Evaluating the health outcomes of aging in place: the role of medicaid aging waiver program on U.S. older adults.

The Medicaid Aging Waiver program (MAW) subsidizes the cost of long-term care (LTC) at home or in communities to satisfy older people's increasing desire to age in place. The MAW program might be health improving for older people by allowing them to age at home. However, less quality and quantity of home-based care comparing to nursing home care could offset some of the potential benefits. I use policy expenditure across states over time linked with detailed health information from the Health and Retirement Study (HRS) to identify the associated effects of MAWs on health outcomes of older adults who are at risk of needing LTC and who are resources constrained to be potentially eligible for Medicaid. Overall, the findings suggest that the MAW program is beneficial to health: a $1,000 increase in MAW spending for each older person results is associated with a 1.4 percent improvement in self-reported health status, a 1.5 percent reduction in functional mobility limitations, a 1.6 percent decrease in Instrumental Activities of Daily Living (IADL) limitations, and a 1.7 percent improvement in negative psychological feelings. For older people who are most likely not eligible for MAWs, such as those who are wealthy or in good health and do not require LTC, these health-improving effects have not been observed.

The Role of Assistive Technology in Enabling Older Adults to Achieve Independent Living: Past and Future.

In this viewpoint, we present evidence of a marked increase in the use of assistive technology (AT) by older adults over the last 25 years. We also explain the way in which this use has expanded not only as an increase in terms of the total number of users but also by going beyond the typical scopes of use from its inception in 1999 to reach new categories of users. We outline our opinions on some of the key driving forces behind this expansion, such as population demographic changes, technological advances, and the promotion of AT as a means to enable older adults to achieve independent living. As well as our review of the evolution of AT over the past 25 years, we also discuss the future of AT research as a field and the need for harmonization of terminology in AT research. Finally, we outline how our experience in North Norfolk (notably the United Kingdom's most old age-dependent district) suggests that cocreation may be the key to not only successful research trials in the field of AT but also to the successful sustained adoption of AT beyond its original scope of use.

"I'll fill in the gaps": perspectives of HHAs on promoting aging in place for older adults with low incomes.

Older adults with low incomes experience disproportionate rates of cognitive and functional impairment and an elevated risk of nursing home admission. Home health aides (HHAs) may have insight into how to optimize aging in place for this population, yet little is known about HHAs' perspectives on this topic. We conducted 6 focus groups with 21 English-speaking and 10 Spanish-speaking HHAs in Pennsylvania and New Jersey. Transcripts were analyzed using qualitative thematic analysis, and three themes emerged. First, HHAs described the uniqueness of their role within multidisciplinary care teams. Second, HHAs shared concrete interventions they employ to help their clients improve their function at home. Third, HHAs discussed barriers they face when helping clients age in place. Our findings suggest that HHAs have important insights into improving aging in place for older adults with low incomes and that their perspectives should be incorporated into care planning and intervention delivery.

Stakeholders' Perspectives on an Area Agency on Aging Serving Urban Older Adults.

Area Agencies on Aging (AAAs), authorized by the 1965 Older Americans Act, seek to promote "age-friendly" communities by offering services that help older adults live independently. This study used Qualtrics survey data (n = 94 respondents) to identify unmet needs for AAA services in the Detroit metropolitan area. Descriptive statistical analyses were used for closed-ended items and content analysis was used to identify themes from open-ended questions. This needs assessment aims to provide the opportunity for in-depth, meaningful input from stakeholders about areas relevant to strategic planning efforts that enhance and enrich older adult programming in an urban AAA service area. Key themes included the need to collaborate with transportation providers, partner with healthcare and hospitals, market the agency to enhance visibility, promote aging in place, address demographic changes, and improve access to older adult services and caregiver support. Findings suggest the importance of providing accessible, high-quality services that promote aging in place through community outreach and collaboration activities.

Aging in Place and 'The Little Things': Prioritizing Mobile Health and Social Care in Rural Communities.

Older adults are more frequently wanting to age in place. Governments are seeking cost-effective and efficient methods of supporting aging populations. Older adults who want to stay in their homes for as long as possible encounter multiple barriers, including struggling to maintain their homes, inadequate levels of social and healthcare support, and the lack of financial capacity to pay for home support services. The Mobile Seniors' Wellness Network (MSWN), a multi-disciplinary and person-centered mobile health and social support intervention study was designed to investigate and support aging in place for older adults living in rural New Brunswick, Canada. Secondary analysis of case notes and exit interviews using content analysis revealed concerns with the lack of affordable and mobile care services for vulnerable rural older adults. Older adults revealed that their needs include "the little things" rather than grand gestures or sweeping policies to age in place such as assistance with grounds and home maintenance, in addition to relational and person-centered health and social care in the home. Reliance on private service delivery and volunteer organizations can increase the likelihood that older adults will experience a breakdown of social support networks tied together loosely by friends, family, and their communities. When services are unattainable aging in place becomes an unreachable goal.

The Location of Home Support Services for Older Adults in the Aveiro Region of Portugal.

Home and community-based services are key to an aging society and the aging in place strategies that are preferred by older adults as well as policymakers. But the provision of these kinds of services is often inadequate in territorial terms, raising the question of how to increase their reach and efficiency. This article analyzes the spatial coverage of home support services in the Aveiro Region of Portugal, considering the distribution of their target population and identifying network configurations which would provide these services more efficiently, through a location analysis that minimizes the distance to potential users of these services. This approach showed that, in the Aveiro Region, the spatial coverage of these services is highly uneven and insufficient, considering that the population with difficulties in performing daily tasks exceeds the population benefiting from these services and that the level of coverage differs greatly between territories. It also showed that significant efficiency and equity gains are possible by optimizing the service providers' location at the supra-municipal scale, decreasing the distances to be covered and reducing territorial inequalities.

Provision of Home & Community Based Services to Veterans by Race, Rurality, and Neighborhood Deprivation Index.

Home and community-based services (HCBS) enable frail patients to remain at home. We examined whether there were neighborhood-deprivation, racial, or rural disparities in HCBS utilization provided to Veterans by the Department of Veterans Affairs (VA) or Medicare by comparing the adjusted utilization rate of a historically disadvantaged group with the predicted utilization rate had it been treated as the historically dominant group. Among the 2.7 million VA patients over 66 years old in 2019, 11.0% were Black, 39.2% lived in rural settings, 15.3%/29.2%/30.9%/24.7% lived in least/mild/moderate/most-deprived neighborhoods. On average, 11.2% received VA or Medicare HCBS. Veterans residing in more deprived neighborhoods had 0.11-0.95% higher adjusted probability of receiving HCBS than expected had they resided in the least deprived neighborhoods. Veterans residing in rural areas had 0-0.7% lower HCBS rates than expected had they been treated like urban Veterans. Black Veterans were 0.8-1.2% more likely to receive HCBS than expected had they been treated like White Veterans. Findings indicate that VA resources were equitably employed, aligning with probable HCBS needs, suggesting that VA's substantial and long-standing investment in HCBS for care of frail Veterans could serve as a model for other payers and providers in the U.S.

A semi-supervised approach to unobtrusively predict abnormality in breathing patterns using hydraulic bed sensor data in older adults aging in place.

Shortness of breath is often considered a repercussion of aging in older adults, as respiratory illnesses like COPD1 or respiratory illnesses due to heart-related issues are often misdiagnosed, under-diagnosed or ignored at early stages. Continuous health monitoring using ambient sensors has the potential to ameliorate this problem for older adults at aging-in-place facilities. In this paper, we leverage continuous respiratory health data collected by using ambient hydraulic bed sensors installed in the apartments of older adults in aging-in-place Americare facilities to find data-adaptive indicators related to shortness of breath. We used unlabeled data collected unobtrusively over the span of three years from a COPD-diagnosed individual and used data mining to label the data. These labeled data are then used to train a predictive model to make future predictions in older adults related to shortness of breath abnormality. To pick the continuous changes in respiratory health we make predictions for shorter time windows (60-s). Hence, to summarize each day's predictions we propose an abnormal breathing index (ABI) in this paper. To showcase the trajectory of the shortness of breath abnormality over time (in terms of days), we also propose trend analysis on the ABI quarterly and incrementally. We have evaluated six individual cases retrospectively to highlight the potential and use cases of our approach.

Relationship between person, environmental factors, and activities of daily living performance among physically disabled older adults living at home: a structural equation model.

BACKGROUND: Older adults with physical disability need long-term services and support, which incur enormous costs. However, supportive environments may reduce disability and promote aging in place. It is unclear how the physical and social environment affect different types of functional impairments and influence the performance of activities of daily living (ADL) in physically disabled older adults. OBJECTIVE: The purpose of this study was to examine the relationship between person, environmental factors, and ADL performance among physically disabled older adults living at home. METHODS: This was a cross-sectional study. Using long-term care insurance claims data from a pilot city in China, we used a structural equation model to assess the potential paths among person, environmental factors, and ADL performance. RESULTS: Education and income had different influences on the social environment and physical environment. The functional impairments had significant effects on ADL performance, either directly or through physical environment (with handrails) and social environment (family support). CONCLUSIONS: The present findings offer crucial evidence for understanding the interactions between a person and the environment, as well as their influence on physical ADLs, suggesting the importance of a supportive environment and a subpopulation-targeting strategy for disabled older adults.

Use and Acceptance of Digital Communication Technology by Older Adults for Social Connectedness During the COVID-19 Pandemic: Mixed Methods Study.

BACKGROUND: Older adults are at higher risk for health issues, including mental health problems. This was especially apparent during the COVID-19 pandemic, where older adults were simultaneously more vulnerable to the disease and the mental health concerns created by social distancing. Subsequently, the use of digital communication technology (DCT) became a critical option for maintaining social connectedness in older adults. Prior to the pandemic, the low uptake and use of technology by older adults was an established problem, known as the digital divide. However, not much is known about how this may have changed as a result of the pandemic. OBJECTIVE: This study aims to explore how older adults maintained social connectedness through DCT during the pandemic and to understand factors influencing the use and acceptance of DCT. METHODS: A mixed methods explorative field study was set up, involving surveys and interviews of 25 community-dwelling older adults (65-88 years old) living in the United Kingdom. The surveys included the internet acceptance questionnaire (based on the Technology Acceptance Model [TAM]); COVID-19 dysfunctional anxiety was captured using the COVID-19 Anxiety Scale (CAS). Background information (demographics, use of technology) was gathered before conducting semistructured interviews. We hypothesized that CAS would affect constructs of TAM and that predictive constructs of TAM would have remained valid during the pandemic. We also posited that there would be unidentified themes outside TAM that impacted the acceptance and use of DCT. We used the quantitative data to guide the semistructured interviews, which were then analyzed through thematic analysis to identify additional themes. RESULTS: Correlational analysis showed that CAS influences all constructs of TAM. We also saw that the predictive constructs of TAM, especially the perceived ease of use (PEU) and perceived usefulness (PU), remained valid during the pandemic. Common acceptance-influencing themes were encountered in both quantitative and qualitative analyses, with 3 matching the known constructs of TAM (PU, PEU, and behavioral intention). We identified 2 additional themes affecting acceptance, namely influence of the pandemic (situational context) and privacy and security concerns. DCT use (especially email and videoconferencing use) increased during the pandemic, but the results related to social networking sites were mixed. CONCLUSIONS: The COVID-19 pandemic impacted technology acceptance and use by older adults, encouraging their use of certain DCT apps (email and videoconferencing apps, such as WhatsApp). These apps helped insulate them from adverse effects (social isolation and loneliness). Other social networking apps, however, exerted a negative influence, increasing anxiety and a general feeling of negativity. Future studies should maximize older adult agency related to design, privacy, security, and user requirements for development. We also recommend that when studying DCT acceptance for older adults, our additional identified themes should be considered alongside the existing TAM constructs.

Socially active neighborhoods: construct operationalization for aging in place, health promotion and psychometric testing.

From the year 2003 when the first walkability scale was published to date, person-environment fit models and empirical research, some of which was published in Health Promotion International, have encapsulated healthy communities in 'neighborhood walkability'. While there is no doubt that neighborhood walkability positively influences health-seeking behaviors and health, recent models suggest that their measurement and conceptualization have not emphasized the role played by psychosocial and personal factors in aging in place. Thus, the development of scales measuring human ecosystem factors has not recognized all critical factors suited for older adults. In this paper, we aim to draw on relevant literature to frame a more holistic construct, hereby referred to as Socially Active Neighborhoods (SAN), that would better support aging in place in older populations. Through a narrative review based on a systematic search of the literature, we define the scope of SAN and delineate some contextual implications for gerontology, health promotion and psychometric testing. SAN, unlike neighborhood walkability in its current measurement and conceptualization, incorporates critical theory-informed psychosocial factors (i.e. safety and disability friendliness of neighborhood infrastructure) that can encourage older adults with physiological and cognitive limitations to maintain physical and social activities as well as health in later life. The SAN is the result of our adaptation of key person-environment models, including the Context Dynamics in Aging (CODA) framework, that recognizes the role of context in healthy aging.

SeniorSentry: Correlation and Mutual Information-Based Contextual Anomaly Detection for Aging in Place.

With the ever-growing reliance on IoT-enabled sensors to age in place, a need arises to protect them from malicious actors and detect malfunctions. In an IoT smart home, it is reasonable to hypothesize that sensors near one another can exhibit linear or nonlinear correlations. If substantiated, this property can be beneficial for constructing relationship trends between the sensors and, consequently, detecting attacks or other anomalies by measuring the deviation of their readings against these trends. In this work, we confirm the presence of correlations between co-located sensors by statistically analyzing two public smart-home datasets and a dataset we collected from our experimental setup. Additionally, we leverage the sliding window approach and supervised machine learning to develop a contextual-anomaly-detection model. This model reaches a true positive rate of 89.47% and a false positive rate of 0%. Our work not only substantiates the correlations but also introduces a novel anomaly-detection technique to enhance security in IoT smart homes.

Multisensory System for Long-Term Activity Monitoring to Facilitate Aging-in-Place.

Demographic changes and an ageing population require more effective methods to confront the increased prevalence of chronic diseases which generate dependence in older adults as well as an important rise in social expenditure. The challenge is not only to increase life expectancy, but also to ensure that the older adults can fully enjoy that moment in their lives, living where they wish to (private home, nursing home, …). Physical activity (PA) is a representative parameter of a person's state of health, especially when we are getting older, because it plays an important role in the prevention of diseases, and that is the reason why it is promoted in older adults. One of the goals of this work is to assess the feasibility of objectively measuring the PA levels of older adults wherever they live. In addition, this work proposes long-term monitoring that helps to gather daily activity patterns. We fuse inertial measurements with other technologies (WiFi- and ultrasonic-based location) in order to provide not only PA, but also information about the place where the activities are carried out, including both room-level location and precise positioning (depending on the technology used). With this information, we would be able to generate information about the person's daily routines which can be very useful for the early detection of physical or cognitive impairment.

Oasis Senior Supportive Living: Description of a Novel Aging-in-Place Model in Ontario.

Older adults are the fastest-growing demographic group in Canada, and the majority of older adults want to age-in-place within their communities. Many older adults live in naturally occurring retirement communities (NORCs), unplanned communities with a high proportion of older residents. NORC supportive services programs can help older adults successfully age-in-place. One such program is Oasis Senior Supportive Living, a partnership between older adults, building owners and managers, community partners, funders, and researchers. Using a qualitative approach, interviews were conducted with Oasis participants to understand their experiences of Oasis. This article will describe the three pillars upon which Oasis programming is based and provide insights from Oasis participants. It will discuss nutrition programming implemented in these NORCs and suggest how dietitians can support NORC residents.

Determining the correlation between old age adaptation, aging in place and depression in older adults: A descriptive correlational study.

We conducted this study to determine the correlation between old age adaptation, aging in place, and depression in older adults. We carried out the descriptive correlational study with older adults (n:319) Agri Provincial Directorate of Health between October 2021 and April 2022. "SPSS 25 and Amos 23 programs" were used in the analysis of the data. Python 3.11.1, Microsoft Power BI programs were used for machine learning and graphical visualizations. In the study, it was determined that the model for the relationship between aging at a place level, adaptation difficulty in older adults level, and geriatric depression level was significant (F(2,316) = 37.002, p = 0.001). The aging in place level and the adaptation difficulty in older adults level explain 18.5% of the total variance of the level of geriatric depression. In the regression model, it was determined that the increase in the level of aging in place (t = -6.081, p < 0.001) and the decrease in the level of adaptation difficulty in older adults (t = 4.107, p < 0.001) of the participants caused a statistical decrease in the level of "Geriatric Depression." It has been determined that adaptation difficulty in older adults has a moderator role in the relationship between geriatric depression level and aging in place level. In our data set, while the estimate of the presence of depression was 40 % with logistic regression analysis, it was 97 % with Random Forest. The study determined that as the level of aging in -place increased and the adaptation difficulty in older adults decreased, and depression decreased.

Long-Term Care Preferences Among Chinese Older Adults: The Role of Sociocultural Factors.

Understanding individuals' long-term care preferences is essential to the provision of person-centered care. This study aims to describe the preferences for long-term care settings and investigates sociocultural factors associated with long-term care preferences among older Chinese adults. Responses from 22,112 older adults aged 60 years or above were analyzed using multinomial logistic regression. Four ideal long-term care settings were identified: in-home care, community day care, institutional care, and undecided long-term care arrangements. The study found that the majority of participants desired to age in place at home, regardless of their health status and social support conditions. Therefore, research and advocacy efforts are needed to inform policymakers to strategically develop home-based long-term care supports in China.

Besides needs, social means and values are crucial to long-term care preferences among older Chinese adults.Among different long-term care options, the vast majority of the participants (82%) preferred aging in place in a home setting.China's long-term care policy should prioritize the support for developing home-based services.

Factors influencing the demands for home and community-based care services among older adults living alone in China.

The number of older adults living alone in China is rising sharply. This study aimed to explore the demand for home and community-based care services (HCBS) and related influencing factors of older adults living alone. The data were extracted from the 2018 Chinese Longitudinal Health Longevity Survey (CLHLS). Guided by the Andersen model, binary logistic regressions were used to analyze the influencing factors of HCBS demand from the aspect of predisposing, enabling and need variables. Results show that there were significant differences between urban and rural areas for provision of HCBS. HCBS demand of older adults living alone was influenced by distinct factors including age, residence, income source, economic status, availability of services, loneliness, physical function and number of chronic diseases. Implications for HCBS developments are discussed.

Family Caregivers as Employers of Migrant Live-In Care Workers: Experiences and Policy Implications.

As policymakers globally recognize aging in place as the preferred option for most adults, there is a growing need to supplement family or informal caregiving for frail older adults with formal homecare services, particularly for those who require 24/7 care due to significant physical and/or cognitive impairment. The core objective of this qualitative study was to explore family members' experiences in employing live-in care workers, particularly the nature of their engagement and the quality of their relationships with these care workers. Our analysis of semi-structured interviews with 35 family caregivers revealed four themes: 1) challenges in acquiring support and developing dependency; 2) negotiation of roles, responsibilities, and moral dilemmas; 3) shifting emotions between trust and suspicion; and 4) role confusion, expectations, and disappointments. The study suggests that families might benefit from formal guidance regarding fostering and maintaining positive relationships in the homecare environment. This paper provides nuanced knowledge that may inform the development of such interventions.

Health and Well-Being Among Those Aging in Place in a Jerusalem Religious Community.

An innovative pilot program in a traditional Jerusalem synagogue was developed to increase medical and social well-being of older community members who want to age in place. The study assessed the impact of the program. Interviews and focus groups were conducted in 2019 with 30 program participants, program staff, and non-program residents and with program leaders a year later. The evaluation found that wellness and healthcare features of a faith-based aging in place program had a generally positive impact, magnified by the group's strong social cohesion. The program's impact and value have increased since COVID-19, with some potential for replication.

Preference to Age in Place in Low-Income Senior Housing.

Low-income senior housing provided through the Section 202 Supportive Housing for the Elderly program is a critical site for aging in place, and many of these properties have hired service coordinators to monitor residents' quality of life, provide access to services, and promote their ability to age in place. To address gaps in the limited literature on Section 202 buildings, this study examined the association between service coordination and low-income senior housing residents' preference to age in place with particular attention to the most economically vulnerable. We analyzed data from 255 older adults living in eight Section 202 buildings in Southeastern Michigan using logistic regression. Self-perceived economic vulnerability moderated the relationship between service coordination and preference to age in place. Among those who had not received service coordination, the high economic vulnerability group was more likely to prefer to age in place compared to more economically secure residents. Among those who received assistance from a service coordinator, economically vulnerable residents were less likely to express a preference to age in place compared to other residents. Findings indicate a complex relationship between service coordination, economic resources, and preference to age in place in senior housing, and suggest areas for future research.