At-Homeness Influences the Cognition of Multimorbid Older Adults: Longitudinal Path Analysis Through Loneliness

Abstract Approximately two-thirds of older adults’ experience multimorbidity in North America. Challenges of symptoms management and reduced mobility often coincide with late-life depression which is associated with a 2 to 5-fold increased dementia risk. Loneliness and depression are connected in the prodromal phases. We examine the effects of physical environment (e.g., housing and neighborhood factors) and social environment (e.g., social support) on loneliness, depression, and cognition using path analysis, controlling for baseline. Data(n=15,087) was drawn from the Canadian Longitudinal Study on Aging. Measures of housing, neighborhood and life satisfaction were used to construct an index of “at-homeness” based on theory. We found good model fit (TLI=.989; CFI=.999; RMSEA=.026; SRMR=.006). At-homeness(B=-.20, p<.001) rivaled the effect of social environment(B=-.19, p<.001) on loneliness. Together, physical environment and loneliness had as much effect on cognition as depression. If causality is supported, modifying older adults’ satisfaction with their home environment may reduce loneliness and cognitive decline.

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Neighborhood Cohesion and the Mental Health of Multimorbid Older Adults: CLSA Path Analysis Through Loneliness

Innovation in Aging ◽

10.1093/geroni/igab046.945 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 246-246

Author(s):

Daniel R Y Gan ◽

Andrew Wister ◽

John Best

Keyword(s):

Mental Health ◽

Older Adults ◽

Life Satisfaction ◽

Path Analysis ◽

Social Environment ◽

Physical Environment ◽

Aging In Place ◽

Housing Quality ◽

Neighborhood Cohesion ◽

Intermediate Variables

Abstract More older adults with multimorbidity are aging in place than ever before. Their mental health may be affected by housing and neighborhood factors. In this paper, we use structural equation modelling (SEM) to examine how the physical environment influences life satisfaction and depressive symptoms in two separate models. We included social environment (i.e., social support, social participation, walking) and loneliness as intermediate variables. Data were drawn from baseline and the first follow-up (after 3-4 years) of the Canadian Longitudinal Study on Aging (CLSA). Participants were N=14,301 adults aged □65 with □2 chronic illnesses. Good model fit were found after controlling for age, sex, education and baseline values (TFI=1.00; CFI=1.00; RMSEA<0.001; SRMR<0.001). The total effects of housing quality (Btotal=0.08,-0.07) and neighborhood cohesion (Btotal=0.03,-0.06) were weak but statistically significant in the expected direction. Together, the intermediate variables explained 21-31% of the total effects of housing quality and 67-100% of the total effects of neighborhood cohesion. Loneliness explains 27-29% of the total effects of physical environment on mental health, whereas walking explained a mere 0.4-0.9% of their total effects. Walking did not mediate between housing quality and mental health outcomes. Overall, the results support our path analysis framework: physical environment -> social environment -> loneliness -> mental health. Our model provided excellent explanations of the effects of neighborhood cohesion, especially on life satisfaction. If these associations reflect causal effects, community-based age-friendly interventions should focus on neighborhood cohesion and loneliness to promote the well-being of older adults who are aging in place with multimorbidity.

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Identifying barriers and problems of physical environment in older adults’ homes: An ergonomic approach

Work ◽

10.3233/wor-210765 ◽

2021 ◽

pp. 1-15

Author(s):

Hossein Fallah ◽

Jalil Nazari ◽

Alireza Choobineh ◽

Mohammad Ali Morowatisharifabad ◽

Mohamad Asghari Jafarabadi

Keyword(s):

Older Adults ◽

Home Environment ◽

Physical Environment ◽

Sampling Methods ◽

Structured Interview ◽

Root Cause ◽

Cognitive Limitations ◽

Environment Adaptation ◽

Conventional Content Analysis ◽

Better Than

BACKGROUND: The main purpose of ergonomics is environment adaptation to humans, and the root cause of the barriers and problems of the older adults is the mismatch between the home environment and their limitations. OBJECTIVE: The present study aimed to identify and explain physical environment barriers and problems among older adults’ homes in Yazd, Iran. METHODS: This qualitative study was conducted as conventional content analysis. In total, 53 participants including 36 older adults and 17 caregivers were enrolled in the study. The participants were selected using convenience and purposive sampling methods, while the data collection method was a semi-structured interview. The interviews were recorded and transcribed, and then analyzed using MAXQDA11 software. RESULTS: Following data analysis, 268 initial codes were extracted. They were classified into three major categories and 31 sub categories. The main categories are “barriers and problems associated with older adults’ sensory limitations,” “barriers and problems associated with older adults’ motor limitations,” and “barriers and problems associated with older adults’ cognitive limitations.” CONCLUSIONS: Although the data collected from the older adults and their caregivers are in many cases similar, caregivers can provide reasons for the barriers and problems as well as solutions better than the older adults. The data also indicate that most of the problems and barriers are related to motor limitations.

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Health Promotion for Older Americans in the 21st Century

American Journal of Health Promotion ◽

10.4278/0890-1171-14.6.371 ◽

2000 ◽

Vol 14 (6) ◽

pp. 371-379 ◽

Cited By ~ 47

Author(s):

Meredith Minkler ◽

Helen Schauffler ◽

Kristen Clements-Nolle

Keyword(s):

Older Adults ◽

Health Promotion ◽

Social Environment ◽

21St Century ◽

Physical Environment ◽

Behavioral Risk ◽

Older Americans ◽

The Social ◽

The Individual

Objectives. To provide a broad overview of the role of the individual, the physical environment, and the social environment on health and functioning in older adults (65 and older), and to highlight interventions and recommendations for action on each of these levels. Data Sources. Published studies and government reports on health and functioning in older Americans and on the individual, social, and physical environmental contributors to health were identified through journal and government documents review and computer library searches of medical and social science data bases for 1980–1999. Study Selection. Preference was given to published studies and government reports that focused specifically on behavioral and environmental contributors and barriers to health promotion in Americans 65 and older and/or that highlighted creative interventions with relevance to this population. Both review articles and presentations of original research were included, with the latter selected based on soundness of design and execution and/or creativity of intervention described. Data Extraction. Studies were examined and their findings organized under three major headings: (1) behavioral risk factors and risk reduction, including current government standards for prevention and screening; (2) the role of the physical environment; and (3) the role of the social environment in relation to health promotion of older adults. Data Synthesis. Although most attention has been paid to the role of behavioral factors in health promotion for older adults, a substantial body of evidence suggests that physical and social environmental factors also play a key role. Similarly, interventions that promote individual behavioral risk reduction and interventions targeting the broader social or physical environment all may contribute to health in the later years. Conclusions. With the rapid aging of America's population, increased attention must be focused on health promotion for those who are or will soon be older adults. Promising intervention strategies addressing the individual, the physical environment, and the social environment should be identified and tested, and their potential for replication explored, as we work toward a more comprehensive approach to improving the health of older Americans in the 21st century.

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Wake After Sleep Onset Mediates the Link Between Neighborhood Social Environment and Cognition in Older Adults

Innovation in Aging ◽

10.1093/geroni/igab046.1467 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 380-381

Author(s):

Kexin Yu ◽

Paul Duberstein ◽

Bernadette Fausto

Keyword(s):

Older Adults ◽

Social Environment ◽

Physical Environment ◽

Social Life ◽

Structural Equation ◽

Sleep Onset ◽

Public Health Intervention ◽

Neighborhood Environment ◽

Equation Modeling ◽

Social And Physical Environment

Abstract Cognition is influenced by the neighborhood social and physical environment, but the underlying mechanisms by which neighborhood environment affects cognition are unclear. We tested the hypothesis that sleep mediates the effects between environmental exposures and cognition. We employed structural equation modeling to examine interrelationships among neighborhood social and physical environment, actigraphic sleep characteristics, and global cognition in a sample of older adults (N=3,196) from Round 2 of the National Social Life, Health, and Aging Project. Results indicated that participants with better cognition lived in salutary (e.g., cohesive, safe) social environments (est.=0.03, p<.001) and less disruptive (e.g., noisy, polluted) physical environments (est.=-0.04, p<.001). The mediation hypothesis was partially supported. Time spent awake after sleep onset mediated the social environment-cognition relationship, but sleep characteristics did not mediate the physical environment-cognition relationship. Future work should identify other environmental influences on sleep and cognition in aging to inform public health intervention priorities.

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Social Determinants of Cognitive Health: Studies on Physical and Social Environments and Cognition

Innovation in Aging ◽

10.1093/geroni/igab046.1464 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 380-380

Author(s):

Kexin Yu ◽

Kheng Siang (Ted) Ng ◽

Patricia Heyn

Keyword(s):

Older Adults ◽

Social Environment ◽

Social Determinants ◽

Physical Environment ◽

Living Environment ◽

Social Environments ◽

Cognitive Health ◽

The Social ◽

Living Environments ◽

The Impact

Abstract Living environments profoundly influence the aging process. This symposium presents research on two main aspects of the living environment and their relationships with cognitive health. The living environment is broadly defined, including both physical and social aspects. The physical environment is the characteristics of the built environment, such as tripping hazard in the home, cleanness of the community streets, and presence of deserted buildings, etc. The social environment is the cohesiveness with other people living in the neighborhood. Living environments have multiple layers; the physical environments encompass both in-home and in-community domains, whereas the social environment can be categorized as domestic versus community cohesiveness. This symposium includes studies with investigation scopes spanning from the micro to mezzo levels. The first presentation scrutinizes the buffering effect of marital relationships, as a form of domestic social environments, on cognition among older adults with vision and hearing impairments. Using the NHATS dataset, the second presentation examines social isolation as a potential mediator for the association between physical, social environments and global cognitive functioning. The third presentation evaluates the impact of living environments on cognition among Canadian older adults with multimorbidity. The last presentation examines how the physical environment affects sleep quality and thus influences older adults’ cognition. All four presentations are closely linked to the overarching theme of evaluating the environmental impact on cognition and provide possible explanations mediating the association observed. This symposium contributes to advancing gerontological knowledge by offering new perspectives on the social determinants of cognitive health.

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Refining Evidence-Based Treatments for Late-Life Depression

GeroPsych ◽

10.1024/1662-9647/a000127 ◽

2015 ◽

Vol 28 (2) ◽

pp. 67-76

Author(s):

Grace C. Niu ◽

Patricia A. Arean

Keyword(s):

Older Adults ◽

Mental Illness ◽

Brain Plasticity ◽

Late Life ◽

Aging Population ◽

The United States ◽

Future Research ◽

Evidence Based ◽

Late Life Depression ◽

Evidence Based Treatments

The recent increase in the aging population, specifically in the United States, has raised concerns regarding treatment for mental illness among older adults. Late-life depression (LLD) is a complex condition that has become widespread among the aging population. Despite the availability of behavioral interventions and psychotherapies, few depressed older adults actually receive treatment. In this paper we review the research on refining treatments for LLD. We first identify evidence-based treatments (EBTs) for LLD and the problems associated with efficacy and dissemination, then review approaches to conceptualizing mental illness, specifically concepts related to brain plasticity and the Research Domain Criteria (RDoc). Finally, we introduce ENGAGE as a streamlined treatment for LLD and discuss implications for future research.

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The Effect of Neighborhood Experiences on Positive Mental Health Among Community-Dwelling Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.1408 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 436-436

Author(s):

Daniel R Y Gan ◽

Grand H-L Cheng ◽

Tze Pin Ng ◽

John Chye Fung ◽

Im Sik Cho

Keyword(s):

Mental Health ◽

Older Adults ◽

Path Analysis ◽

Linear Regression Analysis ◽

Psychosocial Health ◽

Positive Mental Health ◽

Community Dwelling ◽

Neighborhood Environment ◽

Community Based Interventions ◽

Psychosocial Wellbeing

Abstract Given reduced life spaces, the neighborhood often functions as a social venue for older adults. Yet how these everyday social spaces affect older adults’ psychosocial wellbeing remains largely unknown. Drawing on the GRP-CARE Survey data, this paper examined the relation between neighborhood experiences and positive mental health. Participants were 601 community-dwelling Singaporeans aged 50+ who lived in public housing neighborhoods. Neighborhood experiences were measured using the four-factorial, 16-item OpenX scale (Gan, Fung, Cho, 2019); positive mental health was measured using a six-factorial, 19-item scale (Vaingankar et al., 2011). Both scales have good psychometric properties and had been validated. Path analysis between relevant factors of both scales was conducted using Stata, within a theorized model of causation from neighborhood environment to social factors to psychosocial health. Age, education, ethnicity and sex were controlled for. Multiple linear regression analysis showed a strong, positive association between neighborhood experiences and mental health (p=0.000) even after controlling for personal traits (operationalized as depressive symptoms, GDS) in addition to sociodemographic variables. Path analysis showed that two distinct neighborhood health processes mediated this association. These were (1) the potential for a sense of community in the neighborhood improved emotional support, and (2) having better neighborly friendships improved interpersonal skills. These neighborhood health processes provide us with new lenses to understand older adults’ everyday experiences of their neighborhoods. Community-based interventions to improve older adults’ psychosocial wellbeing may be developed to facilitate these processes. Spatial and programmatic implications will be discussed in relation to age-friendly cities and communities (AFCC).

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The Relationship Between the Home Environment and Falls for Older Adults With Visual Impairments

Innovation in Aging ◽

10.1093/geroni/igaa057.2783 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 770-770

Author(s):

Bonnielin Swenor ◽

Aleksandra Mihailovic ◽

Pradeep Ramulu

Keyword(s):

Older Adults ◽

Home Environment ◽

Visually Impaired ◽

Visual Impairments ◽

Fold Increase ◽

Engineering Society ◽

Environment Assessment ◽

Risk Factors For Falls ◽

The Relationship

Abstract The home environment and features of the home have been identified as important risk factors for falls, and may pose particular risk for older adults with visual impairments given difficulty with hazard perception. We used data from 245 participants in the Falls in Glaucoma Study [mean age: 71 years, mean follow-up: 31 months] with homes graded using our previously validated Home Environment Assessment for the Visually Impaired (HEAVI), which quantifies the number of in-home fall-related hazards and found that neither the number of hazards nor the percentage of hazardous items were associated falls/year. However, each 10-fold increase in lighting was associated with a 35% lower rate of falls/year (RR=0.65, 95%CI=0.46 to 0.92) and there was a 50% reduction in falls/year when lighting was at or above 30 footcandles (minimum lighting level recommended by the Engineering Society of North America) compared to lighting <30 footcandles (RR=0.50, 95%CI=0.26 to 0.96).

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Health and social care service utilisation and associated expenditure among community-dwelling older adults with depressive symptoms

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796020001122 ◽

2021 ◽

Vol 30 ◽

Author(s):

Shiyu Lu ◽

Tianyin Liu ◽

Gloria H. Y. Wong ◽

Dara K. Y. Leung ◽

Lesley C. Y. Sze ◽

...

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Symptom Severity ◽

Social Care ◽

Late Life ◽

Community Dwelling ◽

Service Utilisation ◽

Late Life Depression ◽

Social Care Service ◽

Health And Social Care

Abstract Aims Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity. Methods We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year. Results The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126–10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520–5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854–2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444–939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854). Conclusions The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.

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Obstructive Sleep Apnea Treatment and Dementia Risk in Older Adults

SLEEP ◽

10.1093/sleep/zsab076 ◽

2021 ◽

Author(s):

G L Dunietz ◽

R D Chervin ◽

J F Burke ◽

A S Conceicao ◽

T J Braley

Keyword(s):

Older Adults ◽

Statistical Significance ◽

Fee For Service ◽

Medicare Beneficiaries ◽

Lower Odds ◽

Logistic Regression Models ◽

Not Otherwise Specified ◽

Dementia Risk ◽

Obstructive Sleep ◽

Study Participants

Abstract Study Objectives To examine associations between PAP therapy, adherence and incident diagnoses of Alzheimer’s disease (AD), mild cognitive impairment (MCI), and dementia not-otherwise-specified (DNOS) in older adults. Methods This retrospective study utilized Medicare 5% fee-for-service claims data of 53,321 beneficiaries, aged 65+, with an OSA diagnosis prior to 2011. Study participants were evaluated using ICD-9 codes for neurocognitive syndromes [AD(n=1,057), DNOS(n=378), and MCI(n=443)] that were newly-identified between 2011-2013. PAP treatment was defined as presence of ≥1 durable medical equipment (HCPCS) code for PAP supplies. PAP adherence was defined as ≥2 HCPCS codes for PAP equipment, separated by≥1 month. Logistic regression models, adjusted for demographic and health characteristics, were used to estimate associations between PAP treatment or adherence and new AD, DNOS, and MCI diagnoses. Results In this sample of Medicare beneficiaries with OSA, 59% were men, 90% were non-Hispanic whites and 62% were younger than 75y. The majority (78%) of beneficiaries with OSA were prescribed PAP (treated), and 74% showed evidence of adherent PAP use. In adjusted models, PAP treatment was associated with lower odds of incident diagnoses of AD and DNOS (OR=0.78, 95% CI:0.69-0.89; and OR=0.69, 95% CI:0.55-0.85). Lower odds of MCI, approaching statistical significance, were also observed among PAP users (OR=0.82, 95% CI:0.66-1.02). PAP adherence was associated with lower odds of incident diagnoses of AD (OR=0.65, 95% CI:0.56-0.76). Conclusions PAP treatment and adherence are independently associated with lower odds of incident AD diagnoses in older adults. Results suggest that treatment of OSA may reduce risk of subsequent dementia.

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