and health and social care. We show that a more equitable allocation of resources is vital to fulfil the ageing in place policy agenda. Furthermore, we highlight a need to recognise commitments to ageing in place displayed by people aged 80 and above, especially when remaining in place becomes difficult to achieve.

The Association between Residential Environment and Self-Rated Mental Health among Older Canadians: The Moderating Effects of Education and Gender

This study examined the associations between residential environment and self-rated mental health (SRMH) among Canadians aged 65 or older (n = 16,304) and whether education and gender moderated the associations. Data came from the 2018 Canadian Housing Survey. Hierarchical multiple regressions were conducted to test the associations. Analyses revealed that increased dwelling size was associated with better SRMH among older women with high school education. Older adults with higher satisfaction with their dwelling design were more likely to report better SRMH, except for women with some college education. Feeling safer in the community was uniquely associated with better SRMH for men with high school education and women with a university degree. Results confirmed significant associations between specific home and residential environment features and SRMH for each gender-by-education group. Environmental programs designed to improve SRMH for older adult populations should consider within- and between-group diversity.

Social Determinants of Health Inequities for Older LGBT Adults: A Scoping Review

INTRODUCTION

Despite the research on a health-disparate population, less is known about the social determinants of health (SDOH) inequities among older lesbian, gay, bisexual, and transgender (LGBT) adults. This scoping review aimed to explore and summarize what is known in the literature regarding the SDOH among older LGBT adults.

METHODS

The Joanna Briggs Institute's (JBI) approach guided this scoping review, which examined 31 articles that included quantitative, qualitative, and mixed-method studies. Data were analyzed by three independent reviewers through a predesigned process of data charting, descriptive summary, and thematic analysis.

RESULTS

Older participants were primarily LGBT and LGB. The findings identified four intersecting dimensions of individuals, social, economic, and health care system, contributing to health inequities and poor health outcomes.

CONCLUSION

Given the importance of SDOH for older LGBT adults, stakeholders including health care providers need to better understand the multiple intersecting influences, provide culturally congruent health care, and integrate sources of support into the care of these sexual- and gender-minority older adults.

Privacy Barriers in Health Monitoring: Scoping Review

BACKGROUND

Health monitoring technologies help patients and older adults live better and stay longer in their own homes. However, there are many factors influencing their adoption of these technologies. Privacy is one of them.

OBJECTIVE

The aim of this study was to provide an overview of the privacy barriers in health monitoring from current research, analyze the factors that influence patients to adopt assisted living technologies, provide a social psychological explanation, and propose suggestions for mitigating these barriers in future research.

METHODS

A scoping review was conducted, and web-based literature databases were searched for published studies to explore the available research on privacy barriers in a health monitoring environment.

RESULTS

In total, 65 articles met the inclusion criteria and were selected and analyzed. Contradictory findings and results were found in some of the included articles. We analyzed the contradictory findings and provided possible explanations for current barriers, such as demographic differences, information asymmetry, researchers' conceptual confusion, inducible experiment design and its psychological impacts on participants, researchers' confirmation bias, and a lack of distinction among different user roles. We found that few exploratory studies have been conducted so far to collect privacy-related legal norms in a health monitoring environment. Four research questions related to privacy barriers were raised, and an attempt was made to provide answers.

CONCLUSIONS

This review highlights the problems of some research, summarizes patients' privacy concerns and legal concerns from the studies conducted, and lists the factors that should be considered when gathering and analyzing people's privacy attitudes.

Unlocking the potential of smartphone and ambient sensors for ADL detection

The detection of Activities of Daily Living (ADL) holds significant importance in a range of applications, including elderly care and health monitoring. Our research focuses on the relevance of ADL detection in elderly care, highlighting the importance of accurate and unobtrusive monitoring. In this paper, we present a novel approach that that leverages smartphone data as the primary source for detecting ADLs. Additionally, we investigate the possibilities offered by ambient sensors installed in smart home environments to complement the smartphone data and optimize the ADL detection. Our approach uses a Long Short-Term Memory (LSTM) model. One of the key contributions of our work is defining ADL detection as a multilabeling problem, allowing us to detect different activities that occur simultaneously. This is particularly valuable since in real-world scenarios, individuals can perform multiple activities concurrently, such as cooking while watching TV. We also made use of unlabeled data to further enhance the accuracy of our model. Performance is evaluated on a real-world collected dataset, strengthening reliability of our findings. We also made the dataset openly available for further research and analysis. Results show that utilizing smartphone data alone already yields satisfactory results, above 50% true positive rate and balanced accuracy for all activities, providing a convenient and non-intrusive method for ADL detection. However, by incorporating ambient sensors, as an additional data source, one can improve the balanced accuracy of the ADL detection by 7% and 8% of balanced accuracy and true positive rate respectively, on average.

Moving in together in later life: Making spaces into places as a joint endeavor

BACKGROUND AND OBJECTIVES

We focus on the linkages between relocation, new forms of partner cohabitation, and retirement. What are the patterns and trajectories of moving in with a partner in retirement? How do older adults experience different transitions, place attachment, and placemaking when they move in with a partner?

RESEARCH DESIGN AND METHODS

In this qualitative study, 50 persons between 60 and 75 years old were interviewed in Sweden and Germany. For this paper, we focused on nine participants who experienced a relocation with a partner in retirement. Interviews were transcribed and analyzed using a strategy derived from social constructivist Grounded Theory and thematic analysis.

RESULTS

Research participants described experiences of several relocations and cohabitation trajectories. In particular, we identified two patterns of relocating with a partner in retirement: moving into a new place with a partner and moving into a partner's pre-existing home, the latter proving more challenging for forming place attachment and for the couple relationship. Relocation experiences appeared to form a joint process in which relationships and retirement were renegotiated.

DISCUSSION AND IMPLICATIONS

Using cross-cultural data, this novel study shows an unexpected diversity in housing and cohabitation trajectories among older adults. More research is needed to understand what "aging in the right place" with "the right person" really means and the role of life course trajectories and couple negotiations in such processes. Future research should focus on what comes before and after relocation rather than solely studying the decision-making process that leads up to a move.

Ambiguous personhood: Paradoxes of social belonging in Danish nursing home care

In oldest old age (generally considered to be from 85 years onwards), personhood is often called into question, impacting well-being as a result. Based on ethnographic fieldwork, this article examines the well-being of oldest old nursing home residents at the intersections of ageism, fraying personhood and fragile social belonging in Danish nursing home care. In Denmark personhood hinges on both independence and social belonging; or "fællesskab." We examine how these concepts are practiced in nursing home care. Taking its starting point in the distinction between the "inside world" of the nursing home and the "real world" outside, the article examines how processes of othering occur in nursing home care, imperilling resident personhood and opportunities for social belonging. We consider how oldest old residents navigate social belonging, finding it in turn life-sustaining and vexatious. We argue that tacit ageism permeates the nursing home, to the detriment of resident well-being, despite the best intentions of an aged care system that is structured to specifically maintain personhood.

The timescapes of older adults living alone and receiving home care: An interview study

In this study, we drew on Barbara Adam's (1998) timescape perspective and applied a timescape lens to our analysis of how nine older adults who live alone, receive home care and are considered by home care professionals to be frail, experience living (in) time. Over a period of eight months, we conducted three interviews with each of the nine participants. We analysed the data using reflexive thematic analysis and drew on timescapes to further interpret our preliminary analysis. Our results show that situated everyday time, place across time, and large-scale time interact in the framing and shaping of older adults' everyday lives. Older adults' embodied experiences of being of advanced age, living alone and receiving home care influenced their timescapes. We propose that paying attention to older adults' timescapes can enable home care professionals and other supporters to consider older adults' health, well-being, vulnerabilities and strengths from a broader perspective than the 'here and now' and thereby enhance the provision of person-centred care.

Theorizing "Place" in Aging in Place: The Need for Territorial and Relational Perspectives

This paper argues for a greater theorization of "place" within aging-in-place research. It extends calls for a relational conceptualization of place by demonstrating the need for aging-in-place researchers to also pay greater attention to territorial aspects of place. This complementary understanding will help establish a new spatial grammar within aging-in-place research, that not only would improve conceptual clarity to aging in place, but would also support a more critical engagement of aging in place in questions of inequality. The paper demonstrates this through a discussion of 2 forms of inequality pertinent to older people: the uneven capacity of places to support older people and experiences of social exclusion in relation to place attachment for older people from marginalized groups.

The role of family support in the self-rated health of older adults in eastern Nepal: findings from a cross-sectional study

BACKGROUND

Nepal's low fertility rate and increasing life expectancy have resulted in a burgeoning older population. For millennia, filial piety shaped family cohesion and helped Nepali older adults achieve positive outcomes, but recently, it has been eroding. Furthermore, there are not enough institutional support options or alternatives to family-based care to deal with the biosocial needs of older adults. This study explored the association between family support and self-rated health among Nepali older adults.

METHODS

A community-based cross-sectional survey in eastern Nepal's two districts, Sunsari and Morang, interviewed 847 older adults (≥ 60 years). The final analytical sample was 844. Participants were asked whether they received assistance with various aspects of daily life and activities of daily living from their families. Multivariable logistic regression examined the association between family support and self-rated health.

RESULTS

Participants who received support with various aspects of daily life had 43% higher odds of good health, but after adjusting for control variables, the result only approached statistical significance (p = 0.087). Those who received family assistance with activities of daily living had nearly four times higher odds (OR: 3.93; 95% CI: 2.58 - 5.98) of reporting good health than participants who lacked this support.

CONCLUSIONS

Given the important role of family support in Nepali older adults' health, government programs and policies should create a conducive environment to foster family-based care until more comprehensive policies for older adults' care can be put into effect. The results of this study can also help shape the global aging environment by highlighting the need for family support in older care, particularly in low-income nations with declining traditional care systems and weak social security policies.

Middle aged and older adult's perspectives of their own home environment: a review of qualitative studies and meta-synthesis

BACKGROUND

Most people prefer to remain in their homes and communities as long as possible. Staying at home is widely beneficial as ageing within the home promotes independence and costs less than residential aged care. Understanding meanings and drivers of remaining at home is an area of importance.

OBJECTIVE

The objective of this systematic review of qualitative studies was to synthesise middle and older aged adult's perspective of their home environment and determine the factors that are important when making decisions about future housing.

METHODS

This review and meta-synthesis was conducted in accordance with JBI (formally known as the Joanna Briggs Institute) methodology for systematic reviews of qualitative evidence. Meta-aggregation was used as the method of synthesis. Included qualitative studies involved middle and older aged adults and their views about ageing and housing. Published studies were identified in four electronic databases and grey literature. Critical appraisal and extraction were conducted using JBI tools and findings were categorised and synthesised into findings.

RESULTS

A total of 46 papers with 5183 participants on the concept of home were included. Most of the participants were older (> 65 years old) and the perspectives of middle-aged people were largely absent. Factors impacting on future housing decisions among individuals were identified. Seven synthesized findings emerged-independence, finances, stigma, attitudes towards ageing, attachments with home, aesthetics, and family connection.

CONCLUSION

Older people have a greater sense of independence and autonomy if they remain in their own home. Multiple external factors impacted on their perspectives including a sense of stigma about ageing, fear of being a burden to others and their own financial position which in some cases restricted their options. This review provides a comprehensive description of the different factors that need to be considered when planning future housing needs; both for individuals and for communities.

Self-care interventions of community-dwelling older adults: a systematic review and meta-analysis

Introduction

The current notion of "care in old age" should be reconceptualized in the ageing societies of the 21st century. Currently, "being old" means that one is actively involved in their care and has the desire to retain control and independence.

Objective

Understand and analyze the efficacy of interventions in the physical and psychological self-care practices of healthy community-dwelling older people.

Methodology

Systematic review and meta-analysis. The guidelines of the PRISMA guide were followed. The methodological quality of the studies was checked using Cochrane Effective Practice and Organisation of Care criteria, and the search was performed between 2016 and 2021.

Results

Of the 1,866 evaluated, 8 studies met the criteria. The systematic review reveals that self-care interventions focus on physical health-related variables but not on psychological variables. The meta-analysis shows that interventions significantly improve physical health-related variables (care visits, hospital admission, medication, and gait speed).

Conclusion

Self-care training programs should include psychological variables to increase health and well-being in healthy older people.

The role of performativity in informal dementia carers' capability to be mobile

Informal carers are and will remain a vital part of dementia care. Given the nature of their caring tasks, which focus on enabling the care recipient to engage in meaningful activities, informal dementia carers are affected in their everyday mobility. Expectations manifested by society, loved ones and the carers themselves play a critical role in how carers perform their caring role and how they perceive their opportunity, or capability, to be mobile. This article uses Butler's concept of performativity to understand informal dementia carers' capability to be mobile. In the spring and summer of 2021, we combined remote graphic elicitation with telephone interviews to gather the views of 17 informal dementia carers (aged 50+) living in England. Three key themes emerged from our analysis of the data. Firstly, participants perceived that becoming a carer changed their capability to be mobile. Secondly, the caring role in relation to the capability to be mobile resulted in an emotional toll and perceived loss of autonomy. Thirdly, the performativity of the caring role created feelings of guilt, selfishness and resentment due to the impact caring had on participants' capability to be mobile. Our study enriches the literature on informal dementia carers' mobility, as we suggest that performativity is a key factor in how this population experiences their everyday mobility. The findings suggest that existing ageing-in-place policies should take a more holistic approach by better including those ageing adults who provide the most support: informal dementia carers.

Locked down by inequality: Older people and the COVID-19 pandemic

This paper develops the argument that post-COVID-19 recovery strategies need to focus on building back fairer cities and communities, and that this requires a strong embedding of 'age-friendly' principles to support marginalised groups of older people, especially those living in deprived urban neighbourhoods, trapped in poor quality housing. It shows that older people living in such areas are likely to experience a 'double lockdown' as a result of restrictions imposed by social distancing combined with the intensification of social and spatial inequalities. This argument is presented as follows: first, the paper examines the disproportionate impact of COVID-19 on older people, highlighting how the pandemic is both creating new and reinforcing existing inequalities in ageing along the lines of gender, class, ethnicity, race, ability and sexuality. Second, the paper explores the role of spatial inequalities in the context of COVID-19, highlighting how the pandemic is having a disproportionate impact on deprived urban areas already affected by cuts to public services, the loss of social infrastructure and pressures on the voluntary sector. Finally, the paper examines how interrelated social inequalities at both the individual and spatial level are affecting the lives of older people living in deprived urban neighbourhoods during the pandemic. The paper concludes by developing six principles for 'age-friendly' community recovery planning aimed at maintaining and improving the quality of life and wellbeing of older residents in the post-pandemic city.

"There isn't anybody else like me around here": the insider-outsider status of LGBT residents in housing with care schemes for older people

The intersections between aging, social minority status and housing needs in later life is a neglected area of sociological exploration, even more so for older people who identify as lesbian, gay, bisexual and trans (LGBT). Recent sociological findings indicate that older LGBT people in housing schemes stress the importance of bonding social capital and look to other people in their social networks who reflect their identities and experiences as sources of support. In this paper, we examine the insider-outsider status occupied by older LGBT residents living in housing schemes that provide some form of care and support, for example extra care and independent living schemes. We present qualitative findings generated from a mixed-methods study of social inclusion practices in housing with care in England and Wales (UK) (2019-22). In this study 15 LGBT residents participated in semi-structured interviews (55-79 years of age) across a total of 31 interviews. Through a queer gerontological lens we examine how older LGBT people are socially situated within mainstream housing schemes in which they experience partial visibility while also encountering exclusionary pressures that locate them as "the other." This insider-outsider status undermines the premise of housing with care schemes to provide safe, secure spaces to grow old. We discuss three core themes: (1) how LGBT residents navigate their outsider status in scheme life and how the intersection of disability and minority status amplifies this social location; (2) the exclusionary practices exercised by other residents that reinforce boundaries of sexual and gender normalcy; and, (3) the heightened importance of maintaining external social connections among LGBT residents. We conclude by introducing an alternative notion of marginal aging and expanding on the implications for housing providers, reflecting on their responsibilities for promoting and maintaining queer-friendly environments.

Early onset of care needs in the older population: The protective role of housing conditions

Most older people wish to live in their own homes as they age and to have a choice over their housing and care situation. Housing has the potential to play a key role in promoting independence, delaying and/or preventing the onset of care needs and in influencing the level and type of care provision required. However, many older people live in homes that are not suitable for their comfort and needs. Our study focuses on older people living in non-specialist housing in England and aims to i) explore how housing characteristics cluster; and ii) investigate their association with an early onset of care needs. We used four waves of a large representative longitudinal sample of people aged 50 or over, covering the period 2012 to 2020. We performed Latent Class Analysis and a Cox regression survival model to provide answers to our research questions. We found that people living in poor housing conditions or living in social rented housing are more likely to experience early onset of care needs, which may lead to a higher demand for, and utilisation of, long-term care services. We believe that gaining a better understanding of the relationship between housing-related conditions and care needs is paramount from the preventative and service provision point of view, and is of relevance to policymakers, practitioners, and current and future adult long-term care users.

Understanding the Meaningful Places for Aging-in-Place: A Human-Centric Approach toward Inter-Domain Design Criteria Consideration in Taiwan

BACKGROUND

Aging is key to inclusion, and it should be taken into account when designing every place of human activity. However, the implementation of such guidelines often fails the human-centric aspiration as health and design domain interpretation gaps impede the suitable reading and implementation strategies.

PURPOSE

This study aimed to understand critical factors in the place-of-aging and to examine the gap in domain interpretation affecting age-friendly housing.

METHODS

Using grounded theory as a base, questionnaire interviews were implemented either face-to-face or through an online process by health and design domain experts. Overall, 40 respondents (20 health and 20 design experts) evaluated the key criteria to prioritize according to their value of importance. The factor analysis resulted in the stated deviation, suggesting a necessity to redefine the attributes of the dwelling based on a people, place and process framework.

RESULTS

The systemic analysis affirmed the inter-disciplinary gap to enhancing the dwelling provision. The health domain experts consistently ranked the criteria higher or equal than the design domain except for safety and security criteria. Both domains agreed that affordability is a main concern, as elders must be able to afford their dwelling choice.

CONCLUSION

The valuable finding of the key criteria in the study is to uphold the value of the urban health resilience implication as the core of this study.

Living in an Age-Friendly Community: Evidence from a Masterplanned Development in Southwest Sydney

This paper is situated at the interface of a growing urban studies literature concerned with 'masterplanning' practices in urban planning and another, hitherto relatively discrete, body of research concerned with age-friendly cities and communities. The authors are interested in exploring a gap in aging in place literature around how neighbourhoods and residential settings developed with aging in place principles in mind are experienced and perceived by residents. To explore this research gap, the authors analyse qualitative (primarily interview and focus group) data collected in Park Central, a masterplanned development located in the Campbelltown suburb in the southwest region of the Sydney metropolitan area, Australia. This development was delivered in response to a need identified by the state's land and property development agency, Landcom, for more diverse and affordable medium-density housing in Campbelltown. In particular, a need was identified for housing developments that would be able to sustainably accommodate the changing lifestyle needs of a maturing population in the region. Drawing on our thematic analysis of our data, we discern three key themes in research participants' experiences of Park Central as a place for aging. These themes are elaborated via recourse to excerpts from our data and discussed with a view to informing how the conception, development and practice of further age-friendly communities is approached.

Restoring Balance-A Woman's Expressions of Lived Experience of Everyday Life During a Period of Aging: A Case Study

Bereaved older people face stressors from the changes in roles associated with the death of a spouse. To illustrate the lived experience of everyday life during a period of aging after a woman's loss of her spouse. One woman born in 1918 was followed between 74 and 80 years of age after her husband died. Data consisted of daily diary. The text from the diaries were analyzed with a phenomenological hermeneutical approach. Everyday life after becoming a widow is characterized by balancing between personal resources to manage everyday life and vulnerability. In health and social care, it is important to identify experiences of vulnerability because these are associated with poor health.

Aging in Place: Connections, Relationships, Social Participation and Social Support in the Face of Crisis Situations

OBJECTIVES

We seek to identify active coping strategies used by older adults to face the pandemic and to deal with daily stressors, and to clarify which factors had an effect on stress, positive emotions and depression in active and healthy community-dwelling older adults in the first and second year of the pandemic in Costa Rica.

METHODS

Participants were living in their own homes in Costa Rica (n = 218, mean age 69.96, 82.1% women). Participants were interviewed by phone and answered an online survey, which included socio-demographic information, mental health variables such as stressors (perceived health and fear of COVID-19, illness, perception of pandemic gravity), loneliness (whether they felt lonely and how often they felt lonely), access to Information and Communication Technologies, socio-emotional coping variables, social participation and physical activity level during the pandemic.

RESULTS

Positive socio-emotional indicators related to well-being such as self-efficacy, social support, perceived health and proactive behavior were high. Negative well-being indicators such as perceived stress, emotional COVID-19 fear and loneliness showed low values in the sample studied during both years. We found significant relations across the dependent variables (perceived stress, positive emotions and depression) by studying the psychological well-being coping strategies.

CONCLUSIONS

Findings highlight the importance of coping strategies and social participation in the capacity of older adults to mitigate the negative psychological consequences of crisis situations and provide evidence of "aging in place".

Global prevalence of edentulism and dental caries in middle-aged and elderly persons: A systematic review and meta-analysis

OBJECTIVE

The aim of the study was to analyze data collected from studies worldwide on the prevalence of edentulism and dental caries, in community-dwellers aged ≥ 45 years.

DATA

Inclusion criteria; participants aged ≥ 45 years, community-dwellers. Exclusion criteria; participants aged < 45 years, in nursing homes, data obtained from dental clinics or pre-2005. The quality assessment tool by The National Heart, Lung and Blood Institute for Observational Cohort and Cross-sectional studies was used. Meta-analysis using the random-effects model (95% confidence interval) was done with data on participants who were edentulous and/or had active dental caries and stratified by regions of the world, age and Gross National Income per capita. Limitations in the data arose from several factors such as design of the studies included differences in socioeconomic status and access to health care among different countries.

SOURCES

Embase, MEDLINE via Pubmed and Scopus, manual searches, from January 2016, restricted to English. Experts from different countries were contacted to identify National oral health surveys (NOHS) conducted from 2010 onwards.

STUDY SELECTION

Eighty-six papers and seventeen NOHS were selected for data extraction. Majority of the studies (n = 69) were cross-sectional and of fair quality. 1.1%-70%, 4.9% - 98% prevalence of edentulism and dental caries, respectively. 22%, 45% estimated random-effects pooled prevalence of edentulism and dental caries, respectively.

CONCLUSIONS

Within the limitations of this study, the findings indicate that untreated dental caries and tooth loss are prevalent on a global level with wide variations among different countries, age groups and socioeconomic status.

CLINICAL SIGNIFICANCE

The findings demonstrate the reality of the new cohort of older adults, with higher tooth retention implying more dental caries incidence and the need for different care strategies to ensure better oral health. Large variations and difficulty in making comparisons among different countries highlight the need for more standardized, regular research.

The multi-subject cooperation mechanism of home care for the disabled elderly in Beijing: a qualitative research

BACKGROUND

Currently, population aging has been an obstacle and the spotlight for all countries. Compared with developed countries, problems caused by China's aging population are more prominent. Beijing, as a typical example, is characterized by advanced age and high disability rate, making this capital city scramble to take control of this severe problem. The main types of care for the disabled elderly are classified as home care, institutional care, and community care. With the obvious shortage of senior care institutions, most disabled elderly people are prone to choose home care. This kind of elderly care model is in line with the traditional Chinese concept and it can save the social cost of the disabled elderly to the greatest extent. However, home care for the disabled elderly is facing bumps from the whole society, such as lack of professional medical care, social support and humanistic care, and the care resources provided by a single subject cannot meet the needs of the disabled elderly.

OBJECTIVE

Based on the demands of the disabled elderly and their families, this study aims to explore the current status of home care service, look for what kind of care is more suitable for the disabled elderly, and try to find an appropriate elderly care mechanism which could meet the diverse needs of the disabled elderly.

METHODS

A total of 118 disabled elderly people and their primary caregivers were selected from four districts of Beijing by using multi-stage stratified proportional sampling method. A one-to-one and semi-structured in-depth qualitative interview were conducted in the study to find out the health status of the disabled elderly, the relationship between the disabled elderly and their primary caregivers, and utilization of elderly care resources, etc. The views of the interviewees were analyzed through the thematic framework method. All the methods were carried out in accordance with relevant guidelines and regulations.

RESULTS

The results showed that the average age of 118 disabled elderly is 81.38 ± 9.82 years; 86 (72.9%) are severe disability; 105 (89.0%)are plagued by chronic diseases; the average duration of disability is 5.63 ± 5.25 years; most of disabled elderly have 2 children, but the primary caregiver are their own partner (42, 35.6%), and there is an uneven sharing of responsibilities among the disabled elderly's offspring in the process of home care. The disabled elderly enjoy medical care services, rehabilitation training, daily health care, psychological and other demands. However, the disabled elderly and their families in Beijing face a significant financial burden, as well as physical and psychological issues. The care services provided by the government, family doctors, family members and social organizations fall far short of satisfying the diverse care needs of the disabled elderly.

CONCLUSIONS

In order to effectively provide home care services for the disabled elderly, it is therefore necessary to establish a coordination mechanism of multiple subjects and give full play to the responsibilities of each subject. This study proposes a strengthening path for the common cooperation of multiple subjects, which taking specific responsibilities and participating in the home care for the disabled elderly: (1) The government should give full play to the top-level leading responsibilities and effectively implement people-oriented measures to the disabled elderly. (2) Family doctors strengthen their responsibilities as health gatekeepers and promote continuous health management of the disabled elderly. (3) Family members assume the main responsibility and provide a full range of basic care services. (4) Social forces promote supplementary responsibilities of public welfare and expand the connotation of personalized care services. (5) The disabled elderly should shoulder appropriate personal responsibility and actively cooperate with other subjects.

Age-friendly interventions in rural and remote areas: A scoping review

OBJECTIVES

In 2007, the World Health Organization published a guide on age-friendly cities. However, little is known about interventions that have been implemented to promote age-friendly communities in rural and remote areas. This paper presents the findings from a scoping review undertaken to locate available evidence of interventions, strategies, and programs that have been implemented in rural and remote areas to create age-friendly communities.

METHODS

This scoping review used the Joanna Briggs Institute (JBI) methodology.

RESULTS

A total of 219 articles were included in this review. No intervention studies were referred to as 'age-friendly'. However, there were interventions (mostly healthcare-related) that have been implemented in rural and remote areas with older people as participants. There were also non-evaluated community programs that were published in the grey literature. This review identified the common health interventions in older people and the indirect relevance to the WHO age-friendly framework domains in rural and remote contexts.

CONCLUSIONS

The eight age-friendly domains were not explicitly utilised as a guide in the development of interventions for older people in rural and remote settings. Implementation of age-friendly interventions in rural and remote areas requires a multisectoral approach that is tailored to address the specific needs of individual communities. Age-friendly interventions also need to consider socio-ecological factors to adequately and holistically address community needs and ensure long-term sustainability.

Musculoskeletal Biomarkers Response to Exercise in Older Adults

Exercise is an essential component of any good health style, being particularly important for older adults to counteract the effects of aging, including sarcopenia and osteoporosis, which can result in lower fall probability. Exercise programs for older adults are especially designed for that population. A rigorous evaluation of those programs is necessary to assure most benefit is achieved. Serum biomarkers of proteins intrinsic to musculoskeletal homeostasis could contribute objectively to the assessment of the benefits of exercise. In this work, in addition to the usual physical fitness and balance tests, ELISA assays quantified the serum levels of six proteins and one polysaccharide important for the homeostasis of muscle (troponin T and alpha-actinin), tendon/ligament (tenomodulin), cartilage (cartilage oligomeric matrix protein and hyaluronan) and bone (osteocalcin and sclerostin), before and after 8 weeks of an exercise program tailored to older adults, Stay Strong Stay Healthy, offered at a Community Center and at an Independent Senior Living facility. Statistical significance was determined by non-parametric tests (Wilcoxon Signed Ranks and Mann-Whitney U). Physical fitness and balance improved as expected along with a significant decrease in sclerostin, pointing to less inhibition of bone deposition. However, when considering each type of dwelling separately, older adults always saw a significant decrease of the isoform of troponin T associated with fast-twitch muscles, suggesting that daily levels of physical activity may also have a role in the benefit of older adults from exercise.

Community-based responses to loneliness in older people: A systematic review of qualitative studies

In many countries across the world, older people are one of the groups most vulnerable to loneliness. Community-based responses are well placed to support and enhance pre-existing coping strategies in older people. However, the evidence base of these responses remain scattered and obscured, particularly in relation to their design and reasons behind their success. In this systematic review, we focus on qualitative studies on community-based responses to loneliness among older people to learn how these responses work in practice with in-depth details. At the end of a systematic searching and screening process, 17 studies conducted in five countries (Australia, Canada, New Zealand, Spain and the UK) published in English were selected and reviewed initially in October 2020 and then updated at the end of August 2021. Three themes were identified as being most valuable to addressing loneliness in a specific community, namely, autonomy, new social connections, and belonging. These interventions were also employed according to three primary considerations: what the community lacked, how that community experienced loneliness, or a combination of both. Several implications for policymakers and future research emerged, urging future interventions to take a more contextual approach that encompasses community-level considerations before establishing a user-led and tailored setting that facilitates social engagement.

Human Factors and Ergonomics Considerations for Aging-in-Place Part 2: The Intersection of Environment and Technology

This article is part 2 of a two-part series focused on aging-in-place. Aging-in-place is a term that has been increasingly used over the past 40 years to describe the process of remaining in one’s home. In attempt to advance the discussion on the future of aging-in-place, this feature series provides an overview of the grand challenges to aging-in-place with an emphasis on human factors and ergonomics considerations. Part 2 will discuss a variety of ways to conceptualize “place” and describe the need for integrated technology within the home and beyond.

Aging in the downtown corridor: Mapping the neighborhood experiences of Seattle's unhoused adults over age 50

Research has established the importance of understanding the dynamic relationship between older adults and the environments in which they are embedded. However, the meaning of place for unhoused older adults amidst an increasingly contested urban landscape is largely unknown. This exploratory study aims to further include unhoused older adults' experiences in the scholarship on aging and place by asking how unhoused adults over age 50 (1) describe their spatial patterns and experiences and (2) negotiate their relationship with common urban places. Through iterative mapping conducted in focus groups and interviews at Seattle senior centers, respondents identified how they interacted with their communities and environment. Using inductive and deductive coding of both textual and geospatial data, thematic analysis indicated that respondents: (1) experienced confinement to the downtown corridor and expulsion from surrounding areas- a phenomenon compounded by physical and subjective aging; (2) created routines amidst geographic and temporal restrictions to maximize comfort and security; (3) attempted to create residential normalcy in public places through adaptive and accommodative practices; and (4) experienced identities shaped by movement through and access to place. Current social, spatial, and political contexts of city living present many challenges for older unhoused adults. Supports that ignore people's identification with the places that are important to them are unlikely to be successful. Findings from this paper call for service, policy, and design strategies that facilitate personal agency and connection to place among unhoused people midlife and beyond.

Evaluating the Color Preferences for Elderly Depression in the United Arab Emirates

The elderly are more prone to develop depression from physical, psychological, and economic changes, and 25.7% of the United Arab Emirates’ (UAE) elderly population suffer from depression. Color therapy is a widely accepted treatment to solve the depressive symptoms of the elderly. The color preference of the Seniors’ Happiness Centre—in Ajman UAE—a residential space for the elderly, could improve the quality of life, including depression symptoms. This paper explored the relationship between the color preference of the resident bedroom space and the depressive symptoms. As a methodology, using color images as stimuli, the physiological and psychological responses of the 86 elderly participants to the proposed color preference of the resident bedroom interiors—observed through a viewing box to simulate 3D space perception—were compared and analyzed to investigate the relationship between the color preference and depression by a survey with the Geriatric Depression Scale (GDS) and Electroencephalogram (EEG) measurement. The results showed that the elderly’s preference for warm colors is higher than that of cold colors, and each room needs a different color scheme because the elderly, 65 and above, have different visual characteristics. There was no significant difference between the left and right alpha wave values of the prefrontal cortex of the participant group. The main reason is that the brain waves are minute electrical signals and appear different from person to person. The color scheme on one side of the wall with increased saturation seemed to improve depressive symptoms effectively. It was found that psychologically, healthy elderly reacted positively to the single-color scheme of the Blue cool color, but elderly with depression reacted well to the contrast color scheme of the Blue-Yellow/Red cool color. This study will serve as critical data to propose more color preferences for the Seniors’ Happiness Center suitable for the elderly by studying the response to more diverse colors in the UAE.

Preferences of seniors living in selected Baltic Sea region countries towards the use of indoor public space furniture

Demographic changes can be observed all over the world. The number of seniors located in the societies of well-developed countries continues to rise. Both enterprises and governments need to be prepared for such changes. Consequently, public spaces need to evolve to reduce problems related to ageism and be friendly to all. Much attention is currently being paid to finding solutions for redesigning public spaces and adjusting them to the needs and requirements of senior citizens. To identify the preferences of seniors in relation to the characteristics of furniture in indoor public spaces, a survey study with 1539 respondents aged 60+ was conducted in Denmark, Finland, Latvia, Poland, Russia and Sweden. The gathered data were coded and implemented to the unified database. The statistical grouping method was used to recognize the characteristics of the needs and attitudes of seniors related to the use of public space furniture. The main variables taken into consideration in the analysis were the age and gender of respondents and their country of living. Among the most important findings are those indicating the necessity to provide the increased number of furniture for sitting in the public spaces and making sure they are not located too far away from each other. As the main disadvantages of public space furniture respondents indicated the lack of armrests or other solutions to facilitate getting up and/or sitting down, as well as profiled backrests that constitute solid support for the spine. The implementation of these data in the process of rethinking and redesigning public spaces may support the adaptation of indoor public furniture according to the requirements of a very large group of customers, namely, seniors.

Aging well in the community: Understanding the complexities of older people's dial-a-ride bus journeys

Older peoples' independent living in their own homes and their ability to move around and maintain social relations in their communities have been acknowledged as important aims to support their well-being. In this article, we study Special Transport Services as a means to support older persons with 'aging in place' - that is, within their communities. From "go-alongs" (shared dial-a-ride bus journeys) and "sit-down interviews" (at participant's home or a café) with 12 older people living in a Finnish suburb, we explored their everyday dial-a-ride bus trips to the local mall. We used actor-network theory and the concept of motility to show how at first glance what appeared to be simple dial-a-ride journeys were in fact produced by a complex and fluid actor network consisting of people, rules, norms, practices, technical devices, as well as other objects and tools. Associations between various human and non-human actors compensated for the functional limitations experienced by the participants, but also created difficulties during the journeys. Our main finding is that the actor network of dial-a-ride bus did physically help older people be more mobile, but at the same time the service required a wide range of know-how and skills. We argue that developing a truly age-friendly environment - with inclusive services to help older individuals age well within their community - requires a detailed understanding from their perspective of the actor networks that produce those services. When planning old age services, there is a need to engage with older people from different social backgrounds to develop services that are genuinely supportive and easy to use for a heterogeneous group. Our findings can be utilized in developing physical and social environments that better support older people's mobility and enable them to age well in the community.

Cross-National Perspectives on Ageing and Place: Implications for Age-Friendly Cities and Communities

BACKGROUND AND OBJECTIVES

The age-friendly cities and communities (AFCC) agenda has led to a range of policy initiatives aimed at supporting ageing-in-place for older people. Whilst there is case study evidence of how people age across urban contexts, there has been little research exploring cross-national understandings of age-friendly places amongst older people. The objective of this paper is to identify the place experiences of older people living across cities and communities in India, Brazil and the UK and to discuss implications for the AFCC agenda.

RESEARCH DESIGN AND METHODS

A total of 300 semi-structured interviews were undertaken with older people across nine cities and 27 communities in India, Brazil and the UK. The data was analysed using thematic analysis undertaken by each national team and then discussed and revised at collaborative workshops with researchers from each of the three country teams.

RESULTS

The data captures the ways in which place is constructed from the perspective of older people drawing upon social, community and cultural dimensions of ageing across diverse urban environments. We explore how older people negotiate place in the context of their everyday life and identify the relational and interconnected ways in which place attachment, belonging and identity is constructed.

DISCUSSION AND IMPLICATIONS

Age-friendly interventions need to attend to the changing physical, social and cultural dimensions of ageing and place. Integrated place-making practices are required to support older people to age in the right place across rapidly transforming urban contexts globally.

Understanding the Key Factors of Older Adults' Continuance Intention in Congregate Meal Halls

Eating congregate/community meals with friends promotes a balanced and healthy diet among older adults. It is helpful for postponing aging, preventing chronic diseases, and improving their quality of life. However, little research has examined the continuance intention for older adults with the congregate meal program in Taiwan. This study established a model for key factors of older adults' continuance intention dining at senior meal halls, and hypotheses to explain them, and subsequently designed questionnaires and scales. By analyzing the longitudinal data collected from 416 individuals using survey questionnaires, we found that the perceived service quality is the main factor that affects the perceived satisfaction, and the perceived satisfaction of the older adults plays an important role in this survey. It showed that if the older adults are satisfied with the service quality provided by the senior meal halls, which will accordingly affect the post-use trust, they will show a positive continuance intention to participate in the senior meal halls. We also found that the older adults have positive views on the planning and service contents of the existing senior meal halls. Together, these results illustrate the process and provide comprehensive insights and evidence to create a better user experience and improve the satisfaction of the congregate meal for older adults.

Ageing in place processes in the neighbourhood environment: a proposed conceptual framework from a capability approach

The concept of "ageing in place" has become increasingly significant in the environmental gerontology literature. Despite its predominance, there have been limited efforts to offer a more comprehensive and nuanced conceptualization of this topic. Definitions found in the literature are often too simplistic and only partially capture the various aspects of older adults' experience while ageing in place. This paper presents a conceptual framework on ageing in place in the context of neighbourhood environment which aims to address this gap by proposing a multi-faceted understanding of ageing in place processes through the lenses of a capability approach, a more comprehensive definition of the concept, and related overarching principles. Building on predominant theories in environmental gerontology, this conceptual framework offers new insights into the interactions between "place" and the "ageing individual". It is meant to offer opportunities for discussion, to suggest new paths of inquiry, and to explore implications for policy and practice.