Factors Associated with Healthy Aging among Older Persons in Northeastern Thailand

The aim of this study was to describe factors associated with perceived health and healthy aging among older people in northeastern Thailand. Thailand’s aging population is growing and facing an increasing old-age dependency ratio. Northeastern Thailand, known as Isan, is a region in which the number of older residents is projected to grow rapidly. Older people in this region are likely to confront great threats to their health and well-being. These issues require appropriate attention and actions to promote healthy aging. However, healthy aging in this region has not been studied. A cross-sectional study was conducted on a sample of 453 older people, aged 60 years or older. Participants completed the Healthy Aging Instrument (HAI) and provided relevant demographic characteristics. Mann-Whitney U tests, Kruskal-Wallis tests and multiple regression models were used to analyze the data. Through comparative analyses, significant differences in HAI scores were observed for the following factors: marital status, residential area, disability, income level, and perceived meaningfulness in life. In the multiple regression models, residential area, disability, and marital status explained 24.30 % of the variance in HAI scores. Health promotion strategies and future targeted intervention programs should consider the importance of these factors.     

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Resilience, which relates to one's ability to respond to stressors, typically declines with age and the development of comorbid conditions in older organisms. Although progress has been made to improve our understanding of resilience in older adults, disciplines have employed different frameworks and definitions to study various aspects of older adults' response to acute or chronic stressors. “Overview of the Resilience World: State of the Science,” a bench-to-bedside conference on October 12–13, 2022, was sponsored by the American Geriatrics Society and National Institute on Aging. This conference, summarized in this report, explored commonalities and differences among the frameworks of resilience most commonly used in aging research in the three domains of resilience: physical, cognitive, and psychosocial. These three main domains are intertwined, and stressors in one domain can lead to effects in other domains. The themes of the conference sessions included underlying contributors to resilience, the dynamic nature of resilience throughout the life span, and the role of resilience in health equity. Although participants did not agree on a single definition of “resilience(s),” they identified common core elements of a definition that can be applied to all domains and noted unique features that are domain specific. The presentations and discussions led to recommendations for new longitudinal studies of the impact of exposures to stressors on resilience in older adults, the use of new and existing cohort study data, natural experiments (including the COVID-19 pandemic), and preclinical models for resilience research, as well as translational research to bring findings on resilience to patient care.     

The Experience of Homebound Older Adults During the COVID-19 Pandemic

BackgroundHomebound older adults have heightened risks for isolation and negative health consequences, but it is unclear how COVID-19 has impacted them. We examine social contact and mood symptoms among previously homebound older adults during the COVID-19 pandemic.Design/SettingCross-sectional analysis using data from the National Health and Aging Trends Study (NHATS), a nationally-representative longitudinal study of aging in the USA.ParticipantsA total of 3,112 community-dwelling older adults in 2019 who completed the COVID-19 survey in the summer/fall of 2020.MeasurementsHomebound status was defined via self-report as rarely/never leaving home or leaving the house with difficulty or help in the prior month. We measured limited social contact during COVID-19 (in-person, telephone, video or email contacts <once/week), as well as loneliness, anxiety, and depression.ResultsAmong homebound older adults, 13.2% experienced limited social contact during COVID-19 vs. 6.5% of the non-homebound. Differences in social contact were greatest for contacts via email/text/social media: 54.9% of the homebound used this <once/week vs. 28.4% of the non-homebound. In adjusted analyses of those without limited social contact prior to the pandemic, the homebound had higher but not significantly different odds (OR 1.83; 95% CI 0.95–3.52) of limited social contact during COVID-19, with increased risk among the older individuals, those with dementia, and those in assisted living facilities. Of the homebound, 13.2% felt lonely every/most days during the pandemic vs. 7.7% of non-homebound older adults. Homebound and non-homebound older adults reported similar rates of increased loneliness, anxiety, or depression during COVID-19. Fewer homebound older adults learned a new technology during the pandemic (16.3%) vs. non-homebound older adults (30.4%).DiscussionIsolation among homebound older adults increased during COVID-19, partially due to differences in technology use. We must ensure that homebound persons have the connection and care they need including new technologies for communication during and beyond COVID-19.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07361-9.KEY WORDS: Homebound, COVID-19, NHATS, Isolation, Social contact     

Social support network,social support,self-efficacy,health-promoting behavior and healthy aging among older adults: A pathway analysis

AimsTo determine the pattern of relationships among social support network, social support, self-efficacy, health-promoting behavior and healthy aging in older adults.MethodsTotally, 485 community-dwelling participants aged 60 years and older were recruited from four districts of Beijing, China. Data were obtained from July to November, 2017 using a questionnaire containing general information items, the Lubben Social Network Scale-18, the Medical Outcomes Study Social Support Survey-Chinese version, the Self-rated Abilities for Health Practices Scale, the Health-Promoting Lifestyle Profile II and a Healthy Aging Instrument. Path analysis was applied to examine the pattern of relationships between one’s social support network and healthy aging.ResultsThe influence of a neighbor network on healthy aging was stronger than that of a family and friend network. Friend network had greater impact than family network on health-promoting behavior and self-efficacy. However, support from family members had a stronger effect than friend support and neighbor support on health-promoting behavior, self-efficacy and healthy aging. Furthermore, the finding revealed that self-efficacy had the stronger effect on healthy aging than that of health-promoting behavior.ConclusionThese findings demonstrate that one’s social support network plays an important role in promoting healthy aging. In China, medical and human resources for community healthcare systems are often limited. We propose that community nurses, as the “gatekeepers” to the healthcare system, should actively collaborate with older adults’ social network resources to promote healthy aging. Moreover, nurses should develop efficient programs which focus on the ways of improving self-efficacy.     

Healthy aging predicts mortality risks: Results from the Korean longitudinal study of aging (2006–2014)

IntroductionWhile there has been some gerontological research on healthy aging, few studies have identified a reasonable health status for the older adults. Guided by the four healthy aging concepts in studies from the US and Spain, this study sought to determine a useful definition for Korean older adults by examining the associations between each of the four healthy aging definitions and mortality.MethodsA longitudinal analysis was conducted based on the 2,960 older people (65 years or older) who participated in the Korean Longitudinal Study of Aging (2006–2014). Four healthy aging gradient definitions (Rowe and Kahn, Group Ⅰ, Group II, and Group III) were determined: absence of disease, free of disability, physical and cognitive function, and engagement with life.ResultsThe young old who failed to achieve healthy aging were found to have a higher risk of mortality in all four healthy aging gradient definitions in both males (HR range from 4.15 to 5.39) and females (HR range from 4.07 to 9.55). In old old, however, the unhealthy aging mortality risk in Rowe and Kahn's definition was disappeared, but predominant mortality risks were found in Group III for both male (HR = 3.16, 95% CI 1.67 – 5.98) and female (HR = 3.65, 95% CI 1.36 – 9.81)ConclusionTo promote healthy aging, we suggest that the definition for the young old includes rigid disease criteria, and old old emphasize functional ability. Age-specific aims for healthy aging may be useful for defining healthy aging.     

Built environment and mobility of older adults: important policy and practice efforts

As people age, they prefer to "age in place." The concept of aging in place refers to the ability to live in one's own home, wherever that might be, for as long as one can feel confident and comfortable. Where people live and whether these environments can support them are critical questions for public health and public policy, especially since the baby boomers began to turn 65 on January 1, 2011. Equally important for public policy, those aged 85 and older are the fastest growing population group in the United States. The Health and Aging Policy Fellows Program, with the Centers for Disease Control and Prevention Healthy Aging Program, has supported a project to determine how design features of the built environment can support the mobility of older adults. Mobility refers to physical activity, usually walking, but also encompasses the ability to stay connected to nearby community resources and services. The project's purpose is to investigate features that support mobility in built environments. This policy brief introduces the realist synthesis method used in the project and selected national initiatives and activities to place this work in a broader context. Given the importance of mobility concerns to older adults, it must be determined without delay which design features support mobility and how local areas can better prepare to support the health of their aging populations.     

Intergenerational relations: pre-med students at senior centers

Misconceptions about aging and a negative bias against caring for older adults entail unfortunate consequences for society. This study explored the potential of frequent personal contact in reducing misconceptions and improving personal attitude towards older adults. Thirty students, predominantly Asian, with English as their second language, attended senior centers three times per week for 11 months, on the average. They assisted in teaching health promotion classes for the prevention of falls, conducted health assessments by interview, and collected physiological data. At the senior centers, a sample of 70 older adult Americans participated in the health promotion classes and in this evaluation of intergenerational relations. Students completed anonymously two questionnaires; one was objective, testing misconceptions about aging; the other was subjective, rating their reactions to elders at senior centers. Older adults completed, also anonymously, a subjective questionnaire on their reactions to students at their centers. Results on students' misconceptions about aging were similar to those among students at Duke University who did not experience frequent personal contact with well elderly. According to the Facts on Aging Quiz, the overall attitude among students at senior centers was more biased in the negative direction than among Duke students, especially among students who had just joined the project. However, in the subjective questionnaires, students at senior centers expressed feeling at ease at the centers and they disagreed with statements of impatience and frustration. Older adults at the centers had a positive attitude toward the students and most thought that students were sympathetic.     

Knowledge of memory aging in adulthood

The Knowledge of Memory Aging Questionnaire (KMAQ) measures laypersons' knowledge of memory changes in adulthood for research or educational purposes. Half of the questions pertain to normal memory aging and the other half cover pathological memory deficits due to non-normative factors, such as adult dementia. In this study, we compared memory knowledge in middle age adults (40-59 years), young-old adults (60-79 years) and very old adults (80 years and over). These data were collected as a part of the Louisiana Healthy Aging Study, a multidisciplinary population-based study that examines the determinants of healthy aging in adulthood. Results indicated that very old adults performed more poorly overall. Follow-up analyses revealed that they endorsed stereotyped views of normal memory aging more often than did the other age groups. Analyses of response accuracy by gender yielded comparable performance for men and women. Implications for research and the design of educational programs are considered.     

The Arkansas aging initiative: an innovative approach for addressing the health of older rural Arkansans

The Donald W. Reynolds Institute on Aging at the University of Arkansas for Medical Sciences in Little Rock is addressing one of the most pressing policy issues facing the United States: how to care for the burgeoning number of older adults. In 2001, the Institute created the Arkansas Aging Initiative, which established seven satellite centers on aging across the state using $1.3 to $2 million dollars annually from the state's portion of the Master Tobacco Settlement. These centers on aging assist the state's population of older adults, many of whom reside in rural areas, live in poverty, and suffer from poor health. The centers provide multiple avenues of education for the community, health care providers, families, and caregivers. The Arkansas Aging Initiative, in partnership with local hospitals, also makes geriatric primary and specialty care more accessible through senior health clinics established across rural Arkansas. In 2005, older adults made more than 36,000 visits to these clinics. All sites have attracted at least one physician who holds a Certificate of Added Qualifications in geriatrics and one advanced practice nurse. Other team members include geriatric medical social workers, pharmacists, nutritionists, and neuropsychologists. This initiative also addresses other policy issues, including engaging communities in building partnerships and programs crucial to maximizing their limited resources and identifying opportunities to change reimbursement mechanisms for care provided to the growing number of older adults. We believe this type of program has the potential to create a novel paradigm for nationwide implementation.     

Severe COVID-19 and aging: are monocytes the key?

The ongoing pandemic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes a disproportionate number of severe cases and deaths in older adults. Severe SARS-CoV-2-associated disease (coronavirus disease 2019 (COVID-19)) was declared a pandemic by the World Health Organization in March 2020 and is characterized by cytokine storm, acute respiratory distress syndrome, and in some cases by systemic inflammation–related pathology. Currently, our knowledge of the determinants of severe COVID-19 is primarily observational. Here, I review emerging evidence to argue that monocytes, a circulating innate immune cell, are principal players in cytokine storm and associated pathologies in COVID-19. I also describe changes in monocyte function and phenotype that are characteristic of both aging and severe COVID-19, which suggests a potential mechanism underlying increased morbidity and mortality due to SARS-CoV-2 infection in older adults. The innate immune system is therefore a potentially important target for therapeutic treatment of COVID-19, but experimental studies are needed, and SARS-CoV-2 presents unique challenges for pre-clinical and mechanistic studies in vivo. The immediate establishment of colonies of SARS-CoV-2-susceptible animal models for aging studies, as well as strong collaborative efforts in the geroscience community, will be required in order to develop the therapies needed to combat severe COVID-19 in older adult populations.

     

COVID-19 exposures and infection control among home care agencies

Background and objectivesHome care agencies (HCAs) provide caregivers, who perform an important role in maintaining the health and well-being of older adults. However, during the COVID-19 pandemic, paid caregivers had the potential to inadvertently spread COVID-19. We sought to characterize the effects of COVID-19 on HCAs and examine HCAs’ infection prevention and control (IPC) policies.Research design and methodsThis was a qualitative analysis of data collected from a national survey of HCAs. Surveys were e-mailed to members of a national HCA association on March 18, 2020. Questions included queries on demographics, COVID-19 exposures, effects of COVID-19, and IPC protocols.Results1204 HCAs responded with an average census of 96.2 (5−2800) patients daily. Across 36 states, 238 HCAs reported COVID-19 cases or exposures among caregivers. HCAs experienced challenges related to changing patient needs (e.g. decreased caregiver requests), staffing shortages (e.g., fear of COVID-19, inability to train caregivers), and management issues (e.g., inability to obtain supplies). ICP protocols varied in how HCAs followed recommended guidelines, responded to COVID-19 exposures, performed infection surveillance, and implemented precautions. Additionally, HCAs had varying policies for caregiver PTO.ConclusionsHCAs experienced COVID-19 exposures and/or cases early in the pandemic. HCAs identified staffing and PPE shortages, and lack of IPC guidance as challenges. Although caregivers are providing essential care for millions of older adults, they have been largely absent from federal, state, and health system strategies for mitigating the spread of COVID-19. Future policies must include HCAs and their caregivers to optimize care for older adults.     

The University of Arizona College of Medicine Optimal Aging Program: stepping in the shadows of successful aging

The Optimal Aging Program (OAP) at the University of Arizona, College of Medicine is a longitudinal mentoring program that pairs students with older adults who are considered to be aging successfully. This credit-bearing elective was initially established in 2001 through a grant from the John A. Hartford Foundation, and aims to expand the concept of aging to include those of active, independently living, healthy older adults. The program goals are to provide students with the opportunity to develop a relationship with an older adult who continues to be active in her community and expand students' concepts of aging to include the increasing reality of healthy, active older adulthood. A review of students' journals, verbal feedback, and questionnaire surveys has been used to evaluate the OAP, and has resulted in minor modifications of the program since inception. These findings and the program modifications are described in the present study. "Success factors" are identified that may be employed by others attempting to develop such programs.     

The Aging Brain Care Medical Home: Preliminary Data

The Aging Brain Care (ABC) Medical Home aims to improve the care, health outcomes, and medical costs of Medicare beneficiaries with dementia or depression across central Indiana. This population health management program, funded by the Centers for Medicare and Medicaid Services Innovation Center, expanded an existing collaborative dementia and depression care program to serve 1,650 older adults in a local safety‐net hospital system. During the first year, 20 full‐time clinical staff were hired, trained, and deployed to deliver a collaborative care intervention. In the first 18 months, an average of 13 visits was provided per person. Thirty percent of the sample had a diagnosis of dementia, and 77% had a diagnosis of depression. Sixty‐six percent of participants with high depression scores (Patient Health Questionnaire‐9 score ≥14) had at least a 50% reduction in their depressive symptoms. Fifty‐one percent of caregivers of individuals with dementia had at least a 50% reduction in caregiver stress symptoms (measured by the Healthy Aging Brain Care Monitor‐Caregiver Version). After 18 months, the ABC Medical Home has demonstrated progress toward improving the health of older adults with dementia and depression. Scalable and practical models like this show initial promise for answering the challenges posed by the nation's rapidly aging population.     

Effect of the COVID-19 pandemic on the oral health and nutritional status of Japanese older adults who underwent total hip or knee arthroplasty: A 3-year single-institution retrospective cohort study

The coronavirus disease 2019 (COVID-19) pandemic affected the physical and mental health, socioeconomic status, and community behavior of people worldwide. The aim of this retrospective cohort study was to analyze the impact of the COVID-19 pandemic on the oral health and nutritional status of Japanese older adults based on the results of preoperative assessment in patients who underwent total hip or knee arthroplasty under general anesthesia. This study included older adults (≧65 years) who underwent total hip or knee arthroplasty in whom orthopantomography was performed for preoperative oral health assessment, during January 2019 to December 2021. Gender, age, number of family members living together, number of teeth, body mass index, and serum total protein and serum albumin levels were collected for analysis of this study. A total of 201 patients aged 65 to 89 years participated in the study. While the COVID-19 pandemic has had no impact on the oral health status, there has been a drop in serum albumin level from the results of multivariable-adjusted regression analysis considering age, gender, number of family members, and time. The COVID-19 pandemic has affected the serum albumin level of Japanese orthopedic patients aged 65 years or older.     

Rowe and Kahn's model of successful aging revisited: positive spirituality--the forgotten factor

PURPOSE: We explain a new concept, positive spirituality, and offer evidence that links positive spirituality with health; describe effective partnerships between health professionals and religious communities; and summarize the information as a basis for strengthening the existing successful aging model proposed by Rowe and Kahn. DESIGN AND METHODS: A missing component to Rowe and Kahn's three-factor model of successful aging is identified, and we propose strengthening the model with a fourth factor, positive spirituality. RESULTS: We developed an enhanced model of successful aging based on Rowe and Kahn's theoretical framework. Evidence presented suggests that the addition of spirituality to interventions focused on health promotion has been received positively by older adults. IMPLICATIONS: Leaders in gerontology often fail to incorporate the growing body of scientific evidence regarding health, aging, and spirituality into their conceptual models to promote successful aging. The proposed enhancement of Rowe and Kahn's model will help health professionals, religious organizations, and governmental agencies work collaboratively to promote wellness among older adults.     

Creating the Next Generation of Translational Geroscientists

Advances in understanding fundamental processes of aging have led to a variety of investigational therapies to delay or prevent age‐related diseases and conditions. These geroscience therapeutics hold the promise of revolutionizing medical care of older adults by treating the complex syndromes of aging and preserving health and independence. A crucial bottleneck is the study of geroscience therapeutics in early‐stage, first‐in‐human, or proof‐of‐concept clinical trials. There is a limited pool of clinical investigators with the combination of knowledge and skills at the interface of clinical research, care of older adults, and aging biology needed to successfully design, fund, and implement geroscience trials. Current training pipelines are insufficient to meet the need. The sixth retreat of the National Institute on Aging R24 Geroscience Network brought together basic scientists, gerontologists, clinicians, and clinical researchers from the United States and Europe to discuss how to identify, recruit, and train investigators who can perform early‐stage clinical trials in geroscience. We present herein the group's consensus on necessary subject domains and competencies, identification of candidate learners, credentialing learners, and the efficient and rapid implementation of training programs. Foundations and funding agencies have crucial roles to play in catalyzing the development of these programs. Geriatrician investigators are indispensable but cannot meet the need alone. Translational geroscience training programs can create a cadre of groundbreaking investigators from a variety of backgrounds and foster institutional cultures supportive of multidisciplinary translational aging research to turn innovative ideas into transformative therapeutics that can improve the health and independence of older adults. J Am Geriatr Soc 67:1934–1939, 2019