Aging and Family Life: A Decade Review

Conceptualisation and measurement of healthy ageing: Insights from a systematic literature review

This paper enhances the understanding and measurement of Healthy Ageing (HA) through a systematic review of its multidimensional operationalisation. Despite progress in HA research, no consensus exists on its constitutive elements, and current frameworks often do not capture its full complexity. Building on the World Health Organization (WHO) HA definition, we organise empirical evidence under three dimensions: intrinsic capacity (IC), functional ability (FA) and the environment (ENV). To identify conceptual, empirical and methodological gaps, we provide a structured synthesis of concepts, measures and instruments used in HA research, evaluating methodological advancement and standardisation in HA measurement. Following PRISMA guidelines, we extract data from 55 quantitative, qualitative and mixed-methods studies with a multidimensional HA focus. We arrange evidence into three primary domains (IC, FA and ENV; first order), 15 sub-domains (second order) and 84 themes (third order). We identify operational categories via thematic analysis and inductively determine the final categorisation, moving from third to first order based on conceptual and measurement considerations. Given the lack of systematic knowledge on ENV, we generate a more nuanced categorisation capturing different levels of analysis and contexts. We compute a mean usage ratio to assess differences in the application of validated tools across HA aspects. The review revealed substantial variability in HA conceptualisation and measurement. IC and FA are the most extensively studied domains, with well-established measurement approaches and widespread use. Common themes include locomotion, cognitive capacities and functional status. ENV remains significantly underexplored and lacks standardised measurement, as mainstream assessments still prioritise deficit-based approaches over enabling environments. This analysis calls for a standardised, multidimensional HA model integrating individual and contextual factors, recognising the role of structural environmental supports in shaping ageing trajectories. Future research should prioritise comprehensive HA measurement and pursue an interdisciplinary approach bridging conceptual and methodological gaps to inform HA policies effectively.

'I care for my grandma because she's one of my best friends': Intergenerational caregiving and the everyday geographies of aging in Palm Beach County, Florida

In this article, we examine the intricate dynamics of caregiving arrangements where individuals under the age of 18 and older adults care for each other and share caregiving responsibilities for other household members experiencing chronic illness, disability, or medical needs. Drawing on a subset of geospatial maps, sketch mapping, and interview data collected from a two-year research project with caregiving youth, the article explores how caregiving shapes the lived experiences of both young people and older adults in peri-urban Florida, and the spaces and places available to them in their everyday care routines. The analysis provides valuable insights into the broader societal implications of intergenerational caregiving, remaining sensitive to the varieties of care arrangements that support the health and well-being of families with aging adults.

The influence of intergenerational relationships on depressive symptoms in elderly patients with multiple chronic conditions: the mediating roles of self-rated health and well-being

BACKGROUND

The superimposition of multiple chronic conditions places a heavy physical burden and life pressure on older adults, making them more prone to psychological distress and significantly increasing their risk of depression, which has become an urgent public health issue. Intergenerational relationships, as the main source of social support for older adults, have a profound effect on their mental health. This study aims to explore the potential mediating mechanisms by which intergenerational relationships influence depressive symptoms among older adults within the context of the Chinese "filial piety" culture, providing a theoretical foundation for optimizing intergenerational support and improving the psychological well-being of older adults.

METHODS

Data from the 2020 China Family Panel Study (CFPS) were used, and 739 elderly patients with multiple chronic conditions were selected as the study subjects. Data on intergenerational relationships, self-rated health, well-being, and depressive symptoms were also obtained. A chain mediation model was developed using SPSS PROCESS macro model 6, and one-way ANOVA, Pearson correlation analysis, and mediation effect tests were performed to investigate the effects of intergenerational relationships, self-rated health, and well-being on depressive symptoms in elderly patients with multiple chronic conditions.

RESULTS

Intergenerational relationships, self-rated health, and well-being were found to be significantly correlated with depressive symptoms (P < 0.05). Intergenerational relationships negatively predicted depressive symptoms (β = -0.610, P < 0.01). Self-rated health (β = -1.115, P < 0.001) and well-being (β = -0.653, P < 0.001) mediated the effect of intergenerational relationships on depressive symptoms. Additionally, self-rated health and well-being were identified as chain mediators in this relationship for elderly patients with multiple chronic conditions (β = -1.118, P < 0.001).

CONCLUSION

Intergenerational relationships can reduce depressive symptoms among elderly patients with multiple chronic conditions by enhancing self-rated health and well-being. These findings highlight the importance of family support and emotional communication in mental health interventions for older adults. Therefore, healthcare professionals should incorporate family support and encourage positive intergenerational relationships when designing interventions to foster a supportive environment and improve quality of life.

Womanhood bound to motherhood: Choosing childlessness in Türkiye

This article aims to evaluate the subjective experiences of voluntarily childless Turkish women, and based on the data collected through in-depth interviews where [a] what it means for them to be a childless woman, [b] what the motivations behind choosing a childless life are, and [c] how they negotiate their childless identity in a pronatalist society are explored. A total of 18 women were interviewed, and three meta-themes [negotiating identity and agency in a pronatalist society, the emotional landscape of childlessness, pathways and motivations for remaining childless] were generated through main themes and subthemes based on the data. All participating women reported some degree of emotional and social distress arising from the stigma they feel within their environmental contexts. Many of them tapped into the "felt outsiderness" among people following traditional gender roles ascribed by Turkish society. All of them felt comfortable with their decision to choose and remain childless despite some difficulties it might bring as a result of living in a society that equates womanhood with motherhood. They presented a variety of individual, familial, and social factors that impact their choice of pursuing a childless life. The article argues that the decision to remain childless is not merely a personal preference but a complex, multi-layered process shaped by sociocultural expectations, gender norms, and individual agency. It highlights how voluntarily childless women actively negotiate their identities within a pronatalist society, challenge traditional narratives surrounding womanhood, and construct meaningful lives that do not conform to dominant reproductive expectations.

How Parents' Marital Quality Influences Intergenerational Support Between Older Adults and Their Children: Evidence From Malaysia

With Asia's rapid population aging, intergenerational exchanges between older adults and children are becoming increasingly important for old-age support. However, the relationship between older adults' marital quality and intergenerational support remains underexplored, particularly in multi-ethnic and developing settings. To address this, we examine a subsample of currently married older adults (60+) with at least one child (n = 1575) from Wave 1 (2018) of the Malaysian Aging and Retirement Survey. Using latent class analysis, we identify intergenerational support patterns among older Malaysians. Multinomial logistic regression is employed to investigate how older adults' marital experiences relate to these support patterns. Findings show positive marital experiences are associated with support patterns involving mutual exchange or high receipt of support, while negative marital experiences are linked to patterns characterized by a downward transfer of support to children. Policymakers in developing settings should thus pay more attention to family dynamics when aiming to strengthen intergenerational support.

Do adult children increase the chances of receiving the recommended hospital treatment among older adults with heart disease?

BACKGROUND

We investigated whether having children and their socioeconomic resources are associated with receiving coronary angiogram (CAG) and coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) among older adults with non-ST elevation myocardial infarction (NSTEMI) and unstable angina pectoris.

METHODS

The study included 13 046 older adults diagnosed with first-time NSTEMI and unstable angina pectoris between 2002 and 2018. Logistic regression analyses were used to examine the associations of having children and their socioeconomic resources with receiving a CAG examination within the first 3 days of their diagnosis and CABG or PCI within 30 days of their diagnosis following CAG examination, respectively, adjusted for sociodemographic factors.

RESULTS

Within 3 days, 7158 older adults (54.9%) received a CAG, and of those, 4514 older adults (63.1%) received CABG or PCI within 30 days after their diagnosis following CAG examination. In the adjusted analyses, having children was associated with 21% (OR: 1.21, 95% CI 1.08; 1.36) higher odds of receiving CAG within 3 days and 20% (OR: 1.20, 95% CI 1.01; 1.42) higher odds of receiving CABG or PCI within 30 days after being diagnosed with NSTEMI and unstable angina pectoris, respectively, compared with those not having children. In adults with children aged ≥30 years, having children with short education was associated with 13% lower odds (OR: 0.87, 95% CI 0.77; 0.99) of receiving CAG, compared with older adults with children with long education.

CONCLUSION

Older adults with children had higher odds of receiving examination and treatment after diagnosis with NSTEMI or unstable angina pectoris. Older adults with children with short education had lower odds of receiving examination compared with older adults with children with long education.

Correlates of multicaregiving and singular caregiving among cancer caregivers and associations with caregiver well-being

PURPOSE

Compare demographic, care provision, and health-related characteristics of individuals fulfilling multiple illness-related caregiving roles (i.e. multicaregiving) versus singular (cancer only) caregiving and investigate factors associated with caregivers' mental and physical functioning.

DESIGN

Cross-sectional national survey.

PARTICIPANTS

Family caregivers who self-reported illness-related caregiving for cancer survivors only (singular caregivers: n = 465) or for one or more family members with illnesses in addition to the cancer survivors (multicaregivers: n = 109).

METHODS

Descriptive, logistic, and linear regression analysis.

FINDINGS

Singular caregivers and multicaregivers were similar on demographic, care provision, and health characteristics. Caregiving group was not associated with caregivers' mental or physical functioning. Several caregiver and care recipient characteristics were associated with mental and physical functioning for singular caregivers; however, only age was associated with multicaregivers' mental functioning.

CONCLUSIONS

Uncovering correlates of multicaregiving can help describe who may serve in these roles and how concurrent care responsibilities may influence caregivers' well-being.

The mediating role of aging attitudes between social isolation and self-neglect: a cross-sectional study of older adults living alone in rural China

BACKGROUND

Self-neglect is a significant global public health issue, compromising the health, safety, and well-being of older adults. Despite extensive research on the prevalence and risk factors of self-neglect, the underlying psychosocial mechanisms remain underexplored. Social isolation and aging attitudes have been identified as important correlates of self-neglect; however, the precise interplay between these variables, particularly the mediating role of aging attitudes, has yet to be fully examined in the context of rural older adults.

OBJECTIVES

This cross-sectional study aims to investigate the relationships among social isolation, aging attitudes, and self-neglect, focusing on how aging attitudes mediate the association between social isolation and self-neglect among rural older adults living alone in China.

METHODS

Using convenience sampling, we conducted a survey from December 2022 to February 2023 among rural older adults living alone across eight cities in Guizhou Province, Southwest China. Data were gathered using the General Information Questionnaire, Attitudes to Ageing Questionnaire, Lubben Social Network Scale-6, and Scale of the Elderly Self-Neglect. Data were analyzed using SPSS 27.0 and the PROCESS macro tool.

RESULTS

The scores for aging attitude, social isolation, and self-neglect among older adults living alone in rural areas were 75.00 (69.00-82.00), 16.00 (12.00-21.00), and 10.00 (8.00-14.00), respectively. Social isolation was positively associated with aging attitude (r = 0.353, P < 0.05) and negatively correlated with self-neglect (r = -0.371, P < 0.05). Self-neglect was also negatively correlated with aging attitude (r = -0.367, P < 0.05). Aging attitude partially mediated the relationship between social isolation and self-neglect among older adults living alone in rural areas, with a mediation effect of -0.077, accounting for 28.20% of the total effect.

CONCLUSION

The findings suggest that aging attitudes and social isolation among rural older adults living alone are associated with self-neglect. Furthermore, social isolation may be linked to self-neglect indirectly through its association with aging attitudes. Healthcare professionals should develop strategies to promote positive aging attitudes and enhance social networks of this vulnerable population, contributing to prevent or alleviate their self-neglect behaviours.

How do older adults react to social robots' offspring-like voices

Social robots are being developed as a technological solution to alleviate older adults' loneliness due to separation from their offspring. This study explores how and why offspring-like voices affect older adults' acceptance of social robots from an auditory perspective, which differ from the visual aspects of human-robot interactions. Three scenario-based studies are conducted among a large number of cognitively intact older adults. Our findings reveal a positive correlation between the offspring-like voices of social robots and older adults' acceptance of the robots. Further, social identity served as a psychological mechanism mediating the effect of offspring-like voices on the acceptance of older adults, whereas spatial distance acted as a positive moderator of these direct and indirect effects. Notably, older adults were more willing to accept social robots with grandchildren-like voices. These insights offer theoretical contributions to the literature on social identity theory and the similarity attraction paradigm, as well as practical implications for social robot design and development, thereby contributing to the evolving landscape of human-robot interaction acceptance.

All in the family? Understanding differences in the kin-centricity of older US adults' core discussion networks from classic age, period, and cohort table estimates

Panel data have generated several insights about changes in kin relationships, yet few studies examine these shifts across multiple dimensions of time simultaneously. In this paper, we use data from the National Social Life, Health, and Aging Project (N=5,269) in classic lexis tables to examine age, period, and cohort differences in the kin-centricity of older adults' core discussion networks. We estimate population averages in discussion network size, range, kin composition, and kin co-residency across ages and periods. Results indicate that older adults' core discussion networks have become larger, more diverse, and less kin-centric over time. Comparisons of fit statistics across nested models indicate that period and age effects explain most of these changes. Our findings add nuance to concerns about a growing crisis of social isolation, suggesting that declines in core discussion network kin-centricity may be accompanied by the maintenance or addition of more alternative, non-kin close ties in later life.

The elderly and the right to an active aging: the strategy of social cohousing to counteract relational poverty

The older citizens represent a portion of the population that is not only already high but is also expected to increase according to trend analyses from major national and international research reports. The pandemic experience has shown how they feel the scarcity of relationships and the loneliness of their homes as factors that significantly impact the quality of their daily lives. This challenging historical moment has provided an opportunity to implement a series of projects specifically dedicated to those over 65, aiming to ensure a full range of possibilities for them, starting from highly "enabling" processes. In this perspective, the theme of social senior housing and its various manifestations represents a key strategy to counteract relational poverty, toward intervening in the level of social sustainability through multi-actor network pathways that bring together institutions, private entities, third sector, and research centers. The article aims to analyze the potential that the senior cohousing model can offer, as well as the difficulties this type of shared living arrangement faces-moreover when designed specifically for older individuals and supported by public administrations-, and which still makes it an almost experimental experience in Italy.

Norwegian Biological Parents and Stepparents' Attitudes Towards Family Obligations in Middle and Old Age

This study investigated the associations between the current family structure and the agreement with family obligations in middle and old age. It also tested whether gender differences exist in these associations. Based on research that has observed steprelationships tend to be less close than biological relationships are, it is argued that older individuals who are stepparents have lower agreement with family obligations than their counterparts in biological families have. The analytical sample was drawn from the Norwegian Life Course Ageing and Generation survey and consisted of 5564 individuals aged 50 and older. Findings suggest that individuals who do not have biological children but who are stepparents to their partners' children agree more with filial obligations and less with parental obligations than biological parents do. The findings extend knowledge on diverse family structures in old age.

Association between functional capacity and family functionality with frailty in older adults with cardiovascular risk in southwestern Colombia

Introduction

The changes associated with aging are multidimensional and multifactorial, with the geriatric syndrome of frailty being its most problematic and complex expression. This syndrome leads to vulnerability, disproportionate changes in health status, and functional decline, making its effective identification and comprehensive management necessary.

Objective

To describe the sociodemographic, clinical, and functional characteristics of older adults with cardiovascular risk in Southwestern Colombia.

Materials and methods

This study has an observational, cross-sectional, and analytical design. The selected population included older adults enrolled in a cardiovascular and metabolic risk program in Popayán (Cauca). A multivariate analysis explored the relationship between frailty and certain sociodemographic, clinical, and functional variables.

Results

A total of 293 older adults participated, primarily women (69.6%), with an average age of 71.23 years. Among them, 77.1% were classified as independent in basic activities and 56.3% in instrumental activities of daily living, with autonomy being more prevalent among men. Additionally, 71.1% of women and 43.8% of men were classified as prefrail. The bivariate analysis identified a relationship between frailty and variables such as sex, age, marital status, educational level, occupation, calf circumference, functional capacity, instrumental capacity, and family functionality. The multivariate analysis showed a higher frailty/prefrailty prevalence (55%) in women.

Conclusions

Most participants were classified as prefrail; dependency and frailty were more prevalent in women, suggesting the need for preventive strategies and interventions from a gender-differentiated approach.

Intergenerational solidarity with digital communication and psychological well-being among older parents during the COVID-19 pandemic

We aimed to identify intergenerational solidarity (emotional closeness, in-person contact, phone contact, geographic proximity, consensus, and conflict) with digital communication (texting, video call, and social media interaction) with adult children among older parents during the COVID-19 pandemic. In addition, we aimed to investigate whether intergenerational solidarity with digital communication latent classes were associated with older parents' psychological well-being. We used the 2022 survey of the Longitudinal Study of Generations (LSOG). The sample consisted of 519 older parents who reported about 1245 adult children. Two-level latent class analysis identified six classes at the child level (Level 1: distant but digitally connected, tight-knit and digitally connected, tight-knit traditional, detached, intimate but distant, and sociable). In addition, the analysis identified three classes at the parent level (Level 2: digitally connected, mixed, and intimate but distant). Results of multivariate regression showed that older parents in the digitally connected latent class had better psychological well-being than those in the mixed latent class. Consequently, our finding indicates that digital solidarity with adult children can be beneficial for older parents' psychological well-being during the COVID-19 pandemic.

Advance personal planning knowledge, attitudes, and participation amongst community-dwelling older people living in regional New South Wales, Australia: A cross-sectional survey

BACKGROUND

Advance personal planning (APP) involves planning for future periods of incapacity, including making legal decisions and documents. APP ensures that a person's values and preferences are known and respected. This study aimed to examine knowledge of APP, attitudes and confidence towards APP, and participation in APP activities among older people residing in regional and rural areas.

METHODS

A cross-sectional survey was conducted with people aged over 65 years residing in and around regional towns in New South Wales, Australia. Participants responded to a social media advertisement or information provided through a community organisation. Data was collected via pen and paper survey or an online survey. The survey was developed for the study and included questions about the participant and their experiences with APP. Poisson regression modelling was conducted to explore the relationship between APP participation and APP knowledge, confidence and attitudes as well as the participant characteristics associated with APP participation.

RESULTS

Overall, 216 people completed the survey. Most participants had a will (90%) but only a third (32%) had documented an advance care directive. Knowledge of APP was low with only 2.8% of participants correctly answering all 6 knowledge questions. Participants had a positive attitude towards APP and high level of confidence that they could discuss APP issues with important people in their life. Those with increased knowledge, confidence and attitude towards APP were significantly more likely to participate in APP activities. Older age and having private health insurance were significantly associated with engaging in APP activities. Increased frailty and the presence of health conditions were not associated with increased APP participation.

CONCLUSIONS

There is a need to increase engagement with APP particularly among those who may be considered frail or have chronic health conditions. Increasing knowledge of, confidence and attitudes towards, APP could help to increase engagement in APP activities.

Parent-Child Relationship Typologies and Associated Health Status Among Older Adults in the United States and China: A Cross-Cultural Comparison

Background and Objectives

Cultural differences in intergenerational relationships have been well established in prior research. However, cross-national comparison evidence on the parent-child relationship and its health implications remains limited.

Research Design and Methods

Data from the 2014 U.S. Health and Retirement Study and the 2015 Health and Retirement Longitudinal Study in China were used (N US, non-Hispanic Whites only = 3,918; N China = 4,058). Relationship indicators included coresidence, living nearby, having weekly contact, receiving assistance with daily activities, providing grandchild care, and financial transfer to/from children. Latent class and regression analyses were conducted.

Results

Four classes were identified for non-Hispanic White older Americans: (1) distant and uninvolved (6.58%), (2) geographically proximate with frequent contact and downward support (47.04%), (3) coresident with frequent contact and upward support (13.1%), and (4) geographically proximate with frequent contact (33.28%). Three classes were identified among older Chinese: (1) coresident with frequent contact and upward support (37.46%), (2) coresident/interdependent (25.65%), and (3) geographically proximate with frequent contact and upward financial support (36.89%). For non-Hispanic White older Americans, providing downward support was associated with fewer functional limitations and better cognition. Receiving instrumental support from children was associated with more depressive symptoms, more functional limitations, and poorer cognition among older Chinese.

Discussion and Implications

Cultural contrasts were evident in parent-child relationship typologies and their health implications. Compared to the U.S. non-Hispanic Whites, parent-child relationships in China tended to be closer and associated with poorer health status. The findings call for culturally relevant strategies to improve parent-child relationships and ultimately promote the health of older adults.

Place Attachment and Aging in Place: Preferences and Disruptions

This paper examines the links between place attachment and older persons' preferences to age in place, and factors that disrupt these preferences. We use data from the 2001-2021 Household, Income and Labour Dynamics in Australia Survey and panel-data modelling to confirm strong associations between several place attachment dimensions and aging-in-place preferences. Strong ties to children, strong social capital, residence in social housing, homeownership status, housing wealth, and home and neighborhood satisfaction are all positively linked to a stronger preference to age in place. Our findings reveal important differences between older homeowners and older non-owners. For owners, closeness to children is a strong predictor of aging-in-place preferences, although mortgage debt can trigger involuntary moves. For non-owners, tenure security achieved through longer durations at one's address of residence is linked to stronger aging-in-place preferences. However, private renters are more often exposed to involuntary moves. We discuss the policy implications of these disruptions.

Prolonged grief disorder prevalence in adults 65 years and over: a systematic review

BACKGROUND

Prolonged grief disorder (PGD) is a recently recognised mental health disorder with an estimated prevalence of 10% in the bereaved adult population. This review aims to appraise and summarise evidence relating to PGD in older adults (≥65 years), a growing population group, most likely to experience bereavement and often assumed to cope well.

METHOD

Literature from Medline, PsycINFO, CINAHL, Cochrane Library and Web of Science was searched. Epidemiological and non-epidemiological studies including data on frequency of PGD in older adults bereaved by mainly natural causes were included and a descriptive analysis undertaken.

RESULTS

From 2059 records, three epidemiological and six non-epidemiological studies were included. Most studies had good internal but not external validity. Conditional prevalence for PGD ranged between 3.2% and 48.8%. Heterogeneity in sample characteristics and study methodology contributed to this variability resulting in a descriptive analysis. The prevalence rate of 9.1% by Kersting et al was the best available estimate for PGD in older adults for western countries. The small number of epidemiological studies and the use of varying PGD-constructs which did not match International Classification of Diseases 11th Revision and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria were the main limiting factors.

CONCLUSION

This first review on PGD prevalence in older adults suggests that, despite studies' methodological short comings, a similar proportion of older adults experience PGD as the general bereaved adult population (1:10). With older adults forming the largest subgroup among the bereaved, health and social care systems need to adapt their provision of care to address the specific needs of older adults.

Intergenerational Transmission of Relationship Quality in Later-Life Families

Objective

This article examines the transmission of older women's relationship quality with their mothers and fathers to their relationship quality with their own adult children in midlife. We also investigate how the transmission is moderated by the dimension of relationship quality (closeness vs. strain) and the gender of both the older women's parents and their adult children.

Background

Prior research has primarily examined parents' transmission of relationship quality to young children with little attention to whether and when this pattern occurs in later-life families.

Method

We conducted multilevel analyses using data collected from 249 older women and 643 of their adult children as part of the Within-Family Differences Study-I.

Results

We found evidence for transmission of older women's reported closeness and tension with their mothers and fathers to their reported closeness and tension with their adult children. Adult children's reports also revealed that older women's closeness with their own mothers was transmitted to their adult children's reported closeness with the older women themselves. Mother-child closeness was transmitted more strongly than mother-child tension, and mother-child closeness was transmitted more strongly to daughters than sons, based on adult children's reports.

Conclusion

This study demonstrates the continuity of intergenerational influence in later-life families and highlights the essential roles that selective social learning and social structural position (i.e., gender) play in conditioning the socialization process.

Age-Dependent Differences in Frequent Mental Distress (FMD) of US Older Adults Living in Multigenerational Families versus Living Alone

Frequent mental distress (FMD) is prevalent among older Americans, but less is known about disparities in FMD of older adults living in multigenerational families versus living alone. We pooled cross-sectional data (unweighted, n = 126,144) from the Behavioral Risk Factor Surveillance System (BRFSS) between 2016 and 2020 and compared FMD (≥14 poor mental health days in the past 30 days = 1; 0 otherwise) of older adults (≥65 years) living in multigenerational families versus living alone in 36 states. After controlling for covariates, findings indicate 23% lower odds of FMD among older adults living in multigenerational households compared to counterparts living alone (adjusted odds ratio (AOR): 0.77; 95% confidence interval (CI): 0.60, 0.99). Findings also show that the reduction in the odds of FMD with each 5 year increase in age was larger among older adults living in multigenerational families by 18% (AOR: 0.56; 95% CI: 0.46, 0.70) compared to older adults living alone (AOR: 0.74; 95% CI: 0.71, 0.77), and this difference was significant at the 5% significance level. Multigenerational living may have a protective association with FMD among older adults. Further research is needed to identify multigenerational family and non-kin factors that translate into mental health advantages for older adults.

Cohabiting Adult Children's Transfers to Parents in the United States

Objective

This brief report presents national estimates of transfers of time and money from cohabiting adult children (ages 18 to 65) to their parents (own and in-laws) to test whether cohabiting adults give differently from their counterparts.

Background

Previous U.S. studies use data collected in the late 1980s and mid-1990s, when cohabitation was an emerging family form; they find mixed results. Rising rates of cohabitation and an aging population of parents who may rely on transfers from adult children necessitate updated estimates that can help develop the theory of institutionalization of cohabitation.

Method

This study used the 2013 Panel Study of Income Dynamics (PSID) Rosters and Transfers Module, a sample of U.S. households (N=6,340), and logistic and negative binomial models to estimate the likelihood of giving any time or any money to parents by the respondent's union status, the amounts given, and parent type (own, in-laws).

Results

Cohabitors were less likely to give time to their own parents than their never married counterparts, and gave fewer hours, but were more likely to give time and gave more hours than married adults. For financial transfers to own parents, cohabitors and married respondents gave similarly, but both were less likely to give any money than are single respondents. Cohabitators gave more hours to their in-laws than married respondents.

Conclusion

Cohabitors behave somewhere in-between marital "greedy institution" norms and broader norms of solidarity with parents. More work should be done to understand how union status affects transfers to parents.

[Psychosocial pathomorphosis of depressions]

OBJECTIVE

The aim is to determine the changes in phenomenology of depressions (mostly of melancholic type with pronounced affect of sadness, chronobiological shift, neurovegetative changes and typical affect-congruent depressive ideas) over the past decades.

MATERIAL AND METHODS

We've compared the archival data of one of the authors (V.N.K.) obtained in the study of depression within 1980-1086 years (1st group, 103 patients, 47 with recurrent depression and 56 with bipolar depression) and the data of the study of depression during 2015-2021 years with registration of symptoms with the same psychopathological scale at the same clinic for affective disorders (2nd group, 109 patients, 52 with recurrent depression and 57 with bipolar depression). The groups are age-comparable (21-59 y.o.). The Hamilton Depression Rating Scale (HDRS-17) has been used to assess the severity of depression (score of 21-32 in both groups). Statistics included frequency analysis with use of χ2 criterion.

RESULTS

Biologically mediated symptoms (shortened sleep with early awakening, typical diurnal variations with vitalization of depressive affect and loss of energy mostly first half of day, decreased appetite, libido and motivation for any activity) were not statistically different in the study groups. Whereas symptoms associated with emotional reactivity and congruent depressive ideations like worthlessness, guilt, suicidal thoughts, as well as anaesthesia psychica dolorosa - were statistically rare in 2nd group, except anhedonia. The same time the facts which have been obvious amongst patients of 2nd group were the difficulties to verbalize their feelings, shortage of vocabular for reflections about their suffering, especially amongst young patients.

CONCLUSION

The results of the study can indicate some changes in the phenomenology of depression over the past decades. Basically, the same underlying disorders can produce different clinical presentation, particularly concerning an awareness and verbalization of moral feelings and other emotions. One of the possible psycholinguistic assumption may be limited vocabulary for feelings because of spreading social networks with very poor and formal language instead of live direct communication.

Educational Attainment Differences in Attitudes toward Provisions of IADL Care for Older Adults in the U.S

Educational attainment is increasingly associated with family inequality in the U.S., but there is little understanding about whether and how education stratifies attitudes toward eldercare. Using the General Social Survey 2012 Eldercare Module, I test the association between educational attainment and attitudes toward eldercare provisions of Instrumental Activities of Daily Living (IADL) including different combinations of help and payment for help. IADLs are the most common care received by older adults and needs are projected to grow, so understanding attitudes toward this type of care is timely and relevant. Results show that adults with a bachelor's degree or graduate/professional degree, compared to adults with less than a high school degree, are more likely to support complete family IADL eldercare, where families provide the care and any payment necessary for care, compared to complete outside IADL eldercare, where outside institutions provide both care and payment. Educational attainment is an important axis of stratification in the U.S. and may explain potentially bifurcated policy solutions desired among different groups.

Development and psychometric evaluation of the loneliness inventory for older adults (Lonely): A mixed-methods study

AIM

To develop and initially validate the Loneliness Inventory for Older Adults.

DESIGN

Scale development and evaluation.

METHODS

This was a two-phase study. In phase 1, the initial items pool (126 items) was generated based on the concept analysis and literature review. Moreover, content validity was established by geriatric and psychometric experts. Phase 2 evaluated structural validity by performing item analysis, exploratory factor analysis and convergent validity. Reliability was evaluated by examining internal consistency, stability (ICC) and absolute reliability.

RESULTS

Following the development process, 94 items were removed and a provisional version of the questionnaire with 32 items was subjected to psychometric evaluation. Three hundred and seventy older adults completed the questionnaire. After performing factor analysis, overall 3 items were removed due to low loading, and the questionnaire was reduced to 29 items tapping into five factors. The Cronbach's alpha for the instrument was 0.94, and the ICC value was 0.97.

Extended Family Caregivers for Persons Living With Dementia

Despite changes in the structure of contemporary families, little is known about extended family members-siblings, grandchildren, nieces/nephews, stepkin-who are primary caregivers for a relative living with dementia. Information about these caregivers is needed to help ensure their needs are understood by providers in health care and social service settings. The focus of this research was on the care situations of extended family caregivers and the impact of caregiving on their health and well-being. In Study 1, data from the National Study of Caregiving were used to describe the experiences of 107 extended family caregivers. In Study 2, case study techniques elicited additional information about the experiences of 10 extended family caregivers. Collectively, these caregivers provide care with little or no formal support and occasional help from a small informal network. Caregiving affected their physical and emotional health, depending on the strength of the relationship between the caregiver and the person living with dementia and the type of care provided. Findings contribute new knowledge about extended family caregivers and highlight the important role extended family dementia caregivers play and the challenges they face.

Remote versus In-Person Health Education: Feasibility, Satisfaction, and Health Literacy for Diverse Older Adults

OBJECTIVES

Health education may improve health in geriatric patients. To evaluate differences between remote and in-person education, the DREAMS (Developing a Research Participation Enhancement and Advocacy Training Program for Diverse Seniors) health seminar series compared in-person and remote learning groups to assess feasibility, satisfaction, adherence, health literacy, and cognitive outcomes.

RESEARCH DESIGN

Nonrandomized two-arm interventions occurred remotely or in-person. About 130 diverse, older adults (M age: 70.8 ± 9.2 years; in-person n = 95; remote, n = 35) enrolled. Data from 115 completers (In-person n = 80; Remote n = 35) were analyzed for performance outcomes. Feasibility, adherence, and satisfaction benchmarks were evaluated at baseline, immediately post intervention, and 8 weeks post intervention. Adjusting for baseline performances, outcomes on health literacy and cognitive measures were compared between groups after intervention (at posttest and at 8-week follow-up) using adjusted mean differences (β coefficients).

RESULTS

Eighty in-person and all remote participants completed at least six modules. Both programs had high satisfaction, feasibility, and strong adherence. After adjusting for demographic covariates and baseline values, cognitive and motor cognitive measures between groups were domain specific (e.g., global cognition, executive function, spatial memory, mental tracking capacity, and cognitive integration).

DISCUSSION AND IMPLICATIONS

This work explores feasible measures of knowledge acquisition and its link to health literacy and cognitive outcomes. Identifying effective delivery methods may increase involvement in clinical research. Future studies may encourage remote learning for increased accessibility.

A research framework for the United Nations Decade of Healthy Ageing (2021-2030)

The mission of UN Decade of Healthy Ageing (2020-2030) is to improve the lives of older people, their families and their communities. In this paper, we create a conceptual framework and research agenda for researchers to knowledge to address the Decade action items. The framework builds on the main components of healthy ageing: Environments (highlighting society and community) across life courses (of work and family) toward wellbeing (of individuals, family members and communities). Knowledge gaps are identified within each area as priority research actions. Within societal environments, interrogating beliefs about ageism and about familism are proposed as a way to illustrate how macro approaches to older people influence their experiences. We need to interrogate the extent to which communities are good places to grow old; and whether they have sufficient resources to be supportive to older residents. Further articulation of trajectories and turning points across the full span of work and of family life courses is proposed to better understand their diversities and the extent to which they lead to adequate financial and social resources in later life. Components of wellbeing are proposed to monitor improvement in the lives of older people, their families and communities. Researcher priorities can be informed by regional and national strategies reflecting Decade actions.

Living at the Wrong Time: Effects of Unmatching Official Time in Portugal and Western Spain

Human circadian rhythmicity is subjected to the internal circadian clock, the sun and social clocks (official time, social/work schedules). The discrepancy among these clocks, as occurs when official time does not match its geographical time zone, may produce circadian disruption. Western Spain (GMT+1/+2) and Portugal (GMT0/+1) share similar longitudes (sun time) but have different official times. This provides a unique opportunity to evaluate the effects of official time on circadian rhythmicity and sleep in elderly and retired populations (with no remunerated duties presumed, although other social commitments may be present) at both locations. Although both populations slept enough for their age (7-8 h), circadian robustness (e.g., interdaily stability, relative amplitude) was greater in Portugal, especially during weekdays, while greater desynchronization (both body temperature vs. motor activity and body temperature vs. light exposure) tended to occur in the Spaniards. Once corrected by GMT0, meals took place later in Spain than in Portugal, especially as the day progresses, and a possible interplay between bed/meal timings and internal desynchronization was found. Our results point to the possible deleterious effect on circadian system robustness when official time is misaligned with its geographical time zone.

Psychometric properties of the Persian version of the "Intergenerational relationship quality scale for aging parents and their children"

BACKGROUND

Investigating the status of intergenerational relationships of elderly parents with their adult childen is very important in examining issues related to the status of the elderly such as well being and quality of life and other aspects of elderly life. Giveeen the significance of the topic, the current study aimed to examine the psychometric properties of the Persian version of "Intergenerational Relationship Quality Scale for Aging Parents and Their Children" (IRQS-AP).

MATERIALS AND METHODS

A total of 463 community-dwelling elders (aged 60 years or older) in Tehran participated in this study through multistage cluster sampling method. To investigate reliability, the construct and convergent validity of the IRQS-AP, confirmatory factor analysis (CFA), and interclass correlation coefficient were done.

RESULTS

The content validity index was 0.84 for the entire tool. In the CFA, we found the instrument had a four-factor structure and adequate internal consistency. The scale had a significant and positive correlation with the two measures of loneliness and depression. Furthermore, Cronbach's alpha was estimated at 0.77, and the high value of the interclass correlation was 0.82.

CONCLUSION

The IRQS-AP is a valid and reliable scale that can be used to examine the status of intergenerational relationship quality in Iranian elder population.

The importance of close next of kin for independent living and readmissions among older Swedish hip fracture patients

We investigate the importance of adult children and/or cohabitation with a partner for older hip fracture patients' probability of independent living, public home care use and hospital readmission. Data from 35,066 Swedish hip fracture patients between 2012 and 2017, aged 65 years, and living at home at the time of the fracture in the Swedish Registry for Hip Fracture Patients and Treatment were linked with national registers. We applied adjusted logistic regression models and Cox proportional hazard models. In total, 959 (4.0%) women and 817 (7.3%) men had no adult children, 13,384 (56.0%) women and 3,623 (32.5%) men had no cohabiting partner and 2,780 (11.6%) women and 1,389 (12.5%) men neither had a cohabiting partner nor adult children. In comparison with women and men who had both a cohabiting partner and adult children, those without a cohabiting partner (i.e. only adult children) and those who neither had a cohabiting partner nor adult children had significantly lower probabilities of returning home (at discharge and after 4 months). They also had a greater probability of both receiving home care and having an increase in the amount of home care they receive. Having a close next of kin and hospital readmission were not associated. In conclusion, absence of a close next of kin, specifically a cohabiting partner, reduces the chance of return to independent living and increases the use of home care after a hip fracture hospitalisation. The findings highlight the importance of family support for older adults living situation after a hip fracture.

Material Hardship and the Living Arrangements of Older Americans

This study investigates the extent to which the household living arrangements of older adults influences their experiences of material hardship. Using data from the 2014 Panel of the Survey of Income and Program Participation, we run linear probability models with individual fixed effects to estimate the likelihood that a change in living arrangements predicts a change in food insecurity, housing hardship and utility hardship. Although household living arrangements are associated with reports of material hardship for older adults, individual fixed effect models point to a reduced role for the change in living arrangements on the change in the probability of experiencing material hardship. For older adults, we find that moving into a non-family household increases the risk of housing hardship. This study illustrates how the risk of material hardship related to family living arrangements changes over the life course. We call for increased attention to the risk of material hardship for older adults living alone, those in multigenerational living arrangements, and non-family households.

A Social-Ecological Model of Grandparenting Experiences: A Systematic Review

BACKGROUND AND OBJECTIVES

Grandparenting trends have been increasing due to rises in female employment, economic stressors, and single-parent families. Because the level of grandparental involvement could either result in beneficial or adverse physical and mental health outcomes, this review aims to use a social-ecological model to compare the childcare experiences of primary and nonprimary grandparent caregivers and the effects of childcare on their physical and emotional health.

RESEARCH DESIGN AND METHODS

This is a systematic review. CINAHL, Embase, PsycINFO, PubMed, and Scopus were searched for qualitative papers. A thematic analysis was conducted, and data were framed using the social-ecological model.

RESULTS

Seventy-four qualitative studies were included. Four themes were generated: intrapersonal: attitudes and motivations (obligation and sense of responsibility, limited physical health, and emotional resources), interpersonal: relationships with grandchildren and adult children (grandparental roles and gendered differences, forging bonds with grandchildren, role ambiguities, conflicts and drawing boundaries, and support and relationships with others), organizational: social services and educational needs, and policy: financial and legal issues. Grandparental well-being is likely to be dependent on the context of the childcare provided, relational bonds with adult children and grandchildren, and the availability of a community and institutional, legal, and financial support.

DISCUSSION AND IMPLICATIONS

The act of grandparenting is laden with cost and reward. To ensure a better quality of life in grandparents' later years, joint efforts between policymakers, educators, and organizations are required to meet their childcare support needs such that they can fulfill their grandparenting roles with ease.

Gender, union formation, and assortative mating among older women

This paper presents a search-theoretic model of union formation among women, aged 55 and older. Specifically, it provides new estimates of gender differentials in cohabitation and marriage at older ages, and documents recent patterns of assortative mating using data from the 2008-2017 American Community Survey. Our analyses reveal that cohabitation represents a much smaller share of all older unmarried women, all partnered women, and all women in comparison to patterns observed among their male counterparts. The results also reveal highly uneven patterns of union formation by age, race and marital history, which reflect demographically uneven constraints and preferences. Our analyses also document, for the first time, patterns of assortative mating at older ages. Shortages of similarly-aged men, especially among older African American women, seemingly heighten the likelihood of demographically mismatched unions. Older women are less likely to form unions with same-race or economically attractive partners, defined as men having a college-degree. This study shows that older single women, in general, are at a comparative disadvantage in the marriage market, both in forming co-residential unions and in finding partners who match their own social, demographic, and economic profiles. This paper highlights considerable heterogeneity in the experiences of America's older women. It calls for new theoretical approaches that acknowledge the unequal resources and bargaining power among older women in the marriage market.

Moderating or mediating effects of family characteristics on socioeconomic inequalities in child health in high-income countries - a scoping review

BACKGROUND

By explaining the development of health inequalities, eco-social theories highlight the importance of social environments that children are embedded in. The most important environment during early childhood is the family, as it profoundly influences children's health through various characteristics. These include family processes, family structure/size, and living conditions, and are closely linked to the socioeconomic position (SEP) of the family. Although it is known that the SEP contributes to health inequalities in early childhood, the effects of family characteristics on health inequalities remain unclear. The objective of this scoping review is to synthesise existing research on the mediating and moderating effects of family characteristics on socioeconomic health inequalities (HI) during early childhood in high-income countries.

METHODS

This review followed the methodology of "Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews". To identify German and English scientific peer-reviewed literature published from January 1st, 2000, to December 19th, 2019, the following search term blocks were linked with the logical operator "AND": (1) family structure/size, processes, living conditions, (2) inequalities, disparities, diversities, (3) income, education, occupation, (4) health and (5) young children. The search covered the electronic databases PubMed, PsycINFO, and Scopus.

RESULTS

The search yielded 7,089 records. After title/abstract and full-text screening, only ten peer-reviewed articles were included in the synthesis, which analysed the effects of family characteristics on HI in early childhood. Family processes (i.e., rules /descriptive norms, stress, parental screen time, parent-child conflicts) are identified to have mediating or moderating effects. While families' living conditions (i.e., TVs in children's bedrooms) are suggested as mediating factors, family structure/size (i.e., single parenthood, number of children in the household) appear to moderate health inequalities.

CONCLUSION

Family characteristics contribute to health inequalities in early childhood. The results provide overall support of models of family stress and family investment. However, knowledge gaps remain regarding the role of family health literacy, regarding a wide range of children's health outcomes (e.g., oral health, inflammation parameters, weight, and height), and the development of health inequalities over the life course starting at birth.

'The Primacy of 'Home': An exploration of how older adults' transition to life in a care home towards the end of the first year

This grounded theory study sought to explore how older adults' experience the transition from living at home to a care home with a specific focus on the latter part of the first year of the move. The study was carried out within a large Health Trust in the UK between August 2017 and May 2019. Purposive sampling was used in the initial stages of data collection. Thereafter and consistent with grounded theory methodology, theoretical sampling was employed to undertake semi-structured interviews with 17 individuals from eight care homes between 5 and 12 months after the move. This paper reports five key categories which were: (a) The lasting effect of first Impressions 'They helped me make my mind up' (b) On a Journey 'I just take it one day at a time', (c) Staying connected and feeling 'at home' 'You get something good out of it you know…you get hope'. (d) Managing loss and grief 'It was important for me to say cheerio to the house' and (e) Caring relationships 'I didn't realise that I was lonely until I had company'. Together these five categories formed the basis of the core category 'The Primacy of 'Home' which participants identified as a place they would like to feel valued, nurtured and have a sense of belonging. This study identifies that it is important for individual preferences and expectations to be managed from the outset of the move. Individuals and families need to be supported to have honest and caring conversations to promote acceptance and adaptation to living in a care home while continuing to embrace the heart of 'home'. Key recommendations from this study include the need to raise awareness of the significance of the ongoing psychological and emotional well-being needs of older people which should be considered in policy directives and clinical practice.

Translation and validation of an ageism scale for dental students in Switzerland

PURPOSE

This study aimed to validate an ageism scale for dental students in Switzerland.

METHODS

The original scale was first translated to German and then evaluated by 14 experts for relevance; four items were eliminated. Validation of the resulting questionnaire was performed at three Swiss dental schools. Principal component analysis (PCA) was performed; Cronbach's alpha (α) was used to assess the internal consistency reliability, and Pearson's coefficient to identify any correlations with demographic parameters (P < 0.05).

RESULTS

PCA revealed 11 items among 4 factors (Overall: 11 items, α = 0.63, variance = 56.6%; Factor #1 (F1): items = 3, α = 0.64; Factor #2 (F2): items = 3, α = 0.42; Factor #3 (F3): items = 3, α = 0.35; Factor #4 (F4): items = 2, α = 0.37). F1 and F4 were correlated with clinical experience (F1: P = 0.042; F4: P = 0.006) and participation in a gerodontology course (F1: P = 0.021; F4: P = 0.004). F1 was correlated with experience of dealing with the elderly (P = 0.031), while residence locality was correlated with F3 (P = 0.047) and F4 (P = 0.043). F2 was correlated with the presence of elderly in the family (P = 0.047).

CONCLUSION

The translated dental ageism questionnaire for Switzerland resulted in an 11-item scale with acceptable reliability.

Grey systems in the management of demand for palliative care services in Poland

BACKGROUND

The concept of care for people in a critical or even terminal health condition, who are in the last stage of their life, has become the mission of palliative care facilities. Therefore, the life of a sick patient poses a number of challenges for health care services to make sure that medical services are tailored to the trajectory of the disease, as well as the various needs, preferences and resources of patients and their families.

METHODS

Health systems financed from public funds need to adopt new methods of management to meet the high and arising demand for a long-term care. There are several ways of assessing the demand for long-term care services. The method recommended by the author and presented in more detail in this paper is the one relying on grey systems, which enables the estimation of forecasting models and, finally, actual forecasts of the number of potential future patients.

RESULTS

GST can be used to make predictions about the future behaviour of the system, which is why this article aims to present the possibility of using the first-order grey model GM (1,1) in predicting the number of patients of palliative care facilities in Poland. The analysis covers the data from 2014 to 2019, whereas the prediction of the number of patients has been additionally formulated for 2020.

CONCLUSIONS

Health systems, particularly publicly funded ones, are characterised by a certain kind of incompleteness and uncertainty of data on the structure and behaviour of its individual components (e.g. potential patients or payers). The present study aims to prove how simple and effective grey systems models are in the decision-making process.

The impact of widowhood on wellbeing, health, and care use: A longitudinal analysis across Europe

OBJECTIVE

To estimate whether becoming widowed had a significant effect on individual's health status as well as on healthcare and non-healthcare resources use, compared to people who remained in a couple in Europe.

DATA AND METHOD

It was used the Survey of Health, Aging and Retirement in Europe from 2004 to 2015. The statistical technique used was genetic matching which analysed the differences in wellbeing, mental health, health status, risk of death, health care resources and long-term care utilization of people who have become widowed, comparing with people who remained married or with a partner. We considered shortterm and medium-term effects.

RESULTS

In the short term, those who became widowed had a worse wellbeing and mental health, in addition to a greater probability of receiving formal care and informal care from outside the household. There seems to be a significant effect in the use of formal and informal care from outside the household in the medium term.

CONCLUSIONS

The results might help to concentrate a major effort of any policy or strategy, not only in the field of health but also in the provision of long-term care, immediately after the negative shock occurs.

Caring as curing: Grandparenting and depressive symptoms in China

Research on grandparenting (i.e., caring for grandchildren) and mental health in Asian contexts has been limited, despite the rapid growth of older adults who take care of grandchildren. This study aims to investigate how grandparenting influences depressive symptoms in China. Using the China Health and Retirement Longitudinal Study (2011-2015, N = 4354), we conducted fixed effects regression models to examine the association between various types of grandparenting and depressive symptoms among older adults between the ages of 45 and 80. The results show that for grandparents, providing care to their grandchildren in skipped-generation households (i.e., grandparent-grandchildren families without adult children) is associated with a lower level of depressive symptoms compared to providing no care, after controlling for socioeconomic status, health behaviors, social support, and basic demographic characteristics. Other types of care (i.e., multigenerational household grandparenting, and part-time and full-time noncoresident grandparenting) are not significantly linked to caregiving grandparents' depressive symptoms. Overall, our findings suggest that sociocultural contexts need to be considered in explaining the different mental health implications of grandparenting.

Understanding the role of social support and social support network for depression among informal dementia caregivers: a pilot clinical project on caregivers in NYC

This study aims to explore the association of depressive symptoms with the informal social support network reported by dementia caregivers participating in a community-based caregiver support program. Caregivers in a community-based dementia caregiver program completed an intake assessment, including the social support network instrument. Measures were completed for caregivers' social support network, using the social support network instrument (SSNI). Measures also included depression, caregiver strain, basic activities of daily living, instrumental activities of daily living, and demographics. Findings suggest the effects of social supports and social network on caregivers' depressive symptoms. Caregivers who had financial supports were less likely to have depressive symptoms. Also, the frequency of contact among social network variables predicted the decrease of depressive symptoms.

Patient-Provider Communication and Online Health Information Seeking among a Sample of US Older Adults

Negative communications with health professionals are a stressor to older adults in healthcare settings. In this situation, older adults seek health information on the Internet as alternative information sources and may consider this as having the equivalent value of communicating with a health professional. This study examines the relationship between communications with health professionals and online health information seeking in older adults. This study used the Health Information National Trends Survey, Cycle 3, and included participants (N = 743) aged 65 or older who used the Internet. A multiple logistic regression was employed to examine the association of health professional communication with online health information seeking. Multinomial logistic regression analysis was applied to examine the association between health communications and three types of online health information seeking in older adults. Online health information seeking was significantly associated with negative communications with health professionals. Health communications only predicted online health information seeking by oneself, and females were more likely to search for health information on the Internet than males. The results of this study show that older adults' online health information seeking is an active coping strategy to reduce health risks and improve health promotion in healthcare.

“Be Their Advocate”: Families’ Experience with a Relative in LTC during the COVID-19 Pandemic

Shortly after the COVID-19 pandemic was declared, strict visitor restrictions were issued for long-term care facilities (LTCFs). A year later, restrictions are still in place and they continue to impact family members who have limited or no in-person contact with their relative in LTCFs. The goal of this qualitative longitudinal focused ethnography was to understand the experience of family members who have a relative in a LTCF where visiting has been restricted during the pandemic. Seventeen family members participated in two interviews that were 6 months apart. Data analysis highlighted five key drivers, defined as the workforce, communication deficits, characteristics of care, public health directives, and autonomy of relative which in turn resulted in three main themes: psychological distress, surveillance, and visiting challenges. This study provides a glimpse into the difficult experiences of families with a relative residing in a LTCF in the province of New Brunswick.

Like Parent, Like Child? Aging Anxiety Among Married Korean Baby Boomers

OBJECTIVES

How intergenerational relationships influence individuals' views on aging remains understudied. This study investigated how multiple older family members' health and financial challenges may shape middle-aged adults' aging anxiety.

METHOD

Married Korean baby boomers (N = 1,389) from the Korean Baby Boomer Panel Study reported on their own aging anxiety and rated each of their living parents' and in-laws' health and financial conditions. Using structural equation modeling, we examined how parents' and in-laws' health and financial challenges are associated with one's aging anxiety, and whether gender and frequency of intergenerational contact moderate the link. We expected worse health or financial conditions to be associated with higher levels of aging anxiety, and the effect to be more pronounced for women and those with more contact.

RESULTS

A worse financial condition of the poorest parent/in-law was associated with higher levels of aging anxiety, while worse health condition of the unhealthiest parent/in-law was associated with lower levels of aging anxiety. The same results were found when we considered the sum of all living parents' and in-laws' financial and health conditions. Frequency of contact moderated the effect of the financial condition of the poorest parent/in-law, such that individuals reporting more contact with the poorest parent/in-law showed higher levels of aging anxiety than those with less contact. There was no moderating effect of gender.

DISCUSSION

The findings highlight the role family ties play in shaping one's aging anxiety. Interventions aimed at improving views on aging through intergenerational interactions should target the quality of the intergenerational experience.

Interrelationships Among Fertility, Internal Migration,and Proximity to Nonresident Family: A Multilevel Multiprocess Analysis

Past research has found that relations to nonresident family can influence individual fertility and migration behaviors separately. However, fertility and migration outcomes may also be interrelated, suggesting potential links across all three demographic processes. With this in mind, we track a cohort of women in Norway from age 18 to 31, recording the emergence of birth and migration events as well as their proximity to nonresident family networks (siblings and parents). Using a multilevel multiprocess statistical framework, with observations nested within women and equations for births, migrations, and proximity to nonresident family estimated simultaneously, our results support the notion that linked lives matter. Even in early adulthood, proximity to nonresident family has a positive effect on transitions to motherhood, whereas the presence of children (itself an outcome of past fertility) is associated with lower propensities to migrate. Mothers also have higher propensities to be living near family than women without children. The presence of local nonresident family reduces propensities for second and third migrations. However, after accounting for unobserved heterogeneity and selection, we observe a small positive effect of proximity to family on first migrations undertaken after age 18. Significant cross-process residual correlations exist across all three outcomes, suggesting that separately estimated model estimates may be vulnerable to bias emerging from unobserved sources of heterogeneity and selection. Our analysis therefore suggests that decisions about fertility, migration, and proximity to family are jointly determined and endogenous, and they should be analyzed simultaneously when possible.

Cognitive Impairment in Grandparents: A Systematic Review

OBJECTIVE

To evaluate the relationship between grandparenting and the cognitive impairment in older persons.

METHODS

The protocol was submitted to the International Prospective Register of Systematic Reviews (PROSPERO), registration number: CRD42018105849. Authors conducted a systematic review, following "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) recommendations. Electronic databases were accessed through august 2018: PubMed, ISI Web of Knowledge, Scopus, and EBSCOhost. Selection of records and quality appraisal were made by two reviewers, independently.

RESULTS

A total of 178 records was found, after removing duplicates. From those, 17 were considered eligible for integral text reading and eight were included: five original studies, one classic review and two editorials. From the five original studies included, four suggested a positive effect on cognition resulting from grandparenting and one suggested that there was no evidence for a causal effect. Though the boundary was not consensual, some studies suggested that a higher frequency of grandparenting has a negative impact on cognition.

CONCLUSION

Overall, studies suggested a trend towards a positive effect of grandchild care on grandparents' cognition. However, there was a significant heterogeneity between methodologies and a significant risk of bias which can hamper conclusions, indicating the need for further and more robust research.

The Critical Need to Recognize That Families Matter for Adult Health: A Systematic Review of the Literature

A systemic approach to researching families and health should capture the complex network within which family members are embedded, including multiple family relationships and larger systems of health care. However, much of the families and health research focused on adult family members has focused solely on intimate partnerships, usually the marital relationship. This neglects the remainder of the powerfully influencing family relationships adults retain, and may increasingly focus on as they age. We conducted a systematic review of the families and adult health literature, retaining 72 articles which were subsequently thematically coded to highlight main foci of this area of research. Results highlight six themes, which include family relationship quality, family composition, behavioral factors in health and health care, psychophysiological mediators, caregiving, and aging health. Findings support an underrepresentation of family members, other than the intimate partner, in research on adult health.

Demographics of Patients Receiving Electroconvulsive Therapy Based on State-Mandated Reporting Data

OBJECTIVES

Electroconvulsive therapy (ECT) is an effective treatment of depression and other psychiatric conditions. There are few comprehensive data on how many patients receive ECT in the United States or about the demographics of ECT recipients. This study characterizes the demographics of those receiving ECT and how these demographics may have changed with time.

METHODS

Freedom of information requests for all data from record keeping inception to January 2019 were sent to the Department of Health or equivalent agency of states that mandate reporting of ECT. Information on demographics and the number of treating facilities was extracted.

RESULTS

Data on 62,602 patients receiving treatment in 3 states (California, Illinois, Vermont) were obtained. Overall, 62.3% were women. Fewer than 1% of patients treated were younger than 18 years, whereas 30.3% were 65 years or older. White patients received a disproportionate proportion of treatments, with all other races underrepresented. The total number of facilities offering ECT in the 3 states declined over the study period.

CONCLUSIONS

Recipients of ECT are more likely to be female, more likely to be elderly, and more likely to be white than the average person in their state.

Eldercare in Japan: Cluster Analysis of Daily Time-Use Patterns of Elder Caregivers

Using the data of the 2006 Japanese Survey on Time Use and Leisure Activities, we perform cluster analysis and identify seven unique patterns of daily time-use patterns of co-resident family elder caregivers: (1) ‘Overworkers’, (2) ‘Full-time Workers’, (3) ‘Part-time Workers’, (4) ‘Intensive Caregivers’, (5) ‘Houseworkers’, (6) ‘Leisurely’, and (7) caregivers, who needed medical attention on the diary day (‘Emergency Diaries’). Our results show that the ‘Houseworkers’ and ‘Intensive Caregivers’ spend the most time on adult caregiving activities. Care activities for ‘Houseworkers’ are more likely to coincide with longer housework hours, increasing the total unpaid work volume. The analysis of demographic profiles suggests that similar daily patterns on weekdays and weekends do not belong to people with the same demographic characteristics. For instance, although on weekdays, ‘Leisurely Caregivers’ are mostly represented by the elderly taking care of other elderly, people of any age can belong to this category on weekends. Among all types of caregivers, only 'Intensive Caregivers' are as likely to be men as they can be women, suggesting that when the need for eldercare increases, family caregivers of any gender will step in.