Vaccination Motivators and Deterrents Among Undervaccinated Older Adults in North Dakota.

Despite increased risk of morbidity and mortality among older adults due to preventable infectious diseases such as influenza, shingles, pneumonia, and COVID-19, many forego receiving some, if not all, of these vaccinations. This study examines vaccination motivators and deterrents for undervaccinated older adults in North Dakota (ND). Adults aged 65+ in ND were mailed a survey (n = 901) with questions gauging vaccination behaviors and perceptions, with 132 of these indicating not receiving certain vaccinations. Further questions assessed reasons they have not been vaccinated against the following diseases: influenza, shingles, pneumonia, and COVID-19 (e.g., "Concerned about side effects", "Vaccines are dangerous", "I'm healthy and I do not need it") and what would make it more likely to get a vaccine (e.g., "More information", "Doctor recommendation", "Easy access to vaccines"). Reasons for remaining unvaccinated varied by vaccine. For influenza and pneumococcal vaccines, respondents were more likely to indicate they are healthy and do not need the vaccine. For shingles and COVID-19, respondents were more likely to indicate concerns about side effects. Factors reported to motivate increasing the likelihood of getting a vaccine were receiving a doctor recommendation, receiving more information, and having a vaccine provided at no cost. These results contribute to our understanding of vaccination behaviors among older adults and underscore specific issues around which to frame interventions tailored to increase vaccine uptake for this population.

Longitudinal Implications of Social Integration for Age and Gender Differences in Late-Life Physical Functioning.

Social integration has documented benefits for late-life health; yet, little is known about its impacts on trajectories of physical functioning. This study examines age and gender differences in the longitudinal associations between social integration and activities of daily living (ADLs) using a hierarchical linear model with three waves of survey data collected over 4 years from the Social Integration and Aging Study (N = 400; baseline mean age = 80.3). Findings indicated some interaction effects of age, gender, and/or social integration on ADL trajectories. Among those of more advanced age, women showed greater increases in ADL limitations than men, and individuals with lower social integration experienced greater increases in ADL limitations than those with higher social integration. Neither of these patterns were found among younger older adults. This study highlights the benefits of longitudinal research on social integration and the need to explore practical interventions for promoting social integration particularly among the oldest older adults.

Implications of relationships with family, friends, and neighbors for changes in women's well-being in late life.

This study examined whether relationships with family, friends, and neighbors (both satisfaction and number in the social network) were associated with older women's well-being concurrently and over two years. Additionally, age differences among older women were explored. Women aged 60+ (N = 224, Mage = 80) were sampled from the Social Integration and Aging Study. Greater family and friend satisfaction were positively associated with well-being; number in network was not. Age-related effects for family and friend relationships suggested potential protective effects for the oldest women. Findings highlight unique facets of older women's relationships, suggesting future directions addressing age and support source.

Longitudinal Stress-Buffering Effects of Social Integration for Late-Life Functional Health.

Stress can negatively affect multiple aspects of health, including functional health, among older adults, who are likely to face unique, age-related stressful experiences. Previous research has addressed the protective effects of social relations (i.e., social ties, social participation, and social integration) for physical and mental health outcomes, yet few studies have examined functional health. This study aimed to investigate the longitudinal stress-buffering effects of social integration on late-life functional health. Using three-wave data from 399 older adults (aged older than 60 years), two-level hierarchical linear modeling analysis was conducted and the results indicated that in addition to its main effect on functional (activity of daily living) limitations, social integration moderated the negative effect of stress on the longitudinal trajectory of functional limitations. The findings suggest important directions of future research to identify the mechanisms of such buffering effects over time and develop effective interventions to enhance late-life functional health while promoting social integration.

Reliance on sources of immunization information and vaccine uptake among older adults in a rural state: The mediating role of trust.

Older adults are more vulnerable to the negative impacts of infectious diseases than younger individuals. However, regardless of the importance and effectiveness of vaccines to reduce morbidity and mortality, issues remain with vaccine hesitancy among this population. Older adults' sources of immunization information and their level of trust in those sources may play a role in their vaccination behaviors. This research aimed to better understand the role of information sources and related issues of trust as related to vaccine uptake among older adults. A community-based, cross-sectional survey was conducted with 901 older adults in North Dakota in May-July 2022. Measures included extent of reliance on specific sources of immunization information, levels of trust, and uptake for influenza, pneumonia, shingles, and COVID-19 vaccinations. Immunization information sources were grouped into medical experts, informal, and public outlets. Results indicated older adults were more likely to rely on medical experts than informal sources or public outlets for immunization information. Greater reliance on medical experts was associated with a greater likelihood of vaccine uptake for all vaccines, while reliance on public outlets was associated with a greater likelihood of vaccine uptake only for COVID primary series and boosters. Reliance on informal sources for immunization information was associated with a reduced likelihood of vaccine uptake for all vaccines except shingles. Nearly half of respondents were uncertain who to trust for vaccine information. Uncertainty who to trust for immunization information significantly mediated the associations between reliance on medical experts and uptake for most vaccines indicating that trust in medical experts fosters vaccine uptake. Increasing reliance on medical experts as sources of immunization information is vital to increasing vaccine uptake among older adults. Additionally, this population must be assisted in increasing their ability to successfully assess the trustworthiness of immunization information sources.

"Stronger Than I Thought I Was": Older Adults' Coping Across Two Years of the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVES: Throughout the coronavirus disease 2019 (COVID-19) pandemic, older adults developed coping strategies to adapt to the necessary social distancing precautions; however, over time, especially as vaccines became available, their need and ability to adapt and cope shifted. This longitudinal, mixed-methods study investigates changes in older adults' perceptions of coping across the first 2 years of the pandemic. RESEARCH DESIGN AND METHODS: Between April 2020 and June 2022, 5 waves of interviews were conducted with 76 Midwestern older adults aged 70-97. At each timepoint, participants rated their level of perceived coping. They also answered a series of open-ended questions about their current daily life, experiences, and perceptions during the pandemic. RESULTS: Repeated-measure ANOVA indicated participants' perceived coping significantly increased over 2 years and qualitative explanations contextualized these shifts. Thematic coding of interview transcripts identified themes of: (1) taking problem-focused approaches and (2) cultivating emotional resiliency, with multiple subthemes nested within each. Subtheme meanings shifted once vaccines were available, as participants adapted to a "new normal" lifestyle and appreciated their own resilience. DISCUSSION AND IMPLICATIONS: Findings suggest older adults had nuanced and shifting coping experiences throughout the initial 2 years of the pandemic, but overall coped by drawing on life experiences. Our discussion highlights variability in older adults' coping over time and directions for future study and practice.

Aging Out-of-Place: Perceptions of Successful Aging Among Aging Burundian Refugees in the United States.

BACKGROUND AND OBJECTIVES: Refugees flee their home countries due to life-threatening situations and are resettled in countries such as the United States. For older refugees, their cultural background and forced migration experience may affect how they perceive successful aging in their host countries. As such, it is important to understand how aging refugees perceive aging well to enhance their well-being in the host communities. Thus, the present study explores perceptions of successful aging among refugees in the United States. RESEARCH DESIGN AND METHODS: Twenty-one Burundian refugees, aged 50-67, were recruited from an upper Midwest community to participate in interviews on their perceptions of successful aging. The qualitative interviews were analyzed using thematic content analysis. RESULTS: Emergent themes showed that aging refugees' perceptions of successful aging were in some ways consistent with perceptions among other nonrefugee aging populations, such as perceptions related to physical functioning and health. Yet, in many ways, refugees' unique background and experiences seemed to lead to unique aging perceptions, such as perceiving an earlier onset of aging and expressing surprise and appreciation to experience old age. DISCUSSION AND IMPLICATIONS: Study findings suggest important future directions and potential implications for refugee host regions and communities on how they can better support aging refugees as well as develop effective interventions to promote well-being.

Vaccine attitudes and acceptance among older adults in North Dakota: Understanding demographic characteristic variability.

OBJECTIVES: Older adults face increased risks from infectious diseases which are often preventable with vaccines. The current study examines demographic variation in vaccine hesitancy among older adults in North Dakota. METHODS: A mailed survey assessing age, gender, years of education, self-rated health, rurality, and political leaning as well as vaccine attitudes and vaccine acceptance was conducted with 739 older adults (65+), oversampled from rural counties. RESULTS: Vaccine hesitant attitudes were significantly higher among rural and politically-conservative older adults; whereas, vaccine acceptance was significantly higher among older, healthier, and politically-liberal older adults. Vaccine attitudes were significantly associated with vaccine acceptance and mediated the association between political leaning and vaccine acceptance. DISCUSSION: These findings highlight the demographic characteristics predictive of older adults' vaccine attitudes and acceptance. By better understanding the nuanced factors leading to hesitation to be vaccinated, practitioners can develop strategies to increase vaccination rates among this at-risk population.

Longitudinal Associations of Conscientiousness and Neuroticism With Perceived Mastery and Constraints for Aging Adults.

It has not been well understood how conscientiousness and neuroticism are associated with two related but distinct dimensions of perceived control (i.e., perceived mastery and constraints) among aging adults. The present study examined these associations and their change over time, while addressing whether they differ by age or gender. For respondents aged 50+ at baseline (N = 2,768) in the Midlife in the United States (MIDUS) study, multilevel modeling analyses were conducted to assess how conscientiousness and neuroticism predicted perceived mastery and constraints over 2 decades. As expected, higher conscientiousness and lower neuroticism (for both between- and within-person variability) predicted higher perceived mastery and lower perceived constraints overall. Nuanced findings emerged related to age, gender and change over time for different associations of conscientiousness and neuroticism with the outcomes. These findings can inform future research suggesting directions of further investigations for these complex associations.

Older Adults' Loneliness in Early COVID-19 Social Distancing: Implications of Rurality.

OBJECTIVES: Older adults face greater health risks due to coronavirus disease 2019 (COVID-19), yet preventative social distancing measures may cause increased social isolation, potentially heightening risk of loneliness. In this mixed-methods study we examine changes in older adults' loneliness due to social distancing, explore variability in perceptions, and identify whether such changes differ by rurality. METHODS: A Midwestern sample of 76 older adults aged 70-97 (mean age = 82; 74% female; 95% White; 39% rural) completed a phone interview about their experiences with social distancing due to COVID-19. Interviews were conducted during early weeks of regional social distancing. Participants completed retrospective and current assessments of loneliness, including providing explanations of their responses. RESULTS: On average, loneliness increased during early social distancing, yet variability was evident. Those experiencing increased loneliness described a feeling of loss or lack of control, whereas those experiencing stability in loneliness identified adaptability in social connection modes or feeling accustomed to social isolation. Rural older adults experienced a significantly smaller increase in loneliness than their nonrural counterparts. DISCUSSION: These findings suggest nuanced experiences among older adults, but generally negative implications for loneliness. Interventions to address older adults' social isolation and loneliness during COVID-19 are warranted.

Untapped Insight: A Longitudinal Qualitative Analysis of Older Adults' Advice During the COVID-19 Pandemic.

Background and Objectives: Due to a lifetime of experience, older adults are uniquely positioned to contribute advice and insight to others during a historical, societal crisis such as the coronavirus disease 2019 (COVID-19) pandemic. This qualitative study explores the solicited advice older adults offered their peers, family members, and communities throughout the first year of the pandemic. Research Design and Methods: A sample of 72 older adults aged 70-97 from Minnesota and North Dakota were asked what advice they would provide to others in June 2020 and again in April/May 2021. Participants were asked to provide advice on individual coping and how community members should support older adults during the pandemic, as well as how others should adjust after the pandemic. Responses were coded and developed into overarching themes. Results: Older adults advised others during the pandemic to foster mental and physical well-being, develop positive life perspectives, and connect to others as strategies to cope through the pandemic. Participants advised that after the pandemic people should remain vigilant, return to normal, and emerge as better people. Advice targeted to meeting the needs of older adults during the pandemic included: adopt selfless attitudes, take intentional actions, and maintain balance. A longitudinal approach revealed that advice remained consistent over time, despite the circumstances caused by COVID-19 changing. Discussion and Implications: Findings suggest that older adults utilize their life experiences and coping strategies as sources for drawing advice. These findings also suggest that older adults are sources of insight during crises. Future research should investigate additional advice older adults can offer and how willingly communities listen. Applied work should give older adults opportunities to provide far-reaching advice as well as develop interventions aimed at decreasing ageist perceptions of older adults in times of crisis.

Shifts in Older Adults' Social Connections Throughout the Initial Year of the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic exposed older adults to increased health risks, yet social distancing precautions also heightened risks to their social well-being. This mixed-methods study explores changes in older adults' satisfaction with social engagement and interpersonal connections throughout the first year of the COVID-19 pandemic. RESEARCH DESIGN AND METHODS: A Midwestern sample of 76 older adults aged 70-97 completed a series of 4 interviews from March 2020 through April 2021 about their experiences with COVID-19 social distancing precautions. Participants reported social engagement satisfaction and frequency of contact with family and friends. Additionally, they responded to open-ended questions about social connection experiences. RESULTS: Satisfaction with social engagement rebounded with significant increases across the year of the pandemic, whereas frequency of contact shifted from high remote contact early in the pandemic to greater in-person contact over time, with nuanced distinctions between family and friends. Qualitative thematic analysis identified themes including: (1) shifts in family support, (2) adaptable and flexible friendships, (3) social isolation fatigue, and (4) communication through technology. Within each theme, perceptions of interpersonal connections shifted over time. DISCUSSION AND IMPLICATIONS: Findings suggest diverse social connection experiences among older adults, yet general patterns of strong social connections and adaptation over time. Future research should build upon these findings to better understand older adults' social needs and seek to explore ways to best foster social connections during instances of forced social isolation or historical crises.

Longitudinal Associations Between Perceived Control and Health for American and Japanese Aging Adults.

BACKGROUND AND OBJECTIVES: Research suggests longitudinal and reciprocal relationships between perceived control over life circumstances and health for Western populations; yet, such associations have not been fully understood for non-Western populations. The present study addresses cultural differences in these associations for American and Japanese aging adults. RESEARCH DESIGN AND METHODS: For respondents aged 40 and older at 2 waves (Time 1 [T1] and Time 2 [T2]) of Midlife in the United States (N = 4,455) and Midlife in Japan (N = 827), cross-lagged path models were analyzed for T1 perceived control predicting change in each health measure (i.e., self-rated health, number of chronic health conditions, and functional limitations) from T1 to T2; and the matched T1 health measure predicting change in perceived control from T1 and T2. In these analyses, the effects of T1 age, T1 perceived control, and each T1 health measure were compared cross-nationally. RESULTS: A cross-national difference emerged in that T1 perceived control predicted change in chronic health conditions only for Americans. Similar tendencies were found between the 2 nationalities for T1 perceived control predicting changes in self-rated health and functional limitations. Reciprocal relationships between perceived control and health measures were found for Americans, but neither age nor any of the T1 health measures predicted change in perceived control for the Japanese respondents. DISCUSSION AND IMPLICATIONS: The findings suggest cultural differences and similarities between the 2 nationalities, which have implications for potential health benefits of enhancing perceived control among American and Japanese aging adults. Building on these findings, the present study also indicates future directions of research.

Lessons in Resilience: Initial Coping Among Older Adults During the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVES: In addition to increased physical health risks, older adults may also experience risks to their mental health and social well-being due to coronavirus disease 2019 (COVID-19). Yet, older adults may be uniquely able to cope given their life experiences and coping mechanisms. This study explores older adults' coping experiences and strategies during the initial weeks of the COVID-19 pandemic. RESEARCH DESIGN AND METHODS: A Midwestern sample of 76 older adults aged 70-97 years completed a phone interview about their experiences with social distancing due to COVID-19. Interviews were conducted during the early weeks of regional social distancing (March 28-April 20, 2020). Participants rated their level of perceived coping and responded to open-ended questions about their daily life and coping. RESULTS: Mean perceived coping level (on a scale from 1 to 10) was 7.9, with 87% of participants rating their coping positively. Primary themes that emerged included (a) staying busy, (b) seeking social support, and (c) having a positive mindset. These emotion-focused coping strategies appeared adaptive in the early weeks of the pandemic for most older adults. DISCUSSION AND IMPLICATIONS: Contrary to predominant messaging about the vulnerability of older adults, these findings highlight the resilient nature of older adults in terms of their psychological coping and adaptability during COVID-19. Future research should build upon these findings to better understand and promote late-life coping during crises. Practitioners should seek to support older adults' engagement in such proactive coping, and social policies should be developed to acknowledge the variable needs of older adults.

The Convoy Model and Later-Life Family Relationships.

The convoy model of social relations was developed to provide a heuristic framework for conceptualizing and understanding social relationships. In this Original Voices article, we begin with an overview of the theoretical tenets of the convoy model, including its value in addressing situational and contextual influences, especially variability in family forms and cultural diversity across the life span, but particularly in older adulthood. We also consider the contributions of the convoy model to the field of family gerontology by illustrating concepts, methods, and measures used to test the model, as well as its usefulness and limitations in addressing contemporary issues facing older adults. Finally, we discuss opportunities for innovation and application of the convoy model to the study of later-life family relationships. In summary, we emphasize the benefits and inclusiveness of the convoy model for guiding current and future research to address challenges facing family gerontology now and in the future.

Challenges Faced by Family Caregivers: Multiple Perspectives on Eldercare.

The focus of this study was to identify challenges to family eldercare provision from the perspectives of both caregivers and community stakeholders. This qualitative study used data from 306 family caregivers and 116 stakeholders (aging, social, and health service professionals who work with older adults and their families) in North Dakota. Data sources included an American Association of Retired Persons-ND survey of 110 caregivers, a survey by the ND Family Caregiver Support Program (196 participants), and a Statewide Caregiving Stakeholder Survey (116 participants). Thematic analysis identified five themes: (a) financial burden of providing eldercare, (b) insufficient access to respite care, (c) difficulty finding and navigating available services and programs, (d) lack of knowledge and training on care provision, and (e) challenges related to environmental context of caregiving. Implications for working with family caregivers and developing policies for eldercare are discussed.

Convoys of Social Relations in Cross-National Context.

Purpose of the Study: This study examines national variations in social networks among older adults across 4 countries in diverse regions of the world: Japan, Lebanon, Mexico, and the United States. The aim is to provide insights into universal as well as unique attributes of social networks in later life. Design and Methods: The analyses examine convoy characteristics among adults aged 50+ in metropolitan areas of Japan (N = 557), Lebanon (N = 284), Mexico (N = 556), and the United States (N = 583). Data were collected using the hierarchical mapping technique on representative samples in each locale. Multilevel models were conducted by nation to examine whether convoy characteristics vary by age and closeness. Results: Network size and geographic proximity were dimensions of social networks sensitive to national context. By contrast, how age and feelings of closeness varied with contact frequency and the presence of children in networks revealed universal patterns. Furthermore, feelings of closeness varied by age with regard to size and contact frequency in Lebanon, proximity in Japan, and composition in Mexico. Implications: Identifying universal and unique characteristics of social networks in later life provide a preliminary empirical basis upon which to advance a global perspective on convoys of social relations and how they inform policies that can facilitate health and well-being among middle-aged and older people around the world.

The role of attention in binding shape to color.

Pictures of easily-identifiable objects with novel colors (e.g. a blue frog) or of forms with arbitrary colors (e.g. a green triangle) were presented briefly at 10.6 degrees eccentricity. Stimuli had strong outlines and vivid fill colors (red, green, yellow, blue, or purple). The same pictures were repeated once in each block of 30 trials for 6, 9, or 12 blocks, and recognition was probed after each block. Shapes were acquired quickly, within 3-4 blocks, whether attention was focused on the pictures or split to a demanding foveal task. Color-shape acquisition was also fast with focused attention, but stabilized at a low level with split attention. Delaying the foveal task restored color-shape acquisition. We suggest that attention facilitates the creation and maintenance of novel color-shape bindings in the visual periphery; without attention, binding is less effective.