The role of family support in the self-rated health of older adults in eastern Nepal: findings from a cross-sectional study.

BACKGROUND: Nepal's low fertility rate and increasing life expectancy have resulted in a burgeoning older population. For millennia, filial piety shaped family cohesion and helped Nepali older adults achieve positive outcomes, but recently, it has been eroding. Furthermore, there are not enough institutional support options or alternatives to family-based care to deal with the biosocial needs of older adults. This study explored the association between family support and self-rated health among Nepali older adults. METHODS: A community-based cross-sectional survey in eastern Nepal's two districts, Sunsari and Morang, interviewed 847 older adults (≥ 60 years). The final analytical sample was 844. Participants were asked whether they received assistance with various aspects of daily life and activities of daily living from their families. Multivariable logistic regression examined the association between family support and self-rated health. RESULTS: Participants who received support with various aspects of daily life had 43% higher odds of good health, but after adjusting for control variables, the result only approached statistical significance (p = 0.087). Those who received family assistance with activities of daily living had nearly four times higher odds (OR: 3.93; 95% CI: 2.58 - 5.98) of reporting good health than participants who lacked this support. CONCLUSIONS: Given the important role of family support in Nepali older adults' health, government programs and policies should create a conducive environment to foster family-based care until more comprehensive policies for older adults' care can be put into effect. The results of this study can also help shape the global aging environment by highlighting the need for family support in older care, particularly in low-income nations with declining traditional care systems and weak social security policies.

"I Could Do Stereotypical Old People Things but I Feel Like I Would Get Bored With That Stuff": College Students' Proactive Steps to Avoid Negative Aspects of Aging.

The preventive and corrective proactivity model explores how internal and external resources mediate age-related stressors to counter negative outcomes of aging. Older adults' proactivity about their future is consistently associated with higher quality of life, but research has not explored younger adults' perceptions of their aging. We used interpretive phenomenology analysis to analyze 24 students' essays from the beginning and end of an introductory gerontology course to understand anticipated adaptation to their 75-year-old self. The superordinate theme proactive steps to avoid negative aspects of aging comprised five subordinate themes (being productive, exercising and eating right, being financially stable, being socially connected, and the roles of older adults). Students presented unrealistically positive selves at 75 and discussed how to maintain and adapt to redefine their aging experience. Findings have implications for research on adaption, proactivity, and the future-self, and suggest that pedagogy incorporates realistic expectations of aging.

When I'm 75: College Students' Self Perceptions of the Challenges of Aging.

Despite robust literature on people's attitudes toward aging, far less is known about attitudes toward one's own aging, especially among college students. We examined college students' self-perceptions of the challenges of aging using essays from a "When I'm 75" assignment implemented at the beginning and end of the semester in an introductory gerontology course. Interpretive Phenomenological Analysis was used to analyze 24 students' perceptions of their own aging at age 75. The superordinate theme, challenges of aging, was identified along with five subordinate themes: deterioration, age-related impairments, mental health, loneliness and loss, and experiencing ageism. Findings suggest that after completing the course, students both demonstrated an understanding of realistic age-related changes and had (contradictory) stereotypical ideas of what it would be like to be 75. Findings have implications for research that continues to evaluate self-perceptions and contributes to the development of pedagogical strategies and tools that promote students' optimal aging.

"So we basically let them struggle": Student perceptions of challenges in intergenerational Service-Learning.

Service-learning is a widely used pedagogical practice that integrates community involvement and civic engagement into the classroom. Benefits of service-learning in gerontology include an increased sense of personal growth, greater knowledge of aging, and enhanced interest in aging-related careers. However, relatively little research has specifically explored the challenges associated with intergenerational service-learning. A focus group documented the experiences of 19 students who were required to participate in at least 20 hours of intergenerational service-learning for an introductory gerontology course. Because an administrative error prevented students from knowing about the service-learning requirement until they were enrolled, these participants were well qualified to discuss the challenges and positive aspects of their experiences. In addition to confirming known benefits of service-learning, three major themes regarding challenges emerged: lack of communication, the need for guidance, and creating meaningful relationships. This study provides suggestions for further development of "best practice" guidelines unique to intergenerational service-learning.

Impact of life stories on college students' positive and negative attitudes toward older adults.

Gerontological educators are increasingly interested in reducing college students' negative, and promoting their positive, attitudes toward older adults. Over the course of a semester, students from six 4-year institutions viewed three life story videos (documentaries) of older adults and completed pre- and posttest surveys that assessed their positive (Allophilia Scale) and negative (Fraboni Scale of Ageism) attitudes. The authors assessed changes in attitudinal scales between treatment (with videos, n = 80) and control (no video, n = 40) groups. Change score analysis with 95% bias-corrected bootstrap confidence intervals estimated the effects of the documentaries on students' attitudes. The treatment group showed significant increases in kinship, engagement, and enthusiasm, and decreases in antilocution and avoidance (all ps <.05). There was no significant change in affect, comfort, or discrimination. This study demonstrated how video stories impact students' attitudes about older adults.

Sustainability of the Preferences for Everyday Living Inventory Use in Ohio Nursing Homes Over Time.

OBJECTIVES: In 2015, the Ohio Department of Medicaid incentivized use of the Preferences for Everyday Living Inventory (PELI) as a quality initiative. The pay-for-performance (P4P) program, however, was then deimplemented in 2019. This study investigated the sustainability of use of the PELI in Ohio nursing homes (NHs) from 2017 to 2021 and examined barriers to PELI implementation. DESIGN: This study analyzed 2 waves of Ohio Biennial Survey of Long-Term Care Facilities data. SETTING AND PARTICIPANTS: Data were drawn from 433 NHs in Ohio that reported on PELI implementation efforts between 2017 and 2021. METHODS: This study examined the change in proportion of NHs implementing the PELI (ie, conducted for all residents, used in care planning) and change in proportion of NHs using different PELI assessment formats (ie, the full 72-item PELI, MDS 3.0 Section F items only). Frequencies of reported barriers to PELI implementation by NH administrators were tabulated. RESULTS: Results indicate that although use of the full 72-item PELI decreased over time, only a small percentage discontinued its use despite possible impacts of P4P changes in 2019 and challenges posed by the COVID-19 pandemic. NHs adapted their PELI assessment formats likely in response to perceived barriers of PELI use (ie, length of the full PELI, time constraints, and residents' level of cognitive impairment). CONCLUSIONS AND IMPLICATIONS: Findings suggest that Ohio NHs sustained PELI implementation over time in the context of large systemic changes in P4P financial incentives and COVID-19 safeguards. Barriers were reported at the organizational level, yet NHs continued to prioritize PCC with the PELI. Policy/P4P mandates may serve as effective implementation incentives that encourage sustainability of quality care practices. Future research should explore long-term sustainability and stakeholder perspectives on PELI utilization.

Informal Caregiving and All-Cause Mortality: A Meta-Analysis of Longitudinal Population-Based Studies.

Using the random-effects meta-analysis model, we investigated the effect of informal caregiving on all-cause mortality across 12 longitudinal population-based studies (seven United States; five international: United Kingdom, Northern Ireland [2], Japan, and Australia). Across the studies, the combined effect of informal caregiving on all-cause mortality was 16% lower in favor of caregivers. Subgroup analyses revealed that the relationship between informal caregiving and all-cause mortality was not significant among the U.S. studies, in contrast to the international studies. Also, the mortality advantage of informal caregivers was not evident among those studies in which informal caregiving was operationalized precisely (Activity of Daily [ADL]/Instrumental Activity of Daily Living [IADL] assistance) as opposed to more broadly. Furthermore, studies in which the kinship tie between the informal caregiver and care recipient was unspecified tended to find a mortality advantage in favor of caregivers. When covariates were considered, the results of this meta-analysis provided more support for stress theory than the healthy caregiver hypothesis.

Through the Montessori Looking-Glass: Barriers to Implementing a Montessori-Based Intervention.

Montessori methods are used with individuals with dementia to create meaningful, inclusive, failure-free activities that enhance quality of life. This research qualitatively explored the barriers to implementing a Montessori-based intervention for people living with dementia in a 24-hr memory care setting. A lens comprised of key Montessori values and principles guided a content analysis of field note data to create an overall framework for understanding implementation barriers, which are rarely addressed in the literature. Interestingly, the four themes that emerged as barriers-the absence of respect, interdependence, meaningful activity, and structure-permeated implementation efforts and represent the opposite of Montessori principles. These findings confirm literature that identifies similar barriers across diverse interventions. Findings underscore the need for formal documentation of implementation barriers and extensive pre-implementation work to accomplish culture change in long-term care.

Hypertension in Children and Adolescents.

Hypertension is a growing problem in children and adolescents, with primary hypertension becoming the most common etiology. In addition to demonstrating that high blood pressure in children and young adults is likely to remain elevated into adulthood, this review (1) addresses important aspects of measuring blood pressure in children and adolescents, (2) defines elevated blood pressure and hypertension in this age group, (3) describes the initial evaluation and workup of abnormally high blood pressure, and (4) introduces treatment strategies for youth with sustained hypertension.

Lay explanations and self-management of diabetes in Kathmandu, Nepal.

OBJECTIVE: This research explores the lay explanations and self-management of diabetes among residents in greater Kathmandu, Nepal. METHODS: Interviews were done with 300 respondents drawn from diabetes patient listings and members of a national diabetes club. Sociodemographic and health-related data were collected with two standardized instruments: the Illness Perception Questionnaire and the Summary of Diabetes Self-Care Activities. Hierarchical ordinary least squares regression analyses were employed to examine predictors of self-management of diabetes. RESULTS: Across seven equations, R(2) values ranged from .020 to .221, and with the exception of one domain of self-management (blood sugar testing), one or more lay explanatory factors entered each equation. DISCUSSION: Respondents from this sample appear to hold lay explanations of diabetes that are similar to those of their peers in developed nations. Findings are discussed, including the caveat that these mostly male, relatively educated, and urban-residing adults with diabetes are not necessarily representative of Nepali society.

Measuring positive attitudes toward persons with dementia: A validation of the Allophilia scale.

Efforts to combat ageism typically focus on negative attitudes toward members of an out-group. Changing attitudes also requires assessment and enhancement of positive attitudes. This study examined the psychometric properties of Allophilia scale when used to measure college students' positive attitudes toward persons with dementia. Data collected from 465 students were analyzed using confirmatory factor analysis and multigroup analysis by gender to assess the validity and reliability of the Allophilia scale. Results showed that the Allophilia scale is valid both for male and female students. The Allophilia scale is a valid assessment tool for measuring positive attitudes toward persons with dementia. Use of this scale will contribute to our understanding of attitudes toward persons with dementia and has implications for the design of interventions to facilitate positive attitudes toward members of this out-group.

"It makes me feel like myself": Person-centered versus traditional visual arts activities for people with dementia.

During a 15-month period between February 2010 and April 2011, video data on (n = 38) people with dementia were collected during a person-centered and intergenerational arts activity program called Opening Minds through Art (OMA) at three different long-term care facilities in Ohio. A subsample of the OMA participants (n = 10) were also video recorded during traditional visual arts activities (e.g. coloring books, scrapbooking). A modified version of the Greater Cincinnati Chapter Well-Being Observation Tool© was used to code the intensity and frequency of observed domains of well-being (i.e. social interest, engagement, and pleasure) and ill-being (i.e. disengagement, negative affect, sadness, and confusion). Descriptive results indicate a high percentage of moderate or high intensities of well-being during OMA sessions with little to no ill-being. Paired-sample t-tests comparing OMA vs. traditional visual arts activities showed significantly higher intensity scores for OMA in the domain of engagement and pleasure, as well as significantly lower intensity scores for disengagement. The findings of this exploratory study contribute to the overall discussion about the impact of person-centered, creative-expressive arts activities on people with dementia.

Observed well-being among individuals with dementia: Memories in the Making, an art program, versus other structured activity.

This manuscript analyzes the use of the Greater Cincinnati Chapter Well-Being Observation Tool in observing seven domains of well-being among individuals with dementia. We observed the well-being of 12 individuals while they engaged in Memories in the Making, an art program for persons in the early and middle stages of the disease that encourages self-expression through the visual arts. This was then compared to the observed well-being in the same individuals during participation in more traditional adult day center activities, such as current events and crafts. Results indicated that the individuals demonstrated significantly more interest, sustained attention, pleasure, self-esteem, and normalcy during participation in Memories in the Making, additionally, there were no differences in negative affect or sadness between the two types of activities. Directions for future research are also discussed.

Identifying naturally occurring retirement communities: a spatial analysis.

OBJECTIVES: Guided by the concept of "aging in place" and potential policy implications, the study analyzed naturally occurring retirement communities (NORCs; 40% or greater house owners and renters aged 65 years and older) and whether there were spatiotemporal patterns in Ohio between 2000 and 2010. METHOD: Data were derived from the 2000 and 2010 census tracts. Geovisualization was used to visually examine the distribution of NORCs in 2000 and 2010. Global Moran's I was used to quantify the spatial distribution of NORCs in Ohio and Local Moran's I was used to identify clusters of NORCs (i.e., hot spots). RESULTS: The number of NORCs slightly decreased despite the overall increase of the older population from 2000 to 2010. NORCs were identified in one of the 3 most populous counties (i.e., Cuyahoga) and its neighboring counties. A number of hot spots were identified in Cuyahoga County (among Ohio's most populous and NORC-rich counties), both in 2000 and 2010. There were different patterns including emerging, disappearing, and enduring NORCs and disproportionate distributions of NORCs across the state between 2000 and 2010. DISCUSSION: Locating NORCs could aid governments to create "aging in place" sensitive policies to address issues of independence, social care, health care, volunteerism, and community participation.

Application of the model of allostasis to older women's relocation to senior housing.

OBJECTIVES: Adjustment to senior housing entails significant lifestyle changes and is a stressful process. The adaptation process is dynamic and has yet to be studied using the conceptual model of allostasis. This article presents exemplars of women whose profiles represent three allostatic states: successful adaptation (homeostasis), ongoing adaptation (allostasis), and maladaptation (allostatic load). METHOD: Older women who had relocated to senior housing participated in three interviews and monthly saliva sample collection over a 6-month period. Saliva was assayed for diurnal cortisol secretion. Triangulation of mixed methods was used to analyze data, and psychosocial data were mapped onto the cortisol graphs to illustrate changes in stress reactivity and well-being. RESULTS: Coping abilities, perceptions of stressors, and cortisol measures provide a detailed picture of the interplay among events and perceptions and the effects of both on well-being. DISCUSSION: The case exemplars provide detailed information on the complexity of psychosocial and physiological components of the model of allostasis. This study also fills a gap in knowledge on negative relocation outcomes using the allostatic model.

The impact of a gerontology course and a service-learning program on college students' attitudes toward people with dementia.

We examined the effects of a gerontology course and an intergenerational service-learning project for people with dementia (PWD) on three dimensions of students' attitudes including attitudes toward older people, community service for older people, and working with PWD. Data consisted of a combination of pretest/posttest survey and review of journals that students maintained during the service-learning project. Results indicated that students who completed the gerontology course, and those who completed both the course and the service-learning project, reported significantly more positive attitudes toward older adults, whereas students in the course only had significantly less positive attitudes about working with PWD, and those in the other courses (sociology) showed no change in their attitudes. Students' journals are replete with reports of the satisfaction they derived from their experiences. The findings highlight opportunities and challenges that should be considered in future intergenerational service-learning programs and gerontological education.

Programs to locate missing and critically wandering elders: a critical review and a call for multiphasic evaluation.

As America ages, greater numbers of older adults will be living with Alzheimer's disease or a related dementia, leading to increased incidence of wandering. Currently there are several initiatives to assist older adults who go missing. We describe and critically examine three prominent and widespread programs: Safe Return, Project Lifesaver, and Silver Alert. Despite their emergence, there has been little research on their effectiveness. More fundamentally, the nature and scope of the missing elder problem is understudied. We call for further research into this issue, as well as assessments of how well such programs balance individual liberties with safety concerns.

Silver alerts and the problem of missing adults with dementia.

In the months following the introduction of the National AMBER (America's Missing: Broadcast Emergency Response) Alert plan used to locate missing and abducted children, Silver Alert programs began to emerge. These programs use the same infrastructure and approach to find a different missing population, cognitively impaired older adults. By late 2008, 17 states had enacted Silver Alert policies, and several more planned to take advantage of National Silver Alert grant funding to initiate policies in 2009. To date, however, no research has examined the efficacy of such programs, which have widely varying parameters and criteria to initiate the alerts. In this study, we empirically examine the 17 existing state Silver Alert and related policies. The analysis includes an examination of the varieties of programs: dementia related and AMBER extension, the dates of enactment, the criteria for activation, and the process of activation. We conclude with two salient questions that emerged from the analysis. We examine these questions and make recommendations for future research, including examining whether Silver Alerts are an appropriate response to address the problem of missing adults with dementia or cognitive impairments and examining the costs and benefits of the programs including determining how best to balance efforts to keep cognitively impaired elders safe while keeping their basic human rights of autonomy and empowerment intact.