In-Home Monitoring Technology for Aging in Place: Scoping Review.

BACKGROUND: For successful aging-in-place strategy development, in-home monitoring technology is necessary as a new home modification strategy. Monitoring an older adult's daily physical activity at home can positively impact their health and well-being by providing valuable information about functional, cognitive, and social health status. However, it is questionable how these in-home monitoring technologies have changed the traditional residential environment. A comprehensive review of existing research findings should be utilized to characterize recent relative technologies and to inform design considerations. OBJECTIVE: The main purpose of this study was to classify recent smart home technologies that monitor older adults' health and to architecturally describe these technologies as they are used in older adults' homes. METHODS: The scoping review method was employed to identify key characteristics of in-home monitoring technologies for older adults. In June 2021, four databases, including Web of Science, IEEE Xplore, ACM Digital Library, and Scopus, were searched for peer-reviewed articles pertaining to smart home technologies used to monitor older adults' health in their homes. We used two search strings to retrieve articles: types of technology and types of users. For the title, abstract, and full-text screening, the inclusion criteria were original and peer-reviewed research written in English, and research on monitoring, detecting, recognizing, analyzing, or tracking human physical, emotional, and social behavior. The exclusion criteria included theoretical, conceptual, or review papers; studies on wearable systems; and qualitative research. RESULTS: This scoping review identified 30 studies published between June 2016 and 2021 providing overviews of in-home monitoring technologies, including (1) features of smart home technologies and (2) sensor locations and sensor data. First, we found six functions of in-home monitoring technology among the reviewed papers: daily activities, abnormal behaviors, cognitive impairment, falls, indoor person positioning, and sleep quality. Most of the research (n=27 articles) focused on functional monitoring and analysis, such as activities of daily living, instrumental activities of daily living, or falls among older adults; a few studies (n=3) covered social interaction monitoring. Second, this scoping review also found 16 types of sensor technologies. The most common data types encountered were passive infrared motion sensors (n=21) and contact sensors (n=19), which were used to monitor human behaviors such as bodily presence and time spent on activities. Specific locations for each sensor were also identified. CONCLUSIONS: This wide-ranging synthesis demonstrates that in-home monitoring technologies within older adults' homes play an essential role in aging in place, in that the technology monitors older adults' daily activities and identifies various health-related issues. This research provides a key summarization of in-home monitoring technologies that can be applied in senior housing for successful aging in place. These findings will be significant when developing home modification strategies or new senior housing.

Factor analysis of the Cognitive Abilities Screening Instrument: Kuakini Honolulu-Asia Aging Study.

OBJECTIVE: The Cognitive Abilities Screening Instrument (CASI) is a screening test of global cognitive function used in research and clinical settings. However, the CASI was developed using face validity and has not been investigated via empirical tests such as factor analyses. Thus, we aimed to develop and test a parsimonious conceptualization of the CASI rooted in cognitive aging literature reflective of crystallized and fluid abilities. DESIGN: Secondary data analysis implementing confirmatory factor analyses where we tested the proposed two-factor solution, an alternate one-factor solution, and conducted a χ2 difference test to determine which model had a significantly better fit. SETTING: N/A. PARTICIPANTS: Data came from 3,491 men from the Kuakini Honolulu-Asia Aging Study. MEASUREMENTS: The Cognitive Abilities Screening Instrument. RESULTS: Findings demonstrated that both models fit the data; however, the two-factor model had a significantly better fit than the one-factor model. Criterion validity tests indicated that participant age was negatively associated with both factors and that education was positively associated with both factors. Further tests demonstrated that fluid abilities were significantly and negatively associated with a later-life dementia diagnosis. CONCLUSIONS: We encourage investigators to use the two-factor model of the CASI as it could shed light on underlying cognitive processes, which may be more informative than using a global measure of cognition.

Novel Functional, Health, and Genetic Determinants of Cognitive Terminal Decline: Kuakini Honolulu Heart Program/Honolulu-Asia Aging Study.

To investigate interindividual differences in cognitive terminal decline and identify determinants including functional, health, and genetic risk and protective factors, data from the Honolulu Heart Program/Honolulu-Asia Aging Study, a prospective cohort study of Japanese American men, were analyzed. The sample was recruited in 1965-1968 (ages 45-68 years). Longitudinal performance of cognitive abilities and mortality status were assessed from Exam 4 (1991-1993) through June 2014. Latent class analysis revealed 2 groups: maintainers retained relatively high levels of cognitive functioning until death and decliners demonstrated significant cognitive waning several years prior to death. Maintainers were more likely to have greater education, diagnosed coronary heart disease, and presence of the apolipoprotein E (APOE) ε2 allele and FOXO3 G allele (SNP rs2802292). Decliners were more likely to be older and have prior stroke, Parkinson's disease, dementia, and greater depressive symptoms at Exam 4, and the APOE ε4 allele. Findings support terminal decline using distance to death as the basis for modeling change. Significant differences were observed between maintainers and decliners 15 years prior to death, a finding much earlier compared to the majority of previous investigations.

Understanding Older Adults' Perception and Usage of Indoor Lighting in Independent Senior Living.

The main purpose of this research is to examine the lighting condition and residents' perception of lighting in a senior retirement community in order to understand various environmental issues related to lighting. Also, this research aims to suggest a new lighting solution to compensate for older adults' vision impairment and challenges at home for a successful aging place. In the normal aging process, more than 30% of older adults have a vision impairment, which negatively affects health and well-being of older adults such as limited activities, falling, loneliness, depression, anxiety, and a sense of control. Via a mixed method study design, residents in senior living communities were asked to describe the adequacy of light levels and specific tasks and needs related to lighting at their home. In addition to the survey and interview, indoor lighting assessments were conducted during the in-home session. The research findings highlighted older adults' experience and perception of lighting in their homes. Paired-sample t test indicated that there were statistically significant differences in light levels between normal conditions and full capacity conditions in all spaces. In order to address various challenges which older adults have been experiencing in their home for a long time, this research suggests new smart lighting platform which provides a proper level of illumination in older adult's homes. Such a smart platform is proactive and can dynamically adjust the smart devices or lighting fixtures in situ, while older adults are performing certain tasks.

Values of lifelong learners and their pursuits of happiness and whole-person wellness.

Objectives: In this study, we explored the lived experiences of older adults engaged in lifelong learning programs using the Orientations to Happiness (OTH) framework.Methods: Semi-structured interviews employing a phenomenological approach were conducted with Midwestern older adults (aged 65 years and older) who participated in lifelong learning programs. Interviews were transcribed and collaboratively coded using pattern coding.Results: Six themes were identified that described the values expressed by participants: 1) need for novelty, 2) generativity, 3) spirituality, 4) hedonism, 5) active lifestyle, and 6) family. We created a novel diagram representing the intersectionality of the three OTH components (e.g.meaning, engagement, and pleasure) and explored how the six themes fit within our diagram. In doing so, we elucidated various OTH intersections that highlight a variety of happiness-promoting pathways that lifelong learning programs offer older adults.Discussion: Results suggest that these values and experiences can play an important role in maintaining an engaged lifestyle and providing opportunities for achieving and maintaining happiness and whole-person wellness.

Gerontological education: Course and experiential differences across academic colleges.

A knowledgeable workforce is key to meeting the demands of an aging population that is expected to nearly triple by 2030 and their attitudes influence propensity to seek aging-related careers. Postsecondary education offers an opportunity to increase aging-related knowledge and facilitates intergenerational experiential-learning opportunities; however, research is lacking regarding attitudes toward aging and experiences among an academically diverse sample. To address this gap, the aims of this study were to (1) examine differences in students' attitudes toward older adults by academic college, (2) assess differences in aging-related coursework and course experiences by academic college, and (3) explore key factors associated with students' attitudes toward older adults. Online survey methodology was used with a sample of 816 undergraduate students from a single university who represented all academic colleges offering undergraduate degrees. Significant differences among students' attitudes toward older adults by academic college were noted: those enrolled in the College of Human Sciences reported better stereotype, separation, and affective attitudes. Furthermore, factors associated with students' aging-related attitudes were sex, affiliation with academic college, perception of "old," contact frequency, and desire to learn aging-related content. The authors suggest interdisciplinary and disciplinary-specific educational recommendations to improve students' attitudes toward older adults.

A Community-Based Exergaming Physical Activity Program Improves Readiness-to-Change and Self-Efficacy Among Rural-Residing Older Adults.

Rural-residing older adults (OA) are not meeting physical activity (PA) recommendations, such that identifying methods of increasing PA among OA remains an ongoing challenge. This study evaluated the effect of a community-based exergaming program on PA readiness-to-change and self-efficacy among rural-residing OA (n = 265). There was a significant (p = .008) increase in readiness-to-change classification from PRE to POST. Significant increases in self-efficacy, or confidence in their ability to be physically active for a prescribed period of time, were detected for 35 (p = .011) and 40 min (p = .035) of continuous PA. PA self-efficacy change for 35 min of continuous PA (F [3,137] = 3.973, p = .010) and 40 min of continuous PA (F [3,137) = 2.893, p = .038) were influenced by the interaction between PRE self-reported health and PRE PA readiness-to-change levels. Results suggest that an exergaming-themed PA intervention is effective at increasing PA participation and self-efficacy for PA among rural-residing OA.

Promoting the Congregate Meal Program to the Next Generation of Rural-Residing Older Adults.

Despite a growing older adult population, Iowa Congregate Meal Program (CMP) participation has declined. Motivators and barriers to congregate mealsite participation and wellness programming preferences of baby boomers and older adults were examined to provide insight to how to revise and better promote the CMP for the next generation of older adults. Four focus group sessions were conducted with 27 primarily White, rural-residing adults, ages 48-88 years. Participation motivators included educational programs, food, and socialization while barriers included negative perceptions and stereotypes associated with congregate mealsites. Desired wellness programs were viewed as interactive and relevant. Healthcare was the leading wellness need with financial management and physical activity cited as the most-wanted topics of wellness programs. These results provide insight on factors, aside from funding, that may be adversely impacting CMP participation and identifies areas for further investigation.

Engaging Graduate-Level Distance Learners in Research: A Collaborative Investigation of Rural Aging.

Online educational programs pose challenges to nonresidential graduate students for whom research is a key professional development experience. In this article, the authors share their pedagogical approach to engaging graduate-level online distance learners in research. Five students enrolled in an online master's degree program participated in a directed research course designed to facilitate a semester-long, collaborative, hands-on research experience in gerontology. As such, students recruited participants and conducted phone interviews for a multisite study examining aging in place in rural areas. Several strategies were used to facilitate student engagement and learning, including: regular meetings with faculty mentors, creation of a research team across institutions, interactive training, and technological tools to aid in communication. The authors discuss the process of implementing the project, challenges that arose, strategies for dealing with these issues, and a pedagogical framework that could be used to guide future endeavors of this type.

Comparison of 2 informant questionnaire screening tools for dementia and mild cognitive impairment: AD8 and IQCODE.

BACKGROUND: Dementia and mild cognitive impairment (MCI) are underrecognized in community settings. This may be due in part to the lack of brief dementia screening tools available to clinicians. We compared 2 brief, informant-based screening tests: the AD8 and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) in a community-based neurology practice in the midwestern United States. METHODS: We examined 186 consecutive patients (44 controls, 13 with MCI, and 129 with dementia). Receiver operator characteristic curves were used to examine the ability of AD8 and IQCODE to discriminate between controls and MCI or dementia. Sensitivity, specificity, predictive values, and likelihood ratios were reported. RESULTS: AD8 differentiated healthy controls from MCI (P<0.001) or dementia (P<0.001), and MCI from dementia (P=0.008). The IQCODE differentiated controls and MCI from dementia (both P<0.001), and between controls and MCI (P=0.002). Both AD8 (AUC=0.953; 95% confidence interval, 0.92-0.99) and IQCODE (AUC=0.930, 95% confidence interval, 0.88-0.97) provided discrimination between controls and patients with dementia; however, the AD8 had superior sensitivity detecting dementia (99.2%) and MCI (100%) compared with the IQCODE (79.1% for dementia, 46.1% for MCI) with nonoverlapping confidence intervals. Using published cut-offs (AD8≥2, IQCODE≥3.4), only 1 case of dementia was missed with the AD8, whereas the IQCODE failed to detect dementia in 27 individuals. The AD8 detected MCI in all 13 individuals, whereas the IQCODE misclassified 7 individuals. CONCLUSIONS: Both the AD8 and IQCODE were able to detect dementia in a community setting. The AD8, however, was more successful than IQCODE in detecting MCI. If simple and efficient screening for early cognitive impairment is the goal, particularly in the early stages (e.g., for prevention trials or public screening), the combination of an informant interview (the AD8) and a brief performance measure could be considered as they meet the basic requirements of the Personalized Prevention Plan for Medicare beneficiaries.

Community-based exergaming program increases physical activity and perceived wellness in older adults.

Exergaming may be an effective strategy to increase physical activity participation among rural older adults. This pilot project examined the effects of a 24-wk exergaming and wellness program (8 wk onsite exergaming, 16-wk wellness newsletter intervention) on physical activity participation and subjective health in 46 rural older adults. Sociodemographic data and self-reported physical activity were analyzed using descriptive statistics and Cochran's Q, respectively. Qualitative data were reviewed, categorized on the basis of theme, and tabulated for frequency. Increased physical activity and perceived health were the most reported perceived positive changes. Significant increases in physical activity participation were maintained among participants who were physically inactive at baseline. Best-liked features were physical activity and socialization. Findings suggest that this pilot exergaming and wellness program is effective in increasing physical activity in sedentary rural older adults, increasing socialization, and increasing subjective physical health among rural older adults.

APOE ϵ4, rated life experiences, and affect among centenarians.

OBJECTIVES: The purpose of this study was to assess the relationship between apolipoprotein E (APOE), life events and engagement, and subjective well-being (as measured by positive and negative affect) among centenarians. Based on the life stress paradigm, we predicted that higher levels of stress would allow APOE to influence positive and negative affect. METHOD: 196 centenarians and near-centenarians (98 years and older) of the Georgia Centenarian Study participated in this research. The APOE, positive and negative affect, the number of recent (last 2 years) and lifelong (more than 20 years prior to testing) events, as well as a number of life engagement tasks were assessed. RESULTS: Results suggested that centenarians carrying the APOE ϵ4 allele rated lower in positive affect, the number of lifelong events, and in engaged lifestyle, when compared to centenarians without the APOE ϵ4 allele (t = 3.43, p < .01; t = 3.19, p < .01; and t = 2.33, p < .05, respectively). Blockwise multiple regressions indicated that the APOE ϵ4 predicted positive but not negative affect after controlling for demographics. Gene-environment interactions were obtained for the APOE ϵ4 and lifelong events, suggesting that carriers of the APOE ϵ4 allele had higher scores of negative affect after having experienced more events, whereas noncarriers had reduced negative affect levels after having experienced more events. CONCLUSION: APOE ϵ4 is directly related to positive affect and is related to negative affect in interaction with life events.

Dyadic analysis of self-efficacy and perceived support: the relationship of individual and spousal characteristics with physical activity among middle-aged and young-older adults.

The purpose of this study was to examine the associations among self-efficacy, perceived support, and physical activity in middle-aged and older married couples. A total of 116 middle-aged and older couples (M = 58.86 years, SD = 7.16, range 50-74) participated in the study. A dyadic approach to path modeling was taken. The final model indicated that for both husbands and wives, one's own self-efficacy was directly related to physical activity. In addition, husband self-efficacy was positively related to wive physical activity and indirectly related to wife physical activity through wife self-efficacy. Wife self-efficacy was indirectly related to husband physical activity via the level of husband perceived support. These results provide evidence for the importance of incorporating spousal characteristics in addition to individual characteristics when investigating physical activity during middle and later married life.

Perceptions of technology among older adults.

Changes and advancements in technology have the potential to benefit older adults by promoting independence and increasing the ability to age in place. However, older adults are less likely to adopt new technology unless they see benefits to themselves. This study assessed the perceptions of 30 older adults in the Midwest concerning technology via three separate focus groups (i.e., independent apartment complex, a rural community, exercise program participants), which addressed a need in the literature (i.e., inclusion of oldest-old and rural individuals). The focus group questions included items such as what technology older adults currently used, desired improvements in technology, and the greatest challenges participants were facing or would face in the future. Overall, older adults were enthusiastic about learning new forms of technology that could help them maintain their independence and quality of life. Five themes emerged from all three focus groups: (a) Frustrations, Limitations, and Usability Concerns; (b) Transportation; (c) Help and Assistance; (d) Self-Monitoring; and (e) Gaming. The themes have important implications for future technology developed for older adults; in particular, older adults were willing and eager to adopt new technology when usefulness and usability outweighed feelings of inadequacy.

Correlates of functional capacity among centenarians.

This study investigated correlates of functional capacity among participants of the Georgia Centenarian Study. Six domains (demographics and health, positive and negative affect, personality, social and economic support, life events and coping, distal influences) were related to functional capacity for 234 centenarians and near centenarians (i.e., 98 years and older). Data were provided by proxy informants. Domain-specific multiple regression analyses suggested that younger centenarians, those living in the community and rated to be in better health were more likely to have higher functional capacity scores. Higher scores in positive affect, conscientiousness, social provisions, religious coping, and engaged lifestyle were also associated with higher levels of functional capacity. The results suggest that functional capacity levels continue to be associated with age after 100 years of life and that positive affect levels and past lifestyle activities as reported by proxies are salient factors of adaptation in very late life.

The role of supportive messages and distracting thoughts on everyday problem-solving performance.

UNLABELLED: BACKGROUND/STUDY CONTEXT: An increasing number of studies have examined factors related to everyday problem-solving performance across adulthood. The current study examined the role of experimentally provided supportive messages intended to provide practical or emotional support on everyday problem-solving performance. Other factors such as participant age and distracting thoughts experienced during task completion were also investigated. METHODS: Everyday problem-solving performance, verbal ability performance, inductive reasoning performance, and self-reports of distracting thoughts were obtained from 54 middle-aged and 48 older adults. Participants were also exposed to practically supportive messages, emotionally supportive messages, or no supportive messages prior to completing the everyday problem-solving task. RESULTS: Exposure to emotionally supportive messages increased task performance and lowered levels of distracting thoughts. Distracting thoughts mediated the relation between exposure to emotionally supportive messages and everyday problem-solving performance. Distracting thoughts also mediated the relation between age and everyday problem-solving performance. CONCLUSION: Study findings indicate that emotionally supportive messages may increase everyday problem-solving performance by decreasing the amount of distracting thoughts experienced by participants. This finding suggests that consistent administration of emotionally supportive messages could result in more optimal everyday problem-solving performance among middle-aged and older adults.

Life events and personality predicting loneliness among centenarians: findings from the Georgia Centenarian Study.

Regarding the purpose of this study, the researchers analyzed the roles that both life events (life-time positive events and life-time negative events) and personality (Neuroticism, Extraversion, Trust, Competence, and Ideas) played in participants of the Georgia Centenarian Study. The researchers analyzed these variables to determine whether they predicted loneliness. Analyses indicated that life-time negative events significantly predicted loneliness. In essence, the higher was the number of life-time negative life events, the higher was the loneliness score. Moreover, Neuroticism, Competence, and Ideas were all significant predictors of loneliness. The higher was the level of Neuroticism and intellectual curiosity, the higher was the level of loneliness, whereas the lower was the level of Competence, the higher was the level of loneliness. In addition, both life-time positive and life-time negative life events were significant predictors of Neuroticism. The higher was the number of life-time positive events, the lower was the level of Neuroticism, and the higher was the number of life-time negative events, the greater was the level of Neuroticism. These results indicated that life-time negative events indirectly affect loneliness via Neuroticism. Last, our results indicated that the Competence facet mediated the relationship between lifetime negative life events and loneliness. Life-time negative life events significantly affected centenarians' perceived competence, and Competence in turn significantly affected the centenarians' loneliness. These results as a whole not only add to our understanding of the link between personality and loneliness, but also provide new insight into how life events predict loneliness.

Exceptional longevity: an introduction to the Iowa Centenarian Study.

The primary objective of the Iowa Centenarian Study is to further our understanding of determinants of exceptional longevity above and beyond health outcomes, particularly in rural environments. This introductory article provides a general overview of the study, its methodology and basic descriptive results. One hundred and fifty-two centenarians from a rural state participated in the study (average age was 101.6 years). Baseline data collection included questions on demographics, cognitive representation of being a centenarian, mental status, past family history, life events, activities of daily living, coping, physical health and health history, nutrition, exercise, personality, social support, mental health, economic status and perceptions, and fatigue. A subset of the baseline sample (n = 28) participated in a short-term longitudinal study that assessed stability and change in mental status, mental health, and activity. Four additional papers in this issue (Franke, Margrett, Heinz, & Martin, 2012; Garasky, Martin, Margrett, & Cho, 2012; Margrett, Hsieh, Heinz, & Martin, 2012; Martin, da Rosa, Margrett, Garasky, & Franke, 2012) will highlight substantive findings, including longitudinal analyses, in activities of daily living, economic status, mental status, and positive and negative affect.

Cognitive status and change among Iowa centenarians.

Equivocal evidence exists regarding the degree of cognitive stability and prevalence of cognitive impairment in very late life. The objective of the current study was to examine mental status performance and change over time within a sample of Iowa centenarians. The baseline sample consisted of 152 community-dwelling and institutionalized centenarians. Twenty eight of these centenarians participated in the next phase of the study which involved up to four subsequent assessments conducted over a 6-month period. Centenarians' Short Portable Mental Status Questionnaire (SPMSQ; Pfeiffer, 1975) performance indicated that 40% of the baseline sample performed within the normal range while an additional 40% of centenarians' performed within the moderately or severely impaired range. Examination of individual-level change indicated four patterns of short-term longitudinal performance which depicted stability, enhancement, decrement, and variability in scores across the 8-month testing period. The degree of reliable change as assessed by standard error of measurement largely mirrored change as classified by the traditional scoring categories, however, the former approach appeared more sensitive to meaningful intraindividual change in later assessments.

Stability and change in affect among centenarians.

Much information is available about physical and functional health among very old adults, but little knowledge exists about the mental health and mental health changes in very late life. This study reports findings concerning positive and negative affect changes among centenarians. Nineteen centenarians from a Midwestern state participated in four assessments over a 6-month period. Positive and negative affect, as well as physical activity, financial resources, mental status, and health were assessed at baseline and during four consecutive time points. Mean individual growth curves suggested mean decreases in positive affect, but no changes were observed in negative affect. Physical activity, financial resources, and self-rated health were associated with growth-curve changes in affect. Centenarians with fewer resources were more likely to show decreases in positive affect. Surprisingly, physical activity and health were associated with increases in negative affect over time. The results suggest that continued activity, high levels of financial resources, and self-rated health are important components in affective states among very old adults.