Creating possibilities for action in the presence of environmental barriers in the process of ‘ageing in place’

ABSTRACTThe need for an understanding of ‘ageing in place’ as a progressive process has emerged among researchers in the field of environmental gerontology. The aim of this study was to explore this process, in relation to home modification services. Four older adults who had applied for home modification services in one Swedish municipality were included. Data were collected by open interviews with the participants in their homes on subsequent occasions, from before the modification had been installed until recognised stability in the situation relating to the home modification. In the analysis, the concept of place integration was used as a tool to explore the active relations that connect people and context over time. The main findings show that the participants used creativity and initiative to direct future situations towards increased possibilities for action. This indicates that services aiming to support people ‘ageing in place’ should be directed towards increasing possibilities for action rather than only facilitating activity performance. Furthermore, it can be concluded that if the service-users' creativity and efforts are recognised as resources in design and provision of services, services that aim to support individuals who are ageing in place have the potential to be empowering.

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Smart home modification design strategies for ageing in place: a systematic review

Journal of Housing and the Built Environment ◽

10.1007/s10901-021-09888-z ◽

2021 ◽

Author(s):

Chuan Ma ◽

Olivia Guerra-Santin ◽

Masi Mohammadi

Keyword(s):

Systematic Review ◽

Older Adults ◽

Independent Living ◽

Smart Home ◽

Universal Design ◽

Design Strategies ◽

Ageing In Place ◽

Home Modification ◽

Hand Search ◽

Modification Process

AbstractThis research explores current strategies and approaches directed to integrate innovative technologies in the home modification process to support independent living and ageing in place. The systematic review considered studies conducted from the perspective of architecture, smart technology, and gerontology. Scientific databases of related disciplines (e.g. Scopus, Web of Science, Engineer village, Google Scholar, Crossref) were searched and supplemented by hand search method. Thirty-three out of 2594 articles were analysed from three perspectives: the framework of the smart home environment for ageing in place, the smart home modification process, and problems and countermeasures of independent living. The result shows that both home modification and smart technologies can support older adults’ independent living, especially with fall prevention and indoor accessibility. Technologies deployed in older adults’ homes are transiting from manual assistive technology to more intelligent devices, and the notion of the robotic home has emerged. According to existing practices, universal design is an extensively adopted strategy for smart home design and modification. However, in most cases, universal design is used as a retrofitting guideline for general home settings rather than specifically for smart homes. The fundamental requirements in smart home modification phases are customisation, minimum life interference, and extensible technologies to cope with the ageing process.

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Biopsychosocial Patterning of Multimorbidity and Its Consequences

The Oxford Handbook of Integrative Health Science ◽

10.1093/oxfordhb/9780190676384.013.14 ◽

2018 ◽

pp. 220-236

Author(s):

Elliot Friedman ◽

Beth LeBreton ◽

Lindsay Fuzzell ◽

Elizabeth Wehrpsann

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Functional Outcomes ◽

The United States ◽

Chronic Medical Conditions ◽

Quality Of Life Research ◽

Increased Risk ◽

Over Time

By many estimates the majority of adults over age 65 have two or more chronic medical conditions (multimorbidity) and are consequently at increased risk of adverse functional outcomes. Nonetheless, many older adults with multimorbidity are able to maintain high levels of function and retain good quality of life. Research presented here is designed to understand the influences that help ensure better functional outcomes in these older adults. This chapter presents findings that draw on data from the Midlife in the United States study. The independent and interactive contributions of diverse factors to multimorbidity and changes in multimorbidity over time are reviewed. The degree that multimorbidity increases risk of cognitive impairment and disability is examined. The role of inflammation as a mediator is considered. Multimorbidity is increasingly the norm for older adults, so better understanding of factors contributing to variability in multimorbidity-related outcomes can lead to improved quality of life.

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INTERNET USE AND LONELINESS OF OLDER ADULTS OVER TIME: THE MEDIATION EFFECT OF SOCIAL CONTACT

Innovation in Aging ◽

10.1093/geroni/igz038.697 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S194-S194

Author(s):

Kexin Yu ◽

Shinyi Wu ◽

Iris Chi

Keyword(s):

Older Adults ◽

Older People ◽

Internet Use ◽

Social Contact ◽

Total Effect ◽

Mediation Effect ◽

Health And Retirement Study ◽

Longitudinal Association ◽

Retirement Study ◽

Over Time

Abstract Internet is increasingly popular among older adults and have changed interpersonal interactions. However, it remains controversial whether older people are more or less lonely with internet use. This paper tests the longitudinal association of internet use and loneliness among older people. One pathway that explains the association, the mediation effect of social contact, was examined. Data from the 2006, 2010 and 2014 waves of Health and Retirement Study was used. Hierarchical liner modeling results showed internet use was related to decreased loneliness over 12-year period of time (b=-0.044, p<.001). Internet use was associated with more social contact with family and friends overtime (b=0.261, p<.001), social contact was related to less perceived loneliness longitudinally (b=0.097, p<.001). The total effect of internet use on loneliness is -0.054 and the mediated effect is -0.025. The findings imply that online activities can be effective for reducing loneliness for older people through increased social contact.

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Dynamics of Multimorbidity Resilience and Health Outcomes Over Time in Community-Residing Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.3285 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 890-891

Author(s):

Yingzhi Xu ◽

Zahra Rahmaty ◽

Eleanor McConnell ◽

Tingzhong (Michelle) Xue ◽

Bada Kang ◽

...

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Physical Health ◽

Social Life ◽

Structural Equation ◽

Equation Modeling ◽

Psychological Resilience ◽

Pain Level ◽

Reciprocal Relationships ◽

Over Time

Abstract Multimorbidity resilience may mitigate the adverse effects of multiple chronic diseases on older adults’ health. Wister et al.’s (2018) multimorbidity resilience index was developed and tested in a cross-sectional sample of older adults in Canada. Building on these findings, we examined the reciprocal relationships of resilience on outcomes to test these potentially mitigating effects in a community-based, U.S. sample of older adults over time. The study sample includes 1,054 older adults from waves 2 and 3 of the National Social Life, Health, and Aging Project (NSHAP) study (Waite et al 2020). Wister et al.’s (2018) index was mapped to NSHAP measures, and reciprocal relationships of multimorbidity resilience and health outcomes over a 5-year period was tested using structural equation modeling (SEM). Results indicated significant effects of multimorbidity resilience on self-rated physical health and pain. Interestingly, a better functional resilience at baseline conferred better self-rated physical health at follow-up, while better psychological resilience predicted lower pain level. By contrast, the influence of health outcomes on any domain of multimorbidity resilience was not detectable at all, supporting the direction of these associations from resilience to outcomes. The study systematically investigated the dynamic hypotheses between multimorbidity resilience and health outcomes. That is, whether they are determinants or consequences, or both. Our findings suggest multimorbidity resilience predicts subsequent 5-year change in health outcomes, especially self-rated physical health and pain level, but not vice versa, strengthening the evidence of the importance of resilience in the health of older adults.

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Housing adaptations and housing accessibility problems among older adults with long-standing spinal cord injury

British Journal of Occupational Therapy ◽

10.1177/0308022620979516 ◽

2020 ◽

pp. 030802262097951

Author(s):

Lizette Norin ◽

Björn Slaug ◽

Maria Haak ◽

Susanne Iwarsson

Keyword(s):

Older Adults ◽

Spinal Cord ◽

Spinal Cord Injuries ◽

Occupational Performance ◽

Environmental Barriers ◽

Cord Injury ◽

Long Term Follow Up ◽

Societal Level ◽

The Individual

Introduction Adults with spinal cord injuries are living longer than previously, and a majority are living in ordinary housing in the community. Housing accessibility is important for maintaining independent occupational performance for this population, but knowledge in this area is insufficient. We investigated housing adaptations and current accessibility problems among older adults with long-standing (>10 years) spinal cord injuries. Method Data from home visits among 122 older adults with spinal cord injuries in Sweden were used. Housing adaptations and environmental barriers were descriptively analysed. Findings Kitchens, entrances, and hygiene areas were common locations for housing adaptations and environmental barriers that generated accessibility problems. The most common adaptations were ramps, wheelchair-accessible stovetops, and ceiling-lifts. Wall-mounted cupboards and high shelves (kitchen), inaccessible storage areas (outside the dwelling), and a lack of grab bars (hygiene area) generated the most accessibility problems. Conclusion Despite housing adaptations, there are considerable accessibility problems in the dwellings of older adults with long-standing spinal cord injuries in Sweden, indicating that long-term follow-up of the housing situation of this population is necessary. Focusing on accessible housing as a prerequisite for occupational performance is at the core of occupational therapy, deserving attention on the individual as well as the societal level.

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Age-Cohort Differences in Longitudinal Associations Between the Rate of Internet Use and Memory Functioning

Innovation in Aging ◽

10.1093/geroni/igaa057.1321 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 410-410

Author(s):

Vineet Raichur ◽

Lindsay Ryan ◽

Richard Gonzalez ◽

Jacqui Smith

Keyword(s):

Older Adults ◽

Episodic Memory ◽

Cognitive Complexity ◽

Internet Use ◽

Age Groups ◽

Word Recall ◽

Use Patterns ◽

Younger Age ◽

Rate Of Increase ◽

Over Time

Abstract Cross-sectional analyses of internet use patterns among older adults find that the rate of internet use is less with greater physical and memory difficulties. It is not clear, however, how age-cohorts differ in their internet use as physical and memory difficulties increase over time. In addition to factors such as increasing accessibility (cost) and social influences, the expansion and cognitive complexity of functions performed by the internet-enabled devices over time could influence internet use patterns. In this study, we investigate how the association between internet use and episodic memory difficulties over time varies between cohorts. We analyzed longitudinal data from the Health and Retirement Study (N = 15,703 in 2002; Aged 51 and older) between years 2002-2016 using mixed effects logistic regression models. Immediate and delayed word recall measures were used to assess episodic memory. Rate of internet use in the sample increased from 30% in 2002 to 53% in 2016. Rate of internet use among younger age groups was significantly higher in the baseline year. Younger age groups also showed a significantly higher rate of increase in internet use over time. In general, internet use decreased with episodic memory impairment. In addition to these effects, the effect of episodic memory on the rate of increase in internet use over time is lower in younger cohorts. These results indicate that younger cohorts of older adults are more likely to maintain internet use as they continue to age and therefore could better utilize technology for communication, social interactions and health interventions.

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The Importance of Studying Health Behavior in Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.3020 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 827-827

Author(s):

Jaime Hughes ◽

Susan Hughes ◽

Mina Raj ◽

Janet Bettger

Keyword(s):

Social Support ◽

Older Adults ◽

Behavior Change ◽

Chronic Conditions ◽

Population Level ◽

Multiple Chronic Conditions ◽

Prior Work ◽

Time Changes ◽

The Impact ◽

Over Time

Abstract Behavior change is an inherent aspect of routine geriatric care. However, most research and clinical programs emphasis how to initiate behavior change with less emphasis placed on skills and strategies to maintain behaviors over time, including after an intervention has concluded. This presentation will provide an introduction to the symposium, including a review of prior work and our rationale for studying the critical yet overlooked construct of maintenance in older adults. Several key considerations in our work include the impact of multiple chronic conditions, declines in cognitive and functional capacity over time, changes in environmental context and/or social support, and sustainability of community and population-level programs and services.

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Longitudinal associations between late-life depression dimensions and cognitive functioning: a cross-domain latent growth curve analysis

Psychological Medicine ◽

10.1017/s003329171600297x ◽

2016 ◽

Vol 47 (4) ◽

pp. 690-702 ◽

Cited By ~ 20

Author(s):

A. Brailean ◽

M. J. Aartsen ◽

G. Muniz-Terrera ◽

M. Prince ◽

A. M. Prina ◽

...

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Processing Speed ◽

Memory Function ◽

Somatic Symptoms ◽

Late Life ◽

Late Life Depression ◽

Latent Growth ◽

Depressed Affect ◽

Over Time

BackgroundCognitive impairment and depression often co-occur in older adults, but it is not clear whether depression is a risk factor for cognitive decline, a psychological reaction to cognitive decline, or whether changes in depressive symptoms correlate with changes in cognitive performance over time. The co-morbid manifestation of depression and cognitive impairment may reflect either a causal effect or a common cause, depending on the specific symptoms experienced and the cognitive functions affected.MethodThe study sample comprised 1506 community-dwelling older adults aged ⩾65 years from the Longitudinal Aging Study Amsterdam (LASA). We conducted cross-domain latent growth curve analyses to examine longitudinal associations between late-life depression dimensions (i.e. depressed affect, positive affect, and somatic symptoms) and specific domains of cognitive functioning (i.e. processing speed, inductive reasoning, immediate recall, and delayed recall).ResultsPoorer delayed recall performance at baseline predicted a steeper increase in depressed affect over time. Steeper decline in processing speed correlated with a steeper increase in somatic symptoms of depression over time.ConclusionsOur findings suggest a prospective association between memory function and depressed affect, whereby older adults may experience an increase in depressed affect in reaction to poor memory function. Somatic symptoms of depression increased concurrently with declining processing speed, which may reflect common neurodegenerative processes. Our findings do not support the hypothesis that depression symptoms may be a risk factor for cognitive decline in the general population. These findings have potential implications for the treatment of late-life depression and for the prognosis of cognitive outcomes.

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Age Differences in the Social Associative Learning of Trust Information

10.31234/osf.io/b38rd ◽

2022 ◽

Author(s):

Kendra Leigh Seaman ◽

Alexander P. Christensen ◽

Katherine Senn ◽

Jessica Cooper ◽

Brittany Shane Cassidy

Keyword(s):

Older Adults ◽

Age Differences ◽

Social Cues ◽

Trust Game ◽

Time Model ◽

Younger Adults ◽

Cortical Areas ◽

Age Related ◽

The Social ◽

Over Time

Trust is a key component of social interaction. Older adults, however, often exhibit excessive trust relative to younger adults. One explanation is that older adults may learn to trust differently than younger adults. Here, we examine how younger (N=33) and older adults (N=30) learn to trust over time. Participants completed a classic iterative trust game with three partners. Younger and older adults shared similar amounts but differed in how they shared money. Compared to younger adults, older adults invested more with untrustworthy partners and less with trustworthy partners. As a group, older adults displayed less learning than younger adults. However, computational modeling shows that this is because older adults are more likely to forget what they have learned over time. Model-based fMRI analyses revealed several age-related differences in neural processing. Younger adults showed prediction error signals in social processing areas while older adults showed over-recruitment of several cortical areas. Collectively, these findings suggest that older adults attend to and learn from social cues differently from younger adults.

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Abstract 88: Increasing False Positive Diagnoses May Lead to Overestimation of Stroke Incidence, Particularly in the Young

Stroke ◽

10.1161/str.51.suppl_1.88 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Abhinav J Appukutty ◽

Lesli E Skolarus ◽

Mellanie V Springer ◽

William J Meurer ◽

James F Burke

Keyword(s):

Older Adults ◽

False Positive ◽

Age Groups ◽

Vascular Risk Factor ◽

The United States ◽

Cross Sectional ◽

Stroke Incidence ◽

Ed Visits ◽

Over Time

Introduction: Stroke incidence is reportedly increasing in younger adults. While increasing vascular risk factor prevalence has been suggested as a cause, the reasons for rising stroke incidence in the young are not clear. We explored several alternate explanations: trends in neurologically-focused emergency department (ED) visits, differential diagnostic classification of stroke and TIA over time, and changes in the use of advanced imaging in young and older adults. Methods: We performed a retrospective, serial, cross-sectional study on a nationally representative sample of all ED visits in the United States to quantify changes in patterns of neurologically-focused ED visits, stroke and TIA diagnoses, and rates of MRI utilization for young (18 – 44 years) and older (65+ years) adults over a 17-year period (1995 – 2000; 2005 – 2015) using National Hospital Ambulatory Medical Care Survey (NHAMCS) data. Results: In young adults, 0.4% (95% CI 0.3% – 0.5%) of neurologically-focused ED visits resulted in a primary diagnosis of stroke vs. 6.8% (95% CI 6.2% – 7.5%) for older adults. In both populations, the incidence of neurologically-focused ED visits has increased over time (+111/100,000 population/year, 95% CI +94 – +130 in the young vs. +70/100,000 population/year, 95% CI +34 – +108 in older adults). There was no evidence of differential classification of TIA to stroke over time (OR 1.001 per year, 95% CI 0.926 – 1.083 in the young; OR 1.003 per year, 95% CI 0.982 – 1.026 in older adults) and no evidence of disproportionate rise in MRI utilization for neurologically-focused ED visits in the young (OR 1.057 per year, 95% CI 1.028 – 1.086 in the young; OR 1.095 per year, 95% CI 1.066 – 1.125 in older adults). Conclusions: If the specificity of stroke diagnosis amongst ED visits is similar amongst young and older populations, then the combination of data observed here, including (1) a lower prior probability of stroke diagnoses in the young and (2) an increasing trend in neurologically-focused ED visits in both age groups, suggests that false positive diagnoses will increase over time, with a faster rise in the young compared to older adults. These data suggest a potential explanation that may contribute to higher stroke incidence in the young and merits further scrutiny.

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