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In July 2015, the Journal of the American Geriatrics Society published a manuscript titled, "Failing to Focus on Healthy Aging: A Frailty of Our Discipline?" In response, the American Geriatrics Society (AGS) Clinical Practice and Models of Care Committee and Public Education Committee developed a white paper calling on the AGS and its members to play a more active role in promoting healthy aging. The executive summary presented here summarizes the recommendations from that white paper. The full version is published online at GeriatricsCareOnline.org. Life expectancy has increased dramatically over the last century. Longer life provides opportunity for personal fulfillment and contributions to community but is often associated with illness, discomfort, disability, and dependency at the end of life. Geriatrics has focused on optimizing function and quality of life as we age and reducing morbidity and frailty, but there is evidence of earlier onset of chronic disease that is likely to affect the health of future generations of older adults. The AGS is committed to promoting the health, independence, and engagement of all older adults as they age. Geriatrics as an interprofessional specialty is well positioned to promote healthy aging. We draw from decades of accumulated knowledge, skills, and experience in areas that are central to geriatric medicine, including expertise in complexity and the biopsychosocial model; attention to function and quality of life; the ability to provide culturally competent, person‐centered care; the ability to assess people's preferences and values; and understanding the importance of systems in optimizing outcomes. J Am Geriatr Soc 67:17–20, 2019. [ABSTRACT FROM AUTHOR]

The future welfare of older adults is a worldwide concern. By 2034, it is estimated that individuals 65 and older in the U.S. will be 77 million. Consequently, this reality will impact healthcare facilities and increase Medicare and Medicaid costs, resulting in higher incidents of homeless older adults, children caring for parents, the need for more caregivers, and an increased number of older individuals experiencing various forms of dementia. To address these concerns, the current trend for treating the onset of dementia and Alzheimer's disease has been moving toward nonpharmaceutical interventions. Even though researchers have tapped into the benefits of several nonpharmaceutical treatments, there appears to be a constant debate on establishing which method is most effective. Deciding on best practices and methods to slow down and/or halt the progression of dementia is the gap this research needs to fill. To provide clarity on the topic, an analysis of alternative interventions to treat the onset of dementia is what this paper strived to achieve. The analysis involved comparing and contrasting the benefits of each intervention as well as illustrating the implications of the findings. In this regard, a systematic review was conducted examining the benefits of five nonpharmaceutical strategies; mental training, music therapy, technology usage, physical activity, and social interaction. Although findings revealed some form of improvement in each of the nonpharmacological interventions examined, the overarching theme appeared to lean toward providing mental stimulation. It was also not conclusive that physical activity prevented cognitive decline. More research is recommended. [ABSTRACT FROM AUTHOR]

Financial exploitation (FE) is one of the most common reports to Adult Protective Services (APS) and the cases are often complex. Consequently, APS caseworkers report FE investigations to be among the most difficult while simultaneously reporting low confidence in productive outcomes for these investigations. This necessitates finding ways to support APS FE investigations. This paper describes the structure, process, and formative findings of a collaboration between forensic accounting examiners and APS workers to investigate complex cases of FE. Among the 77 FE cases completed, forensic examiners reviewed multiple years of financial records which included over 101,000 transactions, totaling over $213,000,000.00 in finances, and identified over $8,000,000 in questionable activity. Scores on the 8-item Client Satisfaction Questionnaire were high indicating high program satisfaction by APS workers, subject matter experts, and forensic examiners. These findings support the feasibility and acceptability of forensic accounting and APS collaborations to investigate complex cases of FE. [ABSTRACT FROM AUTHOR]

Between 1949 and 1966, the Stephen Smith Home, one of the oldest African American "homes for the aged" in the United States, went from partially condemned to new construction. Through his leadership at this historic Philadelphia institution, administrator Hobart C. Jackson learned firsthand the "double jeopardy" of Black aging, culminating in the 1970s with his national advocacy efforts on behalf of minority elders. The intersectionality of age and race was intimately tied to the built environment of homes for the aged, the precursor of today's nursing home. This paper considers how structural racism and ageism were materially manifested in the strug gle of African American eldercare institutions to respond to protean building and safety regulations for se nior care. I introduce a necessary architectural analy sis into histories of aging in the United States by examining how building maintenance, upkeep, and volunteerism offer a way of understanding social history. This research reveals Philadelphia's Stephen Smith Home to be both representative and singular: like other African American facilities, the home strug gled with building obsolescence and funding shortfalls, but unlike many of its counter parts, it nonetheless survived and developed into a hybrid campus of historic and newly built structures within a growing Black neighborhood. Ultimately this article does foundational work in exploring the shifting building and social cultures of the charitable old age home in the mid-twentieth century by examining a mode of community- based care that, when rendered within the built environment, contrasts greatly with con temporary perceptions of institutionalization. [ABSTRACT FROM AUTHOR]

Forty-five years ago, the first author of this paper surveyed the US medical schools to determine their offerings on EOL (End-of-Life) issues. The results showed limited exposure for medical school students to learn about dying and death, thus their "learning" was apparently on-the-job training. The EOL offerings were so limited that the American Association of Medical Colleges (AAMC), following the 1975 publication from the survey, contacted the first author to inquire about death and dying in the curricula of their medical schools. Apparently, it was so insignificant that the AAMC did not have such information. Palliative medicine, geriatric medicine, and hospice were then in the "birthing" process, a mere blur on the horizon. Today, as in 1975, it is likely that most medical students have personally had minimal experience with death and that for many entering students, other than on television, the cadaver is their first sight of a dead person. The objective of this research is a longitudinal study at five-year intervals since 1975 reporting on EOL education in US medical schools. The total number of medical schools has increased from 113 in 1975 to 150 in 2020. The current study surveyed medical schools electronically and via postal services with a response rate of 37%. Findings from the survey over time revealed significant inclusion of death and dying and palliative medicine as well as geriatrics and hospice. Gross anatomy has evolved from strictly hands-on to integrating 3D/virtual models, a change not without controversy. A noticeable difference in emphasis is obvious as care now plays a more significant role in medical training than previously, thus making modern medicine not only about cure, but more about care than was previously emphasized. Communication with dying patients and families, analgesics for chronic pain, and advance directives all are covered in over 90% of schools today. The current emphasis on EOL care, not just disease management, is increasing and puts more of a human face on modern medicine. [ABSTRACT FROM AUTHOR]

Frailty represents an integrative prognostic marker of risk that associates with a myriad of age-related adverse outcomes in older adults. As a concept, frailty can help to target scarce resources and identify subgroups of vulnerable older adults that may benefit from interventions or changes in medical management, such as pursing less aggressive glycaemic targets for frail older adults with diabetes. In practice, however, there are several operational challenges to implementing frailty screening outside the confines of geriatric medicine. Electronic frailty indices (eFIs) based on the theory of deficit accumulation, derived from routine data housed in the electronic health record, have emerged as a rapid, feasible and valid approach to screen for frailty at scale. The goal of this paper is to describe the early experience of three diverse groups in developing, implementing and adopting eFIs (The English National Health Service, US Department of Veterans Affairs and Atrium Health—Wake Forest Baptist). These groups span different countries and organisational complexity, using eFIs for both research and clinical care, and represent different levels of progress with clinical implementation. Using an implementation science framework, we describe common elements of successful implementation in these settings and set an agenda for future research and expansion of eFI-informed initiatives. [ABSTRACT FROM AUTHOR]

This paper develops a satellite account for the US health sector and measures productivity growth in health care for the elderly population between 1999 and 2012. We measure the change in medical spending and health outcomes for a comprehensive set of 80 conditions. Medical care has positive productivity growth over the time period, with aggregate productivity growth of 1.5 percent per year. However, there is significant heterogeneity in productivity growth. Care for cardiovascular disease has had very high productivity growth. In contrast, care for people with musculoskeletal conditions has been costly but has not led to improved outcomes. (JEL E01, H51, I10) [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present a case study that illustrates how professional associations can provide the context for development of formal and informal interdisciplinary collaboration and promote advancement and dissemination of useful knowledge among disciplines and across geographic boundaries. This paper reports the work of the Rural Aging Special Interest Group of the Gerontological Society of America to develop and disseminate approaches that leverage existing resources to address the challenges of providing services to rural – dwelling older adults. It describes the challenges and the roles of networks in developing and supporting these partnerships to better meet the challenges.Design/methodology/approach This paper describes how interdisciplinary partnerships can enhance existing resources to better meet the unique needs of rural older adults and describes an example of how a professional association facilitated the process of creation and dissemination of knowledge about this approach. An overview of the process is provided with additional information relating partnerships to improving programs and services for rural older adults.Findings While addressing the unique needs of rural older adults can sometimes prove challenging, a number of entities have developed successful interdisciplinary partnerships that have expanded resources and improved effectiveness in addressing these challenges.Originality/value This paper illustrates how a professional association can play a key role in supporting creative interdisciplinary and international problem solving. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide an overview of rural older veterans in the USA and discuss how the US Department of Veterans Affairs (VA) is increasing access to health care for older veterans in rural areas.Design/methodology/approach This is a descriptive paper summarizing population and program data about rural veterans.Findings VA provides a variety of health care services and benefits for older veterans to support health, independence, and quality of life. With the creation of the Veterans Health Administration Office of Rural Health (ORH) in 2006, the needs of rural veterans, who are on average older than urban veterans, are receiving greater attention and support. ORH and VA have implemented several programs to specifically improve access to health care for rural veterans and to improve quality of care for older veterans in rural areas.Originality/value This paper is one of the first to describe how VA is addressing the health care needs of older, rural veterans. [ABSTRACT FROM AUTHOR]

Social workers (SW) and community health workers (CHW) have emerged as key workforce personnel in efforts to care for elders in the U.S. However, little is known about the presence and roles of SW and CHW in primary care practices. This paper presents findings from a nationally representative survey of geriatrics and primary care practices. Physician and nurse practitioner clinicians were randomly selected within practices, stratifying by practice staffing and presence/absence of geriatric clinicians; our final sample for this analysis included 341 practices. Key findings include: reported challenges in meeting the social service needs of elders, underutilization of SW, and fuller utilization of social work competencies in practices in which both SW and CHW were present. These findings offer a unique perspective of SW on interprofessional teams and have implications for the future of the profession. [ABSTRACT FROM AUTHOR]

We investigate how the type of caregiving arrangement is associated with older Americans' outcomes. We use the Health and Retirement Study (2004–2018) and discrete-time event history analysis to assess the odds of institutionalization or death over a 14-year period among older adults with limitations in Activities of Daily Living (ADLs; e.g., bathing). We consider caregiving arrangements as conventional (i.e., spouse or adult child), unconventional (e.g., extended family, employee, friend), or self-directed (i.e., no caregiver). We find a "care paradox" in that self-directing one's own care was associated with a lower risk of institutionalization or death compared with having conventional care (spouse/adult caregiver) and unconventional care (employee). Relative to conventional care, having an employee caregiver was associated with increased risk of institutionalization. Findings are still observed when controlling for level of impairment and various health-related factors. More research is needed to understand older adults who self-direct their own care. [ABSTRACT FROM AUTHOR]

As a result of the aging of American society and the fact that older persons require a great deal more healthcare and much more expensive treatments, the costs are on the rise and spiraling out of control. As a solution, ethicists Daniel Callahan and others have proposed healthcare rationing on the basis of age. On the basis of utilitarian ethicist, these writers have argued that age-based rationing will lead to the provision of healthcare to the greatest number of people. Of course, utilizing other ethical theories other writers have opposed the rationing of healthcare on the basis of age. The paper presents the arguments made, and the ethical theories employed, by both sides, which suggest an ethical dilemma, thus most probably a debate about age-based rationing in the future. The author found it interesting to seek the views of professors teaching healthcare -related courses about this type of rationing. Utilizing grounded theory/ quantitative research methodology, designing a questionnaire that included some 14 questions, the author interviewed some 18 professors of healthcare courses in Pennsylvania. Utilizing grounded theory in the analysis of the results of the interviews led to some eight interesting themes, which are presented and analyzed in the paper. After presenting the results of that study, and not finding the application of age-based rationing feasible, the paper also discusses other alternative solutions for reducing healthcare costs, including the notion of fair innings suggested by Allan Williams. All these alternatives are discussed in the paper. [ABSTRACT FROM AUTHOR]

Physical/cognitive limitations associated with the aging process place older adults at disproportionate risk of negative consequences during disasters. Guided by the profession's commitment to supporting vulnerable populations, gerontological social workers have long been on the frontlines supporting older adults during disasters. Yet, disaster social work practice remains an undeveloped and under-researched area. Thus, we asked "what is the current role of gerontological social workers in disaster preparedness with older adults in the United States, and potential areas for improvement?" This paper systematically reviews the literature discussing social work and disaster preparedness/response with older adults in the U.S., to identify needs and inform future directions. PRISMA guidelines were followed to conduct a systematic search across relevant databases for peer-reviewed-publications between January 1, 2009-June 12, 2020. Eleven articles met inclusion criteria. This body of literature is small and covers two broad areas: (1) charging the social work profession to engage in this work, and (2) describing current efforts and unique challenges of older adults during disasters. Only three empirical studies were identified. Future educational efforts should formalize training to prepare social workers for this practice area. Research should detail the roles of social workers in disaster preparedness/response, and factors that predict involvement. [ABSTRACT FROM AUTHOR]

To achieve optimal, equitable health outcomes for all older adults, the United States desperately needs equity in access to, quality of, and cost of aging care. To illustrate these needs, we discuss the current inequitable state of frailty care. Frailty disproportionately affects marginalized populations, yet these populations struggle to access high-quality geriatrics care and long-term care services and supports (LTSS) that mitigate frailty, leading to accelerated frailty trajectories. Health services research can provide the data needed to document, elucidate, and address health inequities in frailty care, including early identification and referral of frail adults to specialized care and financing LTSS. [ABSTRACT FROM AUTHOR]

Greater attention is being paid to issues surrounding end-of-life care for aging adults with developmental disabilities. The purpose of this qualitative study was to explore the end-of-life experiences of two aging adults with developmental disabilities and life-limiting serious illnesses who received care in settings in the United States. Using a comparative case study design, data from three sources (records, staff, surrogates) were collected sequentially and triangulated via within and cross-case analyses. Although the setting and design limit the generalizability of these findings, the feasibility of delivering high quality care to adults with developmental disabilities as they age and experience terminal illnesses is supported. Insights are presented regarding how nurses can address barriers by adapting policies and practices to accommodate the distinct needs that arise as people with developmental disabilities age, become seriously ill, and reach life's end. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various topics within the issue, including the cognitive health and psychological well-being of Latinx older adults, health care services, and pension systems.

This paper details a study on ethnic identity in midlife, illuminating identity formation as a complex life course phenomenon. The study addresses the importance of ethnic identity in understanding the experiences of racial and ethnic Baby Boomers as both recipients of care and as caregivers to their aging parents (first generation immigrants). Using a case study of second-generation Korean American Baby Boomers, the primary aims of this study are: (a) to explore how the relationship between age and race/ethnicity influences identity formation, and (b) how contexts influence ethnic identity formation. Findings reveal that cumulative experiences over earlier developmental years resulted in resolutions to appreciate their ethnic identity at midlife. Increasing racial and ethnic diversity in the U.S., combined with the large number of aging Baby Boomers, necessitate recognition of the cultural and racial differences within the Baby Boomer generation. [ABSTRACT FROM AUTHOR]

Despite the documented and well-publicized health and well-being benefits of regular physical activity (PA), low rates of participation have persisted among American older adults. Peer-based intervention strategies may be an important component of PA interventions, yet there is inconsistent and overlapping terminology and a lack of clear frameworks to provide a general understanding of what peer-based programs are exactly and what they aim to accomplish in the current gerontological, health promotion literature. Therefore, a group of researchers from the Boston Roybal Center for Active Lifestyle Interventions (RALI) collaborated on this paper with the goals to: (a) propose a typology of peer-based intervention strategies for use in the PA promotion literature and a variety of modifiable design characteristics, (b) situate peer-based strategies within a broader conceptual framework, and (c) provide practice guidelines for designing, implementing, and reporting peer-based PA programs with older adults. We advance clarity and a common terminology and highlight key decision points that offer guidance for researchers and practitioners in using peers in their health promotions efforts, and anticipate that it will facilitate appropriate selection, application, and reporting of relevant approaches in future research and implementation work. [ABSTRACT FROM AUTHOR]

With the United States older adult population facing dramatic growth over the next several decades, a capable workforce trained with geriatric-centered knowledge and skill sets is required to meet the needs of the aging population. While professional social work programs have made great strides in modifying their curriculum content to address the needs of this demographic, other professional disciplines lag in their curriculum adaptations. Disciplines can collaborate to build a capable workforce to work with older adults. One such collaboration involves social work and criminal justice. An exploratory qualitative study highlighted the interviews of 15 criminal justice faculty members about recommended curriculum content changes needed to respond to justice-involved aging populations. Through content analysis, three major themes emerged along with subthemes. Findings suggest that geriatric-based education is necessary across disciplines that work with older adults and there is a need for interdisciplinary practice and educational collaboration. [ABSTRACT FROM AUTHOR]

Purpose: This viewpoint discusses a plausible framework to educate future speech-language pathologists (SLPs) as socially responsive practitioners who serve and advocate for the burgeoning vulnerable ethnogeriatric populations with neurogenic communication disorders. Method: We provide an overview of the demographic, epidemiological, and biopsychosocial context that supports the implementation of equity-based, population-grounded educational approaches for speech-language pathology services in ethnogeriatric neurorehabilitation caseloads and discuss a plausible perspective based on the educational social determinants of health (SDOH) framework by the National Academies of Sciences, Engineering, and Medicine. Results: The NASEM’s three-domain SDOH educational perspective integrates education, community, and organization to create a self-reinforcing pedagogical coproduction that, grounded in the synergized partnerships of educational institutions, engaged communities, and organizational leadership, aims to address systemic drivers of health perpetuating ethnoracial disparities in health, care, and outcomes. Conclusion: Exponentially growing vulnerable ethnogeriatric populations with age-related neurogenic communication disorders warrant the implementation of health equity education strategies to train technically prepared, socially conscious SLPs as service providers and advocates. [ABSTRACT FROM AUTHOR]

Background: Substance use (SU) is associated with physical injury and mental health disorders in older persons, but recent research has scarcely examined SU in U.S. Vietnam-era veterans who are mostly in or near their eighth decade of life. Objectives: We compared the prevalence of self-reported lifetime and current SU and modeled current usage patterns in a nationally representative sample of veterans versus a matched nonveteran cohort. Methods: Cross-sectional, self-reported survey data were analyzed from the 2016–2017 Vietnam Era Health Retrospective Observational Study (VE-HEROeS) (n = 18,866 veterans, n = 4,530 nonveterans). We assessed lifetime and current alcohol and drug use disorders; lifetime and current use of cannabis, opioids, stimulants, sedatives, "other drugs" (psychedelics, prescription or over-the-counter drugs not prescribed/used as intended); and current SU patterns (alcohol-use-only, drug-use-only, dual-SU, no SU). Weighted descriptive, bivariable, and multivariable statistics were calculated. Covariates in multinomial modeling included sociodemographic characteristics, lifetime cigarette smoking, depression, potentially traumatic events (PTEs), and current pain (SF-8TM). Results: Prevalence of lifetime opioid and sedative use (p ≤.01), drug and alcohol use disorders (p <.001), and current "other drug" use (p <.001) were higher in veterans versus nonveterans. Current use of alcohol and cannabis was high in both cohorts. In veterans, very severe/severe pain, depression, and PTEs were highly associated with drug-use-only (p <.001) and dual-SU (p <.01), but these associations were fewer for nonveterans. Conclusion: This research confirmed existing concerns over substance misuse in older individuals. Vietnam-era veterans may be at particular risk due to service-related experiences and later-life tribulations. Era veterans' unique perceptions toward healthcare assistance for SU may need greater provider focus to maximize self-efficacy and treatment. [ABSTRACT FROM AUTHOR]

Purpose: Home health agencies delivering care in rural counties face unique challenges when providing care to older adults; long travel times between each visit can limit the number of patients seen each day. In 2010, Medicare began paying home health (HH) providers 3% more to serve rural beneficiaries without evaluating the policy's impact on patient outcomes. Methods: Using 100% Medicare data on postacute HH episodes from 2007 to 2014, we estimated the impact of higher payments on beneficiaries outcomes using difference‐in‐differences analysis, comparing rehospitalizations between rural and urban postacute HH episodes before and after 2010. Findings: Our sample included 5.6 million postacute HH episodes (18% rural). In the preperiod, the 30‐ and 60‐day rehospitalization rates for urban HH episodes were 11.30% and 18.23% compared to 11.38% and 18.39% for rural HH episodes. After 2010, 30‐ and 60‐day rehospitalization rates declined, 10.08% and 16.49% for urban HH episodes and 9.87% and 16.08% for rural HH episodes, respectively. The difference‐in‐difference estimate was 0.29 percentage points (P =.005) and 0.57 percentage points (P <.001) for 30‐ and 60‐day rehospitalization, respectively. Conclusions: Increasing payments resulted in a statistically significant reduction in rehospitalizations for rural postacute HH episodes. The add‐on payment is set to sunset in 2022 and its impact on access and quality to HH for rural older adults should be reconsidered. [ABSTRACT FROM AUTHOR]

Uncontrolled asthma in the elderly is a public health issue recognized in developed countries such as the United States and among the European Union, both from patient safety and economic perspectives. Variations in the cutoff, which defines elderly age, contribute to epidemiological study difficulties. Nonetheless, the relevance of elderly asthma from a socioeconomic perspective is inarguable. The projected growth of the enlarging geriatric population in the United States portends an impending national health burden that may or may not be preventable with pharmacologic and non-pharmacologic treatments. Asthma in the elderly might be a consequence of uncontrolled disease that is carried throughout a lifetime. Or elderly asthmatics could suffer from uncontrolled asthma, which overlaps with other ailments common with advancing ages that merit consideration, eg, COPD, heart disease, OSA, diabetes mellitus, and other comorbidities. Because of the heterogeneity of asthma phenotypes and other conditions that could mimic the symptoms of elderly asthma, further cohort studies are needed to elucidate the elderly asthmatic pathophysiology and management. More studies to characterize elderly asthma can help address these patients' unmet need for evidence-based guidelines. We introduce the 5 "Ps" (phenotypes, partnership, pharmacology, practice in acute exacerbations, and problems or barriers for the elderly asthmatics) that establish a framework approach for clinical practice. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Extensive studies have explored the factors affecting caregiving stress, but how oral health of care recipients (CRs) associates with caregiving stress and the mechanism behind it are not well‐known. Guided by Stress Process Theory, this study addressed such research gaps. Caregiver services dataset came from the 13th National Survey of Older Americans Act Participants in the United States (N = 1289). Caregiving stress included physical, emotional, and financial stress. The oral health of CRs was self‐rated by a single item. The functional ability of CRs was assessed by activities of daily living (ADLs) and instrumental activities of daily living (IADLs). PROCESS 3.4 for SPSS 26.0 was used to conduct the mediation analyses. Results from the study showed that caregivers reported slightly high levels of physical (M = 3.06, SD = 1.33, Range = 1–5), emotional (M = 3.43, SD = 1.28, Range = 1–5), and financial (M = 2.83, SD = 1.43, Range = 1–5) stress. The results from hierarchical linear regression revealed that poor oral health of CRs was significantly associated with higher levels of physical (B = 0.11, p < 0.001), emotional (B = 0.09, p < 0.01), and financial (B = 0.12, p < 0.001) stress, respectively. The functional ability of CRs mediated such relationships between the oral health of CRs and the caregiving stress of their family caregivers. Findings from this study enrich our theoretical and practical understanding of caregiving stress in aged care and offer programs and policy implications of oral and physical healthcare for community‐dwelling older adults. [ABSTRACT FROM AUTHOR]

The healthcare costs of elderly inmates are a major concern for state governments. This paper (i) discusses the recent surge in the elderly inmate population; (ii) analyzes the eligibility of prisoners for Medicare coverage, including an exception that allows coverage under certain circumstances; (iii) describes how states can circumvent restrictions on Medicare coverage of the incarcerated by using the aforementioned exception; (iv) explains why, for policy reasons, it may be wiser to allow Medicare coverage for all elderly inmates; and (v) makes policy recommendations for the treatment of the healthcare needs of elderly inmates in the future. [ABSTRACT FROM AUTHOR]

Older adults in North America face similar challenges to successful ageing as other adults around the world, including an increased risk of geriatric syndromes and functional decline, limited access to healthcare professionals specialising in geriatrics and constraints on healthcare spending for Long-Term Services and Supports. Geriatrics as a specialty has long been established, along with the creation of a variety of screening tools for early identification of geriatric syndromes. Despite this, workforce shortages in all older adult care service areas have led to significant gaps in care, particularly in community settings. To address these gaps, innovative programs that expand the reach of geriatric specialists and services have been developed. Opportunities exist for further dissemination of these programs and services, as well as for expansion of an ageing capable workforce. [ABSTRACT FROM AUTHOR]

Cultural failure to recognize tacit knowledge that informs eldercare is key to understanding how and why the labor of workers in this area of professional caregiving, especially those earning low wages, is dramatically undervalued in the US health sector. This essay first explains key differences in credential-based knowledge and tacit forms of health knowledge and then considers how status differentiation privileges credential-based knowledge of clinicians of higher status, such as physicians and nurses, who do not perform the hour-to-hour care for most of our country's elders. Finally, this article suggests the ethical and clinical importance of health care organizations' sources of knowledge and roles in equitably valuing labor to promote quality service delivery, better working conditions, and better pay for workers earning low wages. [ABSTRACT FROM AUTHOR]

The use of complementary/alternative medicine (CAM) is typically modeled as a function of individual health beliefs, including changes in perceptions of conventional medicine, an orientation toward more holistic care, and increasing patient involvement in health care decision-making. Expanding on research that shows that health-related behavior is shaped by social networks, this paper examines the possibility that CAM usage is partly a function of individuals' social network structure. We argue that people are more likely to adopt CAM when they function as bridges between network members who are otherwise not (or poorly) connected to each other. This circumstance not only provides individuals with access to a wider range of information about treatment options, it also reduces the risk of sanctioning by network members if one deviates from conventional forms of treatment. We test this idea using data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative study of older Americans. Analyses of egocentric social network data show that older adults with bridging potential in their networks are significantly more likely to engage in a greater number of types of CAM. We close by discussing alternative explanations of these findings and their potential implications for research on CAM usage. [ABSTRACT FROM AUTHOR]

Objective To assess the efficacy of interventions and environmental factors on increasing fluid intake or reducing dehydration risk in older people living in long-term care facilities. Design Systematic review of intervention and observational studies. Data Sources Thirteen electronic databases were searched from inception until September 2013 in all languages. References of included papers and reviews were checked. Eligibility Criteria Intervention and observational studies investigating modifiable factors to increase fluid intake and/or reduce dehydration risk in older people (≥65 years) living in long-term care facilities who could drink orally. Review Methods Two reviewers independently screened, selected, abstracted data, and assessed risk of bias from included studies; narrative synthesis was performed. Results A total of 4328 titles and abstracts were identified, 325 full-text articles were obtained and 23 were included in the review. Nineteen intervention and 4 observational studies from 7 countries investigated factors at the resident, institutional, or policy level. Overall, the studies were at high risk of bias due to selection and attrition bias and lack of valid outcome measures of fluid intake and dehydration assessment. Reported findings from 6 of the 9 intervention studies investigating the effect of multicomponent strategies on fluid intake or dehydration described a positive effect. Components included greater choice and availability of beverages, increased staff awareness, and increased staff assistance with drinking and toileting. Implementation of the US Resident Assessment Instrument reduced dehydration prevalence from 3% to 1%, P = .01. Two smaller studies reported positive effects: one on fluid intake in 9 men with Alzheimer disease using high-contrast red cups, the other involved supplementing 13 mildly dehydrated residents with oral hydration solution over 5 days to reduce dehydration. Modifications to the dining environment, advice to residents, presentation of beverages, and mode of delivery (straw vs beaker; prethickened drinks vs those thickened at the bedside) were inconclusive. Two large observational studies with good internal validity investigated effects of ownership; in Canada, for-profit ownership was associated with increased hospital admissions for dehydration; no difference was seen in dehydration prevalence between US for-profit and not-for-profit homes, although chain facilities were associated with lower odds of dehydration. This US study did not suggest any effect of staffing levels on dehydration prevalence. Conclusions A wide range of interventions and exposures were identified, but the efficacy of many strategies remains unproven due to the high risk of bias present in many studies. Reducing dehydration prevalence in long-term care facilities is likely to require multiple strategies involving policymakers, management, and care staff, but these require further investigation using more robust study methodologies. The review protocol was registered with the International Prospective Register of Systematic Reviews ( http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42012003100 ). [ABSTRACT FROM AUTHOR]

This special issue of the Journal of Aging and Health honors the memory of James Jackson by elevating his many research contributions to the physical and mental health of older Black Americans. The articles focus on the central problems and questions that James Jackson addressed throughout his illustrious career. All articles in the special issue focus on older Black Americans and include at least one of the following elements: (1) articles based on the National Survey of American Life, the data set for which James Jackson was the Principal Investigator; (2) articles that utilize the Environmental Affordances Model which was developed by James Jackson; (3) articles that include the Everyday Discrimination scale which was originally published by David Williams, James Jackson, and colleagues; (4) and articles based on the Health and Retirement Study (HRS), the data set for which James Jackson served as Editor for a special issue of The Gerontologist. [ABSTRACT FROM AUTHOR]

Simple Summary: People with aging or ill family members often fill the role of caretaker. Companion dogs are often viewed as family members and because they age more rapidly than people and have shorter lifespans, having a dog often includes caring for it during its senior years. Caring for an elderly dog can be physically and emotionally challenging, yet we know little about how caring for an aging dog impacts guardians' lives. This study was designed to better understand dog guardians' experiences and perceptions related to caring for their aging dog. We asked dog guardians to complete an online anonymous survey, resulting in a sample size of 284 participants. We found that the impact on guardians when caring for an aging dog appear to share many similarities with caregivers of human family members. Our results suggest that, for many guardians, caring for an aging dog is a complex dynamic with both positive and negative factors that offers an opportunity to deepen the human-animal bond and create positive, rewarding experiences and memories. Companion dogs are increasingly popular, 38.4% of households in the United States include at least one dog. There are numerous benefits to sharing one's home with a dog, but because they age more rapidly than people and have shorter lifespans, acquiring a dog often includes caring for it during its senior years. Caring for an elderly dog can be physically and emotionally challenging, yet the impact on guardians' lives when caring for an aging dog has received minimal scientific attention. This study was designed to better understand dog guardians' experiences and perceptions related to caring for their aging dog. Utilizing an exploratory mixed methods design, this study asked dog guardians to complete an online anonymous survey. From a total of 284 participants, we found that the impact on guardians when caring for an aging dog appears to share many similarities with caregivers of human family members. Our quantitative and qualitative results suggest that, for many guardians, caring for an aging dog is a complex dynamic with both positive and negative factors that offers an opportunity to deepen the human-animal bond and create positive, rewarding experiences and memories. [ABSTRACT FROM AUTHOR]

The article presents the discussion on socioeconomic and racial/ethnic inequality being the major determinants of longevity. Topics include racial/ethnic, socioeconomic, and geographic disparities being particularly marked in mortality and/or morbidity from cardiovascular disease, cancer, and diabetes; and adults with lower education, higher poverty level, in manual occupations, and with rental housing having substantially lower life expectancy.

The COVID-19 pandemic has produced massive procedural backlogs in many parts of the developed world, with a disproportionate impact on the elderly. Whereas it is well-known that such a backlog would cause undue morbidity and mortality in thousands of patients, it is still unclear how jurisdictions plan on catching up on their missed surgeries and screening tests. In this comparative review therefore, we examine existing literature to quantify the backlog and thereafter summarize the solutions that have been proposed to clear it. Searches were performed on Google, Google Scholar, PubMed, Ovid MEDLINE®, and Ovid Embase® to identify literature from Canada, the United Kingdom, and the United States of America. We report our findings with a focus on three representative types of procedures including cataract surgery, colorectal screening, and hip and knee replacement surgery. Common themes of potential solutions included leveraging more advanced technology, ensuring preventative care, training an appropriate allied health workforce, and innovating in the operating room to improve efficiency and surgical capacity. Although no single solution emerges to be universally applicable, a combination of proposed solutions can be considered after an individualized assessment of the hospital or clinic context, the type of surgery required, and the availability of equipment, facility, and staff. [ABSTRACT FROM AUTHOR]

The definition and measurement of filial piety in existing research primarily focuses on the narrow conceptualizations of Asian filial piety, which would inflate cultural differences and undermine cultural universals in how people approach caring for their elderly parents. Employing the Dual Filial Piety Model (DFPM), this study aimed to examine the relationship between filial piety and attitude toward caring for elderly parents beyond the Asian context. In our study (N = 276), we found that reciprocal filial piety (RFP) does not differ across cultures while authoritarian filial piety (AFP) does. We also found that collectivism, rather than ethnicity, predicted RFP and AFP, which in turn predicted positive attitude toward caring for elderly parents. Our work demonstrates the cross-cultural applicability of the DFPM and highlights the universal and culture-specific aspects of filial piety. [ABSTRACT FROM AUTHOR]

Reporting government performance to the public is key tool in improving accountability. Some evidence, however, has shown that individuals' anti‐public sector biases may distort performance information about public organizations. Using an experimental vignette on U.S. nursing homes, this study fills four gaps in the literature: (1) the need to include nonprofit organizations rather than just public and for‐profit, (2) consideration of the credibility of the source of performance information, (3) the use of simple commonly used performance metrics, and (4) the willingness to use services as a performance dimension. We find the public has a general but modest anti‐for‐profit sector bias in nursing home care with nonprofits perceived the most positively. Sector biases generally disappear when clear performance data are presented. The credibility of the source matters, and respondents' willingness to use organizational services is more sensitive to both sector bias and performance ratings than are performance measures. Practitioner Points: In the field of long‐term care, individuals have no anti‐public sector bias, and they have more favorable views of nonprofit organizations than for‐profit organizations.Perceived sector bias disappears when simple and unambiguous performance information is introduced.The source of performance information matters: individuals perceive the information from government and nonprofit sources as more credible than that from for‐profit sources.A high degree of credibility amplifies the effect of performance information in shaping individuals' evaluations of public services. [ABSTRACT FROM AUTHOR]

Unmet health‐related social needs are common amongst older US adults and impact both quality of life and health outcomes. One of the ways that unmet health‐related social needs impact health is through malnutrition, an imbalance in a person's intake of energy and/or nutrients. Lack of reliable access to a sufficient quantity of nutritious food is a specific health‐related social need that can be assessed rapidly and, when unmet, is a direct risk factor for malnutrition and may be indicative of a broader range of unmet health‐related social needs. We conducted a cross‐sectional study to characterise malnutrition and food insecurity amongst older adults receiving emergency department (ED) care using brief, validated measures and to assess the burden of a broader range of health‐related social needs amongst these patients. Patients were asked about their need for and willingness to receive a range of social services. The study was conducted in an academic ED serving a racially and socioeconomically diverse population in the Southeastern United States. A convenience sample of noncritically ill adults aged 60 years and older was approached between November 2018 and April 2019. Study patients (n = 127) were predominantly non‐Hispanic white (67%), community dwelling (91%) and urban residents (66%) with 28% screening positive for malnutrition risk, 16% for food insecurity and 5% for both. Of those at risk for malnutrition, 25 (69%) reported ≥2 unmet health‐related social needs and 14 (38%) were receptive to social services. Amongst food insecure patients, 18 (90%) reported additional unmet health‐related social needs and 13 (65%) were receptive to receiving social services. In conclusion, a brief set of questions can identify subgroups of older ED patients who are food insecure or at risk for malnutrition. Individuals who screen positive for food insecurity have a high burden of unmet health‐related social needs. [ABSTRACT FROM AUTHOR]

With the increase in life expectancy in the United States comes an increase in years lived with a disability and poverty. This necessitates age-friendly, affordable housing that is appropriate for older adults with disabilities. Board and care homes provide housing and services for older adults with disabilities. This scoping review maps the literature on board and care homes in the United States following the age-friendly communities framework. A synthesis of articles (n = 10) revealed that board and care homes, while probably affordable, can be unsafe; variable in services provided; are mostly unregulated; and may lack opportunities for socialization. [ABSTRACT FROM AUTHOR]

By 2050 the number of older persons is expected to double with figures reaching nearly 2.1 billion worldwide. This projection will challenge every nation's ability to provide the leadership required to reform and develop systems of care for the aged. The purpose of this review is to explore senior management characteristics that impact the performance of healthcare delivery systems in aged care homes. A systematic approach was used to search, extract and synthesise the literature. Both thematic analyses and critical appraisal were undertaken to identify prominent themes and evaluate the quality of each article. Of the 14 articles included in this review, 12 (85%) were from the United States and none from low and middle income countries. Findings from this review indicate that senior management characteristics influence the quality of care in aged care homes. There is some limited evidence of a link between senior management leadership styles (and behaviours) and the quality of health care delivery in aged care homes. Further research to determine the prevailing healthcare challenges concerning care quality in aged care homes is recommended to contribute to the evidence-based literature in the context of the Australian aged care sector. [ABSTRACT FROM AUTHOR]

Objectives This study compares patterns of gender difference in the receipt of informal care among community-dwelling older adults across the United States, Korea, and China where family-oriented systems for providing care to older adults are emphasized. Method Data came from the 2014 Health and Retirement Study, the 2014 Korea Longitudinal Study of Aging, and the 2015 China Health and Retirement Longitudinal Study. Logistic regression models were used to predict the receipt of informal care by gender. We also examined how the effects of health and living arrangement on the receipt of informal care differ depending on gender. Results In the United States and China, older women were more likely to receive informal care than men. However, older Korean women were less likely to receive informal care than men. The effects of health and living arrangement on the use of informal care were moderated by gender in different ways across countries. Discussion This study provides evidence that patterns of gender differences in the receipt of informal care vary across the three countries. More attention needs to be paid to the design and implementation of long-term supports and services to address the unique patterns of gender difference in care arrangement in each country. [ABSTRACT FROM AUTHOR]

Objectives This study compares estimates and determinants of within-individual changes in mobility across surveys of older U.S. adults. Methods Data come from the Health and Retirement Study (HRS) and the Midlife in the United States (MIDUS) study. Measures of mobility comprise self-reported level of difficulty with walking several blocks, going up several flights of stairs, lifting and carrying 10 pounds, and stooping. Predictors include sociodemographic characteristics and indicators of health and health behaviors. We pool the datasets and estimate weighted lagged dependent variable logistic regression models for each activity, assessing cross-study differences using interaction terms between a survey indicator and relevant variables. Results Estimates of declines in mobility differ substantially across surveys for walking, lifting and carrying, and stooping, but there are no between-survey differences in the probability of (not) recovering from a limitation. With the exception of age, determinants of change are similar between studies. For lifting/carrying and stooping, the age-related increase in developing limitations is less steep at younger ages for HRS respondents than MIDUS respondents, but steeper at older ages. Discussion To compare estimates of mobility change across surveys, mobility measures would need to be harmonized. Determinants of mobility change, however, are more comparable. [ABSTRACT FROM AUTHOR]

Objectives: By 2050, individuals aged 65 years and older will comprise over 20% of the American population. A portion is at risk for becoming elder orphans: older adults living in the community who lack caregivers or surrogates. Methods: Using the first wave of the National Health and Aging Trends Survey, we estimated the prevalence of older adults who reside in the community, who are socially or physically isolated, and who lack caregivers. Individuals who are "at risk" meet all of these criteria, with the exception that they live with and receive caregiving from their spouse. Results: We estimated the elder orphan prevalence for this population to be 2.62% (2.24--3.00), with an additional 21.29% determined to be at risk. Discussion: As the population of the United States ages, an understanding of the prevalence and demographics of elder orphans will be useful to guide policies and services to assist this population. [ABSTRACT FROM AUTHOR]

Objective: Geriatricians are skilled in the recognition of asymptomatic and atypical presentations that occur in the elderly and provide comprehensive medication management including recognizing adverse drug events, reducing polypharmacy, and de-prescribing. However, despite the increasing average age of the U.S. population, with the number of individuals above 65 years old predicted to increase 55% by 2030, the geriatric workforce capacity in the United States has actually decreased from 10,270 in 2000 to 8,502 in 2010. Method: We describe physiologic changes in older adults, historical trends in geriatric training, and propose solutions for this looming crisis. Results: Many factors are responsible for the shortage of skilled geriatric providers. Discussion: We discuss the historical context of the lack of geriatricians including changes to the training system, describe the impact of expert geriatric care on patient care and health system outcomes, and propose methods to improve recruitment and retention for geriatric medicine. [ABSTRACT FROM AUTHOR]

Objective: This study examined the trajectories of depressive symptoms and associated factors in older adults using an enhanced group-based trajectory modeling. Method: The study sample consisted of 7,573 adults aged ≥65 years from the National Health and Aging Trends Study (Rounds 1-7). Depressive trajectories were estimated using a group-based trajectory modeling accounting for nonrandom attrition. Results: A four-trajectory model including "persistently low" (77.7%), "increasing" (7.9%), "declining," (5.5%), and "persistently high" (8.9%) was the best fit using methods accounting for nonrandom attrition. In comparison, methods not accounting for attrition estimated that only 3.2% of older adults were on the "persistently high" trajectory. There were significant differences in depressive trajectories by age, race/ethnicity, sex, physical, and cognitive functioning, and social connections. Discussion: Persistently high depressive symptoms affected a larger proportion of older adults than previously estimated. Depression had a more long-term and increasing course in the oldest-old. [ABSTRACT FROM AUTHOR]

While existing work on transnational aging and care has largely focused on the substance of transnational communication and what is being said, this article examines what is being 'silenced' during transnational exchange. I argue that to better understand aging and intergenerational caregiving we need to pay careful attention to what is not being said during transnational contacts, suggesting that silence and 'communication voids' are often formulated and enacted as a care practice. Drawing on ethnographic research with Brazilian migrants in the United States whose aging parents live in Brazil, I illustrate how migrants curate their lives abroad and sieve their lived experiences as an act of care for their aging parents back home. In so doing, I reveal the significance of faith as a coping strategy in the process of silencing and concealing emotions and as a means to fight loneliness, cope with adversity, and protect family exchanges. [ABSTRACT FROM AUTHOR]

Objectives To identify levels and trends in life expectancy at age 65 (e65) by geographic region and metropolitan status in the United States. Methods Using county-level data on population and deaths from the Census and National Center for Health Statistics, we consider spatial inequality in e65 across 4 metropolitan types and 10 geographic regions from 2000 to 2016. We examine whether changes in e65 are driven by mortality developments in metro types or geographic regions, and compare spatial patterns in the United States to mortality trends in other Organization of Economic Cooperation and Development (OECD) countries. We use decomposition and regression methods to estimate the contributions of 10 causes of death to changes and inequalities in e65. Results Life expectancy at age 65 increased in all spatial units from 2000 to 2016. Areas with higher e65 in 2000 also experienced larger gains. Longevity increases were greatest in large metropolitan areas and coastal regions. Nonmetropolitan areas and the interior lagged far behind not only other parts of the United States but all OECD comparison countries. Metropolitan status was a better predictor of mortality changes than geographic region. Circulatory diseases and diseases associated with smoking were the principal sources of life expectancy gains and spatial differentiation in those gains. Larger gains in smoking-related mortality accounted for greater improvements among men than women. Discussion Even at advanced ages, large geographic disparities in life expectancy remain. And as mortality has declined, these disparities have widened. Public health efforts should pay special attention to identifying and ameliorating the sources of lagging life expectancy in nonmetropolitan regions. [ABSTRACT FROM AUTHOR]

Objectives Multiple chronic conditions (MCCs) are common and have harmful consequences in later life. Along with managing their own health, many aging adults care for an impaired partner. Spousal caregiving may be more stressful when caregivers have MCCs, particularly those involving complex management. Yet, little is known about combinations of conditions that are most consequential for caregiving outcomes. Method Using a U.S. sample of 359 spousal caregivers and care recipients from the 2011 National Aging Trends Study and National Study of Caregiving, we examined three categories of MCCs based on similarity of management strategies (concordant only, discordant only, and both concordant and discordant) and their associations with caregiving difficulties and gains. We also considered gender differences. Results Relative to caregivers without MCCs, caregivers with discordant MCCs reported fewer gains, whereas caregivers with both concordant and discordant MCCs reported greater emotional and physical difficulties. Wives with discordant MCCs only reported a trend for greater physical difficulties. Caregivers with concordant MCCs did not report more difficulties or gains. Discussion Spousal caregivers with MCCs involving discordant management strategies appear to be at risk for adverse care-related outcomes and may benefit from support in maintaining their own health as well as their caregiving responsibilities. [ABSTRACT FROM AUTHOR]

Rationale and objective: To evaluate the relationship between receipt of annual physicals and the receipt of provider recommendation for preventive services, during a period when Medicare did not cover annual physicals (before 2011). Methods: Electronic medical records of patients aged 65 years and older from a US health care system were extracted for the 2001 to 2007 period. A fixed‐effects logistic model was used to assess the relationship between receipt of periodic health examination (PHE) and receipt of provider recommendation for mammogram screening for 6466 female Medicare beneficiaries. Logistic regression models were used to assess the relationship between receipt of PHE and receipt of provider recommendation for colonoscopy screening and pneumococcal vaccination for 10 318 Medicare beneficiaries. Nine primary care providers from the network were also interviewed, selected by random sampling stratified by care model. Results: Electronic medical record analyses suggest that patients with a PHE were more likely to obtain provider recommendations for mammogram screening (OR = 2.17, P < 0.0001), colonoscopy screening (OR = 1.54, P < 0.0001), and pneumococcal vaccination (OR = 1.10, P < 0.0001). Providers suggested that prevention care quality improves with the PHE because certain screening measures (eg, skin cancer screening, breast exam) would be neglected without it, and healthy patients could miss recommended preventive services entirely. Without the PHE, some providers reported having tried to incorporate discussions of preventive services by scheduling more frequent follow‐up chronic care visits than they would have otherwise, and some routinely charged Medicare for a more complex follow‐up visit than they would have charged without the preventive service discussions. Conclusion: Periodic health examination is important in connecting patients to recommended preventive services. Provider interviews suggested that, indirectly, Medicare ended up paying for the PHE via greater frequency of follow‐up visits or higher visit charges from providers integrating the services with other visits. [ABSTRACT FROM AUTHOR]