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Background: Community-dwelling older adults often serve as caregivers despite having their own health concerns and disabilities, yet little is known about their care needs., Methods: Cross-sectional analysis including community-dwelling U.S. adults over age 60 years who self-identified as caregivers in the National Social Life, Health, and Aging Project in 2015-2016. Caregiving was defined by self-reported assistance of another adult with day-to-day activities due to age or disability; overlapping care-receiving was defined by simultaneous receipt of help for at least one activity of daily living (ADL) or independent ADL (IADL). Multivariable logistic regression models examined attributes associated with overlapping care-receiving among older caregivers, adjusted for caregiver characteristics (age, gender, spousal caregiving, self-reported physical and mental health, cognitive function, and household assets)., Results: Among the 444 caregivers, the mean age was 67.8 (SD 0.29) years, 55.8% were women, 78.1% were non-Hispanic White, 54.7% self-identified as primary caregivers, and 30.7% were caring for a spouse. Thirty-two percent of older caregivers were caregiving while themselves receiving assistance with at least one ADL or IADL. Thirty-four percent of caregivers reported <$50,000 in household assets and 10% did not answer the question. Given prior research that supports that most nonrespondents fall into the low-income group, subjects were combined. Analyses with and without nonrespondents did not substantially change the results. Compared to caregivers who were not simultaneously receiving care, caregivers reporting overlapping care-receiving had greater odds of being older (AOR 1.30, 95% confidence interval [CI] [1.14, 1.48] per each 5-year age increase), caregiving for a spouse (AOR 1.93, 95% CI [1.20, 3.13]), having limited household assets (AOR 2.10, 95% CI [1.17, 3.80], for <$50,000 compared to ≥$50,000), and having poor or fair self-reported physical health (AOR 2.94, 95% CI [1.43, 6.02])., Conclusions: Over 30% of older adult caregivers report simultaneously receiving care for their own daily activities. Older caregivers who receive care are more likely to be older, spousal caregivers, and have limited assets and worse physical health. Targeted strategies are needed to support older caregivers who are uniquely vulnerable due to their overlapping care needs., (© 2024 The American Geriatrics Society.)

Background/objectives: Many older adults wish to age in place, and voice-controlled intelligent personal assistants (VIPAs; eg, Amazon Echo and Google Home) potentially could support unmet home needs. No prior studies have researched the real-world use of VIPAs among older adults. We sought to explore how older adults and caregivers utilize VIPAs., Design/measurement: Retrospective review of all verified purchase reviews of the Amazon Echo posted on Amazon.com between January 2015 and January 2018, with filtering for health-related older adult key words. Open-ended reviews were qualitatively analyzed to identify relevant themes., Results: On retrieval, there were 73 549 reviews; and with subsequent key word filtering, 125 total reviews were subsequently analyzed. Five major themes were identified: (1) entertainment ("For two very senior citizens…we have really had fun with Echo. She tells us jokes, answers questions, plays music.); (2) companionship ("A senior living alone…I now have Alex to talk to."); (3) home control; (4) reminders ("I needed something that would provide me with information I couldn't remember well, such as the date, day, or my schedule…I highly recommend for anyone with memory challenges"); and (5) emergency communication. Several felt it reduced burdening caregivers. "…You also feel guilt from fear of overburdening your caregivers. Alexa has alleviated much of this." Specifically, caregivers found that: "By making playlists of songs from her youth whoever is providing care, family or professional caregiver, can simply request the right song for the moment in order to sooth, redirect, or distract Mom." Alternatively, negative reviewers felt the VIPA misunderstood them or could not adequately respond to specific health questions., Conclusion: VIPAs are a low-cost artificial intelligence that can support older adults in the home and potentially reduce caregiver burden. This study is the first to explore VIPA use among older adults, and further studies are needed to examine the direct benefits of VIPAs in supporting aging in place. J Am Geriatr Soc 68:176-179, 2019., (© 2019 The American Geriatrics Society.)

Objectives: To understand older adult perceptions about accepting help at home, in particular fears related to potential loss of independence., Design: Qualitative focus groups., Setting: Rural, suburban, and urban areas of Fort Wayne, Indiana, and Chicago, Illinois., Participants: Community-dwelling adults aged 65 and older (N=68)., Measurements: Participants discussed decision-making, reluctance to accept home-based care, barriers, and resources that might affect remaining in the home. Three independent coders used constant comparative analysis to interpret results., Results: Analysis revealed that reluctance to accept home-based support was associated with concerns over inability to complete tasks, perceptions of being burdensome to others, lack of trust in others, and lack of control. To overcome these concerns, some participants reframed the concept of independence to be "interdependence," with people continually depending on each other throughout their lives. Subjects noted that, even if one becomes more limited over time, the recognition that one is still contributing something meaningful to society is important to overcoming refusal of home assistance. Another strategy presented to overcome negative perceptions of accepting assistance in the home was the recognition that helping someone who is in need may engender positive emotions in those providing the help., Conclusion: Older adults perceived multiple reasons for refusing home-based assistance and offered potential strategies to overcome this reluctance. Addressing the reasons and promoting strategies to accept home-based support may lead older adults to have fewer unmet home-based needs, enabling them to remain safely in their homes., (© 2018, Copyright the Author Journal compilation © 2018, The American Geriatrics Society.)

Objective: Few older adults contemplate their home support and health needs that may be required for aging-in-place. We sought to assess the efficacy of PlanYourLifespan.org (PYL), in influencing seniors' planning behaviors, perception of the importance of planning, and confidence accessing services., Method: Randomized controlled trial, of adults, age ≥65 years in urban, suburban, rural areas of Texas, Illinois, Indiana., Results: Among 385 participants, mean age was 71.9 years, 79.5% female. Between baseline and one-month follow-up, average planning behavior score increased 0.22 points in the PYL arm when compared to the attention control (AC) arm. After controlling for baseline, mean one-month planning behavior score was significantly higher in the PYL arm than in the AC arm (1.25 points, CI 0.37-2.12, p=0.005). Secondary analyses via longitudinal linear mixed modelling suggested a study arm-by-time interaction effect for both planning behavior (p=0.047 and perception of importance (p=0.05). Significant baseline covariates included self-efficacy, education, perceived social support, power of attorney, and history of stroke., Conclusions and Practice Implications: PlanYourLifespan.org demonstrated efficacy in helping seniors plan for and communicate their health support needs. This free, nationally available tool may help individuals understand, plan, and communicate their options for their future support needs., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Despite the wishes of many seniors to age-in-place in their own homes, critical events occur that impede their ability to do so. A gap exists as to what these advanced life events (ALEs) entail and the planning that older adults perceive is necessary. The purpose of this study was to identify seniors' perceptions and planning toward ALEs that may impact their ability to remain in their own home. We conducted focus groups with 68 seniors, age ≥65 years (mean age 73.8 years), living in the community (rural, urban, and suburban), using open-ended questions about perceptions of future heath events, needs, and planning. Three investigators coded transcriptions using constant comparative analysis to identify emerging themes, with disagreements resolved via consensus. Subjects identified five ALEs that impacted their ability to remain at home: (1) Hospitalizations, (2) Falls, (3) Dementia, (4) Spousal Loss, and (5) Home Upkeep Issues. While recognizing that ALEs frequently occur, many subjects reported a lack of planning for ALEs and perceived that these ALEs would not happen to them. Themes for the rationale behind the lack of planning emerged as: uncertainty in future, being too healthy/too sick, offspring influences, denial/procrastination, pride, feeling overwhelmed, and financial concerns. Subjects expressed reliance on offspring for navigating future ALEs, although many had not communicated their needs with their offspring. Overcoming the reasons for not planning for ALEs is crucial, as being prepared for future home needs provides seniors a voice in their care while engaging key supporters (e.g., offspring)., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Older adults frequently defer decisions about their aging‐in‐place/long‐term care (AIP‐LTC) needs. As a result, when older adults experience worsening Alzheimer's disease, family members/friends become surrogate decision makers. We sought to understand what aspects of cognition impact older adult AIP‐LTC planning. Methods: As part of the PlanYourLifespan (PYL)‐LitCog study, we longitudinally examined AIP‐LTC decision‐making among a cohort (LitCog) of community‐based older adults (65 years and older) recruited from hospital‐associated primary care clinics in Chicago, Illinois, with extensive cognitive testing. PlanYourLifespan.org (PYL) is an evidence‐based online intervention that facilitates AIP‐LTC planning. Subjects underwent baseline testing, received the PYL online intervention, and then were surveyed at 1, 6, and 12 months about AIP‐LTC decision‐making. Cross‐sectional logistic regression analysis was conducted examining cognitive variables that impacted AIP‐LTC decision‐making. Results: Of the 293 older adults interviewed (mean age 73.0 years, 40.4% non‐White), subjects were more likely to have made AIP‐LTC decisions if they had adequate inductive reasoning (ETS letter sets total—OR = 1.14 (95% CI = 1.03–1.27; p < 0.05)) and adequate working memory (size judgment span total—OR = 1.76 (95% CI = 1.13–2.73; p < 0.05)). There were no differences in decision‐making observed in verbal abilities, long‐term memory, or processing speed. All analyses were adjusted for participant gender, race, age, and decision‐making response at baseline. Conclusion: Inductive reasoning and working memory are critical to AIP‐LTC decision‐making. Screening routinely for these specific cognitive domains is important in targeting and helping older adults prepare in time for their future AIP‐LTC needs. [ABSTRACT FROM AUTHOR]

Social isolation has been associated with many adverse health outcomes in older adults. We describe a phone call outreach program in which health care professional student volunteers phoned older adults, living in long-term care facilities and the community, at risk of social isolation during the COVID-19 pandemic. Conversation topics were related to coping, including fears or insecurities, isolation, and sources of support; health; and personal topics such as family and friends, hobbies, and life experiences. Student volunteers felt the calls were impactful both for the students and for the seniors, and call recipients expressed appreciation for receiving the calls and for the physicians who referred them for a call. This phone outreach strategy is easily generalizable and can be adopted by medical schools to leverage students to connect to socially isolated seniors in numerous settings. [ABSTRACT FROM AUTHOR]