To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Older adults experience high rates of chronic disease that reduce quality of life and independence. In South Texas, these challenges are compounded by limited access to culturally aligned care and a high burden of chronic conditions. Addressing these disparities requires infrastructure that bridges research and practice to support the translation of evidence into real-world care. This manuscript describes the establishment of the Supporting Older Adults through Research Network (SOARNet), a population-specific practice-based research network (PBRN) and reports early lessons from its development and recruitment strategies. SOARNet employs a multi-level leadership structure and an Advisory Board to guide research priorities, review member-initiated proposals, and facilitate collaboration among clinical, research, and community stakeholders. Recruitment strategies included informational materials, clinic visits, and targeted email outreach. Since inception, SOARNet has enrolled 61 members representing healthcare clinicians (55.7%), researchers (18.0%), community members (32.8%), and organizations (8.2%), with targeted email outreach proving most effective (n = 56). SOARNet has supported a collaborative research study, facilitated member consultations, and contributed to dissemination activities. These findings demonstrate the value of population-specific PBRNs in advancing community-engaged translational research to improve care for older adults. Future priorities focus on expanding partnerships and strengthening culturally responsive, bidirectional research.
Immigrant and racialized Canadians constitute an increasing percentage of the older adult population. Attention is needed to the role of municipalities and their key partners in creating urban environments that are supportive of aging in place. We conducted a qualitative descriptive sub-study of policy partners’ perceptions of age-friendly policies and initiatives as part of a larger community-based participatory project in Edmonton (Alberta, Canada). Nineteen participants, including elected municipal representatives, city administrators, advisory committee volunteers and seniors-serving organization staff, took part in semi-structured interviews, which was followed with a reflexive thematic analysis of the data. Participants described high levels of awareness about inequities faced by immigrant and racialized older adults. Advocacy and policy efforts, however, were constrained by insufficient funding, lack of capacity for sustainable initiatives, unclear jurisdictional boundaries and competing priorities.
Malgré le fait que le Nouveau-Brunswick est la seule province officiellement bilingue au Canada, l’accès aux soins de santé dans la langue officielle de la minorité semble demeurer un grand défi. La province est l’une de celles avec la plus grande proportion de personnes âgées de 65 ans et plus, dont 35 % sont francophones. Le but de cette étude qualitative de type théorisation ancrée était d’identifier comment les personnes aînées francophones en situation minoritaire accèdent aux soins en français. Des entrevues avec des personnes âgées provenant des trois communautés francophones minoritaires au N.-B. furent réalisées. Les résultats mettent en lumière le processus de « l’identité contre la vulnérabilité » en présentant six étapes qui illustrent le faible nombre d’actions entreprises pour accéder aux soins de santé en français. De plus, l’influence constante de facteurs extrinsèques et intrinsèques affecte l’étape où on s’identifie comme francophone, ce qui accentue la vulnérabilité de la personne aînée dans le système de santé.
Informed by self-determination theory (SDT), this study explores older adults’ long-term community volunteering experiences and motivations in Shanghai. We took a qualitative research approach to conduct face-to-face, semi-structured, in-depth interviews with older adults who were long-term volunteers in Shanghai communities (N = 69). We performed thematic analysis and generated themes for their experiences and evolving motivations. Participants began volunteering because it was enjoyable and helped them adapt to life after retirement. As their volunteering progressed, participants’ motivations gradually evolved and they developed a fusion motivation––juewu, combining characteristics of intrinsic and extrinsic motivations––for their strong commitment to volunteering. Gradually, participants assimilated juewu into their volunteer identity, which encouraged them to lead community self-governance initiatives. This study sheds light on the evolving, nuanced, underlying motivational process that shapes older adults’ experiences of long-term community volunteering.
This study explores how loneliness affects earthquake risk perception and preparedness behaviors among older adults in Japan. Aging is often accompanied by increased vulnerability to natural disasters, and loneliness is hypothesized to compromise effective preparedness. Using the Japanese Older Adult Preparedness Model (JOAPM), which integrates the Protective Action Decision Model (PADM) and cultural context, we examine how loneliness influences both perceived earthquake risk and protective behaviors.
Methods
An online survey conducted in April 2024 gathered responses from adults aged 55 and older across 4 earthquake-prone Japanese prefectures. Measures included demographics, disaster experience, loneliness (UCLA Loneliness Scale), risk perception, and preparedness actions such as household adjustments. Regression and mediation analyses assessed the direct and indirect effects of loneliness on preparedness.
Results
Findings show that loneliness has a significant negative direct effect on disaster preparedness. However, it also slightly increases risk perception, which in turn has a positive relationship with preparedness behaviors, suggesting a modest indirect pathway. Overall, the direct negative effect of loneliness outweighs the indirect benefit.
Conclusion
The results highlight the complex role of psychosocial factors in disaster readiness, suggesting that interventions should address information dissemination, self-efficacy, and the emotional isolation experienced by older adults in high-risk areas.
Traumatic and stressful life events can have lasting effects on mental health, particularly among older adults in low-resource settings. In Latin America, there is limited qualitative evidence capturing the lived experiences of these events. This study explores how older adults in Peru reflect on traumatic and stressful events throughout their lives, and how these experiences continue to shape their mental health in later life. This qualitative study was nested within the Global Excellence in COPD Outcomes (GECo) study in Lima, Peru. We conducted semi-structured, narrative-based interviews with 38 older adults (≥60 years) with moderate to severe symptoms of depression (Patient Health Questionnaire-9 ≥ 10), anxiety (Beck Anxiety Inventory ≥ 16) or a history of mental health treatment. Four main categories emerged: (1) violence (emotional, physical or sexual), (2) abandonment or loss of close relatives, (3) onset of severe illness or disability and (4) other miscellaneous life disruptions. Participants described their memories of past stressful events as deeply embedded in current thoughts and, in some cases, as shaping how they experience certain emotions in the present. Addressing trauma in older adults may improve well-being in low-resource settings. Recognizing the enduring impact of life-course stressors is crucial for culturally sensitive mental health interventions.
Subjective cognitive decline (SCD) is defined as self-reported increase in confusion or memory loss. There is limited research on the interplay between rural–urban residence and education on SCD.
Aims
Examine rural–urban differences in SCD, and whether education moderates this relationship.
Method
Respondents aged ≥45 years were queried about SCD in the 2022 Behavioral Risk Factor Surveillance System data, creating a sample size of 63 890. A logistic regression analysed the association between rural–urban residence and SCD, and moderation was tested by an interaction with education.
Results
SCD was more common among rural (12.0%) compared with urban (10.7%) residents. Rural residence was associated with 9% significantly higher odds of SCD compared with urban residence after adjusting for sociodemographic and health covariates (adjusted odds ratio (aOR) = 1.09, P = 0.01). There was a negative relationship between education level and SCD, including the association of college degree with 15% lower odds of SCD compared with less than high school degree (aOR = 0.85, P < 0.01). Education was a significant moderator, with higher education associated with lower odds of SCD for urban, but not rural, residents.
Conclusions
Rural setting and lower education were associated with higher odds of SCD, but higher education was protective for only urban residents. These results indicate that higher education may be a gateway for more opportunities and resources in urban settings, with cascading impacts on cognition. Future research should examine reasons for the diverging cognitive benefits from education depending on rural–urban residence.
The role of memory in supporting adolescents' sense of place and past is not well understood, but older adults offer a wealth of life stories and wisdom that they can share with younger generations. This in-depth pilot study positioned Australian high school students as oral historians to interview older Australians about their lives. Oral historian training and materials were provided, and pre- and post-intervention measures of adolescents' sense of everyday Australian history, well-being, and social connection were collected for an intervention school group (n = 17) and a waitlist control school group (n = 12). In-depth supplementary memory and well-being data were also collected for six participating older adults. In the intervention condition, scaffolded memory interviews took place during weekly aged care visits across one school term and were followed by an intergenerational celebration and memory book presentation. As hypothesised, older adults imbued their stories with life lessons for adolescents. Although no quantitative changes in participants' well-being emerged, qualitative data revealed the emergence of rich interpersonal relationships and bonding between adolescents and older adults. There were also benefits of the programme for older adults' reports of generativity and adolescents' understanding of everyday Australian history. The findings demonstrate the social and academic benefits of scaffolded intergenerational memory conversations and represent a scalable educational model and materials with downstream community benefits.
Age-related changes can affect mental health, but aging-focused mental health research is limited. The objective was to identify the top 10 unanswered research questions on aging and mental health according to what matters most to aging Canadians. A steering group of experts-by-experience (e.g., older adults, caregivers, health and social care providers) guided three phases of a modified James Lind Alliance priority-setting partnership: (1) a broad national survey (n = 305) and a rapid literature scan; (2) a follow-up national survey (n = 703); and (3) four online workshops (n = 52) with a nominal group technique. Forty-two unique questions on aging and mental health resulted, of which 18 were determined to be answered by existing evidence. Of the 25 partially and unanswered questions, 10 were ranked as top priority. Findings can be used to prioritize future research, knowledge mobilization, and funding decisions, and to promote and support collaboration between longstanding siloed research and care fields.
Adequate fruit and vegetable consumption is essential for healthy ageing and prevention and management of chronic disease. This study aimed to examine characteristics associated with fruit and vegetable consumption in Chinese men and women aged 50 years and over. Data from the first wave of the Chinese cohort (2008–2010) of the WHO’s Study on global AGEing and adult health (SAGE) survey was used. Fruit and vegetable consumption was assessed by self-reported typical consumption in serves/day. Characteristics examined were age, education, financial security, home ownership, marital status, social cohesion and rural location. Associations with fruit and vegetable consumption were assessed using multiple linear regression adjusted for confounders and stratified by sex. Overall, women consumed more serves of fruit per day than men (mean (standard deviation): 2·6 (2·2) and 2·2 (2·1) serves/day, respectively) whereas men consumed more serves of vegetables than women (7·2 (4·0) and 6·7 (3·7)). Lower fruit consumption was associated with lower education, lower social participation, income insecurity, renting, being un-partnered and rural residency in men and women, as well as older age in women. Lower vegetable consumption was associated with older age, lower education and urban residency in men and women and lower social participation in men and being unpartnered in women. This study has identified characteristics associated with fruit and vegetable intake in a sample of mid aged and older Chinese men and women. Further research on the interrelationships between these characteristics and fruit and vegetable intake as well as longitudinal relationships is warranted.
Suicide is a serious social problem among older adults. However, little is known about how multidimensional factors affect suicide of older adults.
Aims
We classify the multidimensional suicidal risk types of older adults based on their characteristics and identify differences in suicidal ideation.
Method
Data were obtained via a nationwide online survey targeting 612 older adults over the age of 55 years. A latent profile analysis identified three profiles, one of which represented the optimal situation for these adults.
Results
We identified three distinct multidimensional suicidal risk types in older adults: high-risk predicament (24.5%), moderate-risk predicament (57.7%) and abundant internal/external resources (17.8%). In particular, depression, a major risk factor for suicide, was found together with self-neglect in each group. Multiple regression analysis showed that older adults in the moderate-risk predicament and high-risk predicament groups were more likely to have suicidal ideation than those in the abundant internal/external resources group.
Conclusions
Our findings suggest that co-occurrence of depression and self-neglect represents a suicide risk pattern in high-risk older individuals. Therefore, local communities need to urgently screen and provide interventions for such older adults and strengthen their capacity for multidimensional aspects of life to prevent suicide in the long term.
Prior research indicates that neighbourhood disadvantage increases dementia risk. There is, however, inconclusive evidence on the relationship between nativity and cognitive impairment. To our knowledge, our study is the first to analyse how nativity and neighbourhood interact to influence dementia risk.
Methods
Ten years of prospective cohort data (2011–2020) were retrieved from the National Health and Aging Trends Study, a nationally representative sample of 5,362 U.S. older adults aged 65+. Cox regression analysed time to dementia diagnosis using nativity status (foreign- or native-born) and composite scores for neighbourhood physical disorder (litter, graffiti and vacancies) and social cohesion (know, help and trust each other), after applying sampling weights and imputing missing data.
Results
In a weighted sample representing 26.9 million older adults, about 9.5% (n = 2.5 million) identified as foreign-born and 24.4% (n = 6.5 million) had an incident dementia diagnosis. Average baseline neighbourhood physical disorder was 0.19 (range 0–9), and baseline social cohesion was 4.28 (range 0–6). Baseline neighbourhood physical disorder was significantly higher among foreign-born (mean = 0.28) compared to native-born (mean = 0.18) older adults (t = −2.4, p = .02). Baseline neighbourhood social cohesion was significantly lower for foreign-born (mean = 3.57) compared to native-born (mean = 4.33) older adults (t = 5.5, p < .001). After adjusting for sociodemographic, health and neighbourhood variables, foreign-born older adults had a 51% significantly higher dementia risk (adjusted hazard ratio = 1.51, 95% CI = 1.19–1.90, p < .01). There were no significant interactions for nativity with neighbourhood physical disorder or social cohesion.
Conclusions
Our findings suggest that foreign-born older adults have higher neighbourhood physical disorder and lower social cohesion compared to native-born older adults. Despite the higher dementia risk, we observed for foreign-born older adults, and this relationship was not moderated by either neighbourhood physical disorder or social cohesion. Further research is needed to understand what factors are contributing to elevated dementia risk among foreign-born older adults.
Malnutrition is a major problem among older adults with type 2 diabetes mellitus (T2DM). Some studies suggest that well glycaemic control increases the risk of frailty due to reduced intake. Therefore, it could be hypothesised that adequate glycaemic controlled patients may be at risk of malnutrition. This study aimed to examine, in older adults with T2DM, the association between adequate glycaemic control and malnutrition as well as identify the risk factors for malnutrition. Data including general characteristics, health status, depression, functional abilities, cognition and nutrition status were analysed. Poor nutritional status is defined as participants assessed with the Mini Nutritional Assessment as being at risk of malnutrition or malnourished. Adequate glycaemic control refers to an HbA1c level that meets the target base in the American Diabetes Association 2022 guidelines with individualised criteria. There were 287 participants with a median (interquartile range) age of 64 (61–70) years, a prevalence of poor nutrition, 15 %, and adequate glycaemic control, 83·6 %. This study found no association between adequate glycaemic control and poor nutrition (P = 0·67). The factors associated with poor nutritional status were low monthly income (adjusted OR (AOR) 4·66, 95 % CI 1·28, 16·98 for income < £118 and AOR 7·80, 95 % CI 1·74, 34·89 for income £118–355), unemployment (AOR 4·23, 95 % CI 1·51, 11·85) and cognitive impairment (AOR 5·28, 95 % CI 1·56, 17·93). These findings support the notion that older adults with T2DM should be encouraged to maintain adequate glycaemic control without concern for malnutrition, especially those who have low income, unemployment or decreased cognitive functions.
Gender norms embedded in communities may restrict opportunities and harm the mental health of older adults, yet this phenomenon has received little attention. This study investigates the connection between older adults’ perceptions of community gender norms and mental health and suicide-related outcomes.
Design:
Cross-sectional.
Setting:
This study analyzed data from the 2019 wave of the Japan Gerontological Evaluation Study.
Participants:
In total, 25,937 participants aged 65 years or older in 61 municipalities.
Measurements:
Perceptions of community gender norms were assessed by the respondents’ perceptions of the gender-differentiating language used by those around them such as “You should/should not do XXX, because you are a man/woman.”
Results:
The prevalence of all mental health outcomes was higher among both men and women who perceived community gender norms as restrictive. These associations remained in fully adjusted multivariable analyses. Prevalence ratios for men were 1.36 [95% confidence interval: 1.13, 1.65] for psychological resistance to obtaining help, 1.85 [1.54, 2.23] for depressive symptoms, 1.99 [1.34, 2.96] for suicidal ideation, and 2.15 [1.21, 3.80] for suicide attempts. The corresponding figures for women were 1.39 [1.17, 1.65], 1.80 [1.55, 2.10], 2.13 [1.65, 2.74], 2.62 [1.78, 3.87]. There was a more pronounced association between perceiving community gender norms as restrictive and depressive symptoms and suicidal behaviors among those with nonconventional gender role attitudes compared to those with conventional attitudes.
Conclusions:
Considering the effects of community gender norms, in addition to individual gender role attitudes, may be critical in designing effective public health interventions for improving mental health.
Coronavirus disease (COVID-19) lockdowns disproportionately affect older people where most suffer from social isolation and loneliness, which translate into higher rates of depression and anxiety. This study aimed to explore the accessibility, outcomes, and challenges of social technology use among community-dwelling older adults, older adults in long-term care, older adults with neurocognitive disorder, and older adults with pre-frailty and frailty, to help guide future research in this area. A rapid review was conducted, and articles were retrieved from four online databases, including Medline, AgeLine, EconLit and CINAHL, and grey literature from Google Scholar. Of the 131 articles retrieved, 24 were included in this review. The positive outcomes of social technology use include improved mental and physical health, reduced health disparities, and increased autonomy. Adverse outcomes include furthering the digital divide. More research surrounding the economic impacts of social technologies is warranted.
The purpose of this study was to examine the perspectives of support staff, health care professionals, and care coordinators working in or referring to a community-based, slow-stream rehabilitation, hospital-to-home transition program regarding gaps in services, and barriers and facilitators related to implementation and functioning of the program. This was a qualitative descriptive study. Recruitment was conducted through purposive sampling, and 23 individuals participated in a focus groups or individual semi-structured interview. Transcripts were analyzed by six researchers using inductive thematic analysis. Themes that emerged were organized based on a socio-ecological framework. Themes were categorized as: (1) macro level, meaning gaps while waiting for program, limited program capacity, and gaps in service post-program completion; (2) meso level, meaning lack of knowledge and awareness of the program, lack of specific referral process and procedures, lack of specific eligibility criteria, and need for enhanced communication among care settings; or (3) micro level, meaning services provided, program participant benefits, person-centred communication, program structure constraints, need for use of outcome measures, and follow-up or lack of follow-up. Implementation of seamless patient information sharing, documentation, use of specific referral criteria, and use of standardized outcome measures may reduce the number of unsuitable referrals and provide useful information for referral and program staff.
Online delivery is new to the field of music therapy (MT). This research investigated older adults’ perceived quality of MT online by certified music therapists. In this feasibility study, applying both process and outcome assessments, nine older adults volunteered to participate. Zoom was used, and a virtual music therapy (VMT) kit was developed as a resource. Surveys and observed technical difficulties revealed that perceived quality varied slightly by level of technical difficulty experienced; however, overall mean perceived quality was 7.2 out of 9. Post-study interviews revealed three main themes: (a) individual experiences with VMT, (b) individuals’ suggestions for further development of VMT sessions, and (c) individuals’ personal outcomes from VMT sessions. Participants reported overall positive experiences with VMT. Despite a slight decline in perceived quality when more technical difficulties were present, each participant reported a desire for more sessions, and they would recommend it to others.
Several etiologies can underlie the development of late-onset psychosis, defined by first psychotic episode after age 40 years. Late-onset psychosis is distressing to patients and caregivers, often difficult to diagnose and treat effectively, and associated with increased morbidity and mortality.
Methods:
The literature was reviewed with searches in Pubmed, MEDLINE, and the Cochrane library. Search terms included “psychosis,” “delusions,” hallucinations,” “late onset,” “secondary psychoses,” “schizophrenia,” bipolar disorder,” “psychotic depression,” “delirium,” “dementia,” “Alzheimer’s,” “Lewy body,” “Parkinson’s, “vascular dementia,” and “frontotemporal dementia.” This overview covers the epidemiology, clinical features, neurobiology, and therapeutics of late-onset psychoses.
Results:
Late-onset schizophrenia, delusional disorder, and psychotic depression have unique clinical characteristics. The presentation of late-onset psychosis requires investigation for underlying etiologies of “secondary” psychosis, which include neurodegenerative, metabolic, infectious, inflammatory, nutritional, endocrine, and medication toxicity. In delirium, psychosis is common but controlled evidence is lacking to support psychotropic medication use. Delusions and hallucinations are common in Alzheimer’s disease, and hallucinations are common in Parkinson’s disease and Lewy body dementia. Psychosis in dementia is associated with increased agitation and a poor prognosis. Although commonly used, no medications are currently approved for treating psychosis in dementia patients in the USA and nonpharmacological interventions need consideration.
Conclusion:
The plethora of possible causes of late-onset psychosis requires accurate diagnosis, estimation of prognosis, and cautious clinical management because older adults have greater susceptibility to the adverse effects of psychotropic medications, particularly antipsychotics. Research is warranted on developing and testing efficacious and safe treatments for late-onset psychotic disorders.
Autonomy is important to persons, including when they are living in nursing homes. Especially the relational dimension of autonomy is crucial for older adults with physical impairments. They generally have the decisional capacity to make choices about how they want to live their lives, but are often unable, or only partially able, to exercise these decisions themselves. To execute decisions, older adults are dependent on those who support them or care for them. However, little is known about how nursing home residents maintain autonomy in daily life and how others are involved in the decisions and execution of the decisions. To examine how older adults with physical impairments living in nursing homes maintain autonomy in daily life, shadowing, a non-participative observational method, was used. Seventeen older adults were shadowed during the course of one day. The observation ended with a brief interview. After the shadowing, the detailed observation notes were typed out, combined with the verbatim transcript resulting in one extensive report per shadowee. All 17 reports were coded and analysed thematically. Six elements for how older adults maintain autonomy in relation with others were identified, i.e. ‘being able to decide and/or execute decisions’, ‘active involvement’, ‘transferring autonomy to others’, ‘using preferred spaces’, ‘choosing how to spend time in daily life’ and ‘deciding about important subjects’. For all six elements established in this study, it was found that older adults with physical impairments living in nursing homes could only maintain autonomy in daily life when others, such as staff, family and friends, were responsive to signals of the needs of older adults.
The purpose of this study was to identify internal and external factors associated with outdoor winter walking in older adults. In this scoping review, 12 databases were searched. Inclusion criteria included English language, focus on adults 65 years of age or older, and evaluation of factors associated with outdoor winter walking. Two authors screened titles/abstracts and full text. Conflicts were resolved by consensus. Data were extracted, organized into tables, and summarized as pertaining to barriers/facilitators and internal/external factors associated with outdoor winter walking. A total of 6,843 articles were identified, 1,898 duplicates were removed, 4,789 were excluded during title/abstract screening, and 148 were excluded during full-text review. Eight studies were included. Four categories of factors affecting outdoor winter walking in older adults were identified: adverse weather conditions, physical environment, physical function, and perceptions relating to winter walking conditions. Rehabilitation and exercise professionals can use the results to educate their clients and implement the facilitators of and alternatives and solutions to barriers to outdoor winter walking.