Making aging a public health priority

In-home environment and happiness among older adults in Thailand

Background

The fact that housing can play a critical role in maintaining the health and independence related to happiness of the older population has been studied in more developed countries. However, research on the effect of housing conditions on happiness is rare in less developed countries. This study aimed to construct and test a structural equation model describing the structural relationship among personal aspects (living alone and physical disability), in-home environment (sleeping place and toilet/bathroom), and happiness among older adults in Thailand.

Method

The data on the population age 75 years or over were extracted from the 2017 national Survey of Older Persons in Thailand (n = 7,829).

Results

The median age of the sample population was 79. Almost 60 percent were women. The structural equation model showed a good fit with the data. Living alone did not directly influence happiness. Physical disability had a statistically significant negative direct effect on happiness. In-home environment not only had an impact on happiness directly, but also moderated the relationship between physical disability and happiness.

Conclusion

The research suggested that interventions to improve happiness of older adults, particularly those with physical disability, should aim to adapt their housing, including sleeping place and toilet design.

Good places for ageing in place: development of objective built environment measures for investigating links with older people's wellbeing

BACKGROUND

There is renewed interest in the role of the built environment in public health. Relatively little research to date investigates its impact on healthy ageing. Ageing in place has been adopted as a key strategy for coping with the challenges of longevity. What is needed is a better understanding of how individual characteristics of older people's residential environments (from front door to wider neighbourhood) contribute to their wellbeing, in order to provide the basis for evidence-based housing/urban design and development of interventions. This research aimed to develop a tool to objectively measure a large range of built environment characteristics, as the basis for a preliminary study of potential relationships with a number of 'place-related' functional, emotional and social wellbeing constructs.

METHODS

Through a review of urban design literature, design documents, and existing measures, a new tool, the NeDeCC (Neighbourhood Design Characteristics Checklist) was developed. It was piloted, refined, and its reliability validated through inter-rater tests. A range of place-related wellbeing constructs were identified and measured through interviews with 200 older people living in a wide variety of rural-urban environments and different types of housing in England. The NeDeCC was used to measure the residential environment of each participant, and significant bivariate relationships with wellbeing variables were identified.

RESULTS

The NeDeCC was found to have convincing face and construct validity and good inter-rater and test/retest reliability, though it would benefit from use of digital data sources such as Google Earth to eliminate the need for on-site survey. The significant relationships found in the study suggest that there may be characteristics of residential environments of potential relevance for older people's lives that have been overlooked in research to date, and that it may be worthwhile to question some of the assumptions about where and how older people want to live (e.g. villages seem to be positive). They also point to the importance of considering non-linear relationships.

CONCLUSIONS

The NeDeCC provides the basis for generation of evidence-based design guidance if it is used in prospective controlled studies or 'natural experiments' in the future. Ultimately, this will facilitate the creation of better places for ageing in place.

Estimating exposure to chemical contaminants in drinking water

A model is developed that predicts exposure and absorbed dose for chemical contaminants in household drinking water via three pathways: inhalation, direct and indirect ingestion, and dermal penetration. Extensive probability distributions for building characteristics, activity and water use patterns, operating conditions of water devices, and physiological characteristics of the general population are developed. The impacts of different operating conditions on mass transfer coefficients for the shower, bath, washing machine, dishwasher, and faucet are established. Dichlorobromomethane, inorganic lead, and endosulfan, three compounds associated with adverse birth outcomes that have significantly different chemical properties, are selected for analysis. The primary exposure pathways for dichlorobromomethane are inhalation (62%) and ingestion (27%). Seventy percent of total exposure to endosulfan comes from ingestion, and 18% from dermal sorption with the remaining 12% due to inhalation. Virtually all (99.9%) of the exposure to lead occurs via ingestion. A nested Monte Carlo analysis shows that natural variability contributes significantly more (a factor of 10) toward total uncertainty than knowledge uncertainty (a factor of 1.5). Better identification of certain critical input variables (ventilation rate in the shower and bathroom, ingestion rate, the boiling water mass transfer coefficient, and skin permeability) is required.

Caregivers of frail rural older adults. Effects of an advanced practice nursing intervention

Informal caregivers are responsible for providing the majority of post-discharge care for many frail older adults in rural settings. The purpose of this study was to investigate whether an advanced practice nurse (APN) intervention would promote more positive physical and emotional outcomes in caregivers of rural older adults who are frail and were recently discharged from urban-based hospitals. Thirty-two caregivers of frail rural elderly individuals were randomly assigned to treatment (APN intervention) and control groups (no APN intervention). Assessments of caregiver outcomes were collected via telephone interviews at 48-hour, 2-week, and 4-week intervals after hospital discharge of the frail rural older adults. Outcomes were operationalized as caregiver physical health and well being, and stress and burden. The former was measured using the Health and Daily Living form (HDL) and the latter by the Thoughts and Feeling and Time and Energy subscales of the Caregiver Burden Inventory (CBI). Additional information on caregiver problems and APN visit time was collected by the APN using the Omaha Classification System. Caregivers in the treatment group experienced significantly more positive physical and emotional health outcomes. The caregivers who received the APN intervention had higher self-rated emotional health scores, fewer emotional symptoms at Week 4, fewer depressive symptoms at Week 2 and 4, and lower Thoughts and Feelings stress scores at 48 hours than the control group. Findings support the importance of addressing the needs of caregivers post-discharge and the ability of APNs to improve post-discharge outcomes for home health care recipients and their caregivers.