PURPOSE: Home-based primary care (HBPC) for people with dementia is growing. Nurse practitioners (NPs) and physicians (MDs) deliver HBPC, often sharing care. We compared the characteristics of people with dementia receiv...PURPOSE: Home-based primary care (HBPC) for people with dementia is growing. Nurse practitioners (NPs) and physicians (MDs) deliver HBPC, often sharing care. We compared the characteristics of people with dementia receiving HBPC from NPs only, MDs only, and NPs+MDs. METHOD: The current cross-sectional study used 2019 Medicare claims to identify people with dementia and bivariate statistics to assess differences in patient characteristics (e.g., age, dual-eligibility for Medicare and Medicaid, race/ethnicity, comorbidities) across HBPC provider type. RESULTS: In 2019, 62,094 Medicare beneficiaries with dementia received HBPC. Approximately 40% received HBPC exclusively from NPs, 33% from MDs, and 27% from NPs+MDs. Those seen by NPs+MDs were significantly more racially and ethnically diverse with more comorbidities than those who saw NPs or MDs exclusively. CONCLUSION: NPs provide HBPC to a sizeable share of homebound people with dementia. Patients cared for by NPs and MDs are more medically and sociodemographically complex than those cared for by a single provider type.
PURPOSE: Little is known about temporary agency staff (TAS) use in assisted living communities (ALCs) due to regulatory variation in state requirements. The current study compared TAS use in ALCs before and after the cor...PURPOSE: Little is known about temporary agency staff (TAS) use in assisted living communities (ALCs) due to regulatory variation in state requirements. The current study compared TAS use in ALCs before and after the coronavirus disease 2019 pandemic. METHOD: Data were collected from a representative panel of the 2016 ( = 239) and 2023 ( = 298) waves of the Oregon Community-Based Care study. RESULTS: Share of ALCs with any TAS use increased significantly between 2016 and 2023 (13.4% vs. 21.8%; = .012). Most TAS were hired on a part-time basis (55% in 2016; 66% in 2023). We observed lower use of RNs and unlicensed direct care workers and higher use of licensed practical nurses and certified nursing assistants/medication aides in 2023 compared to 2016. Organizational characteristics were not significantly associated with ALC TAS use. CONCLUSION: A better understanding of how ALCs use TAS can inform policy debates around more stringent regulations for long-term care staffing.
PURPOSE: The current study aimed to co-design an intervention and evaluate its effects on knowledge, perceived self-efficacy, group facilitation skills, and core competencies in alleviating loneliness among Thai older ad...PURPOSE: The current study aimed to co-design an intervention and evaluate its effects on knowledge, perceived self-efficacy, group facilitation skills, and core competencies in alleviating loneliness among Thai older adults. METHOD: A quasi-experimental design with two groups and pre-/posttest measures was used. Sixty-one health volunteers from a district in Thailand were randomly assigned to a control group ( = 30), which received a 1-day educational session on addressing loneliness, or an experimental group ( = 31), which participated in a 7-week self-efficacy-based leader development program. Outcome measures included the Loneliness Multiple-Choice Examination and General Perceived Self-Efficacy Scale. Skills and competencies were assessed using the Skills in Facilitating Groups to Address Loneliness Scale and Loneliness Alleviation Competency Scale, with evaluations conducted by trained assessors during simulated sessions and supervised community practicums. RESULTS: The experimental group demonstrated significantly greater improvements in knowledge and perceived self-efficacy compared with the control group ( < .05). Furthermore, participants in the experimental group achieved proficiency in ≥75% of skills and core competencies for alleviating loneliness in older adults during real-world community practice. CONCLUSION: The self-efficacy-based leader development program effectively enhanced health volunteers' knowledge, self-efficacy, and competencies in addressing loneliness. Structured, competency-based training can strengthen community-based interventions led by health volunteers and contribute to improved psychosocial well-being among older adults.
PURPOSE: The Age-Friendly Health Systems (AFHS) is a national initiative that ensures evidence-based care for older adults. To facilitate implementation, direct care providers created a questionnaire for older adults to...PURPOSE: The Age-Friendly Health Systems (AFHS) is a national initiative that ensures evidence-based care for older adults. To facilitate implementation, direct care providers created a questionnaire for older adults to complete before a clinic visit. The current mixed methods study evaluated the questionnaire's acceptability using the Theoretical Framework of Acceptability and explored provider perceptions of the questionnaire. METHOD: In 2022, the questionnaire was sent to 1,100 retail health clinics. After 4 weeks of use, an online survey was sent to 3,300 direct care providers (e.g., nurse practitioners, physician assistants) at these clinics. RESULTS: Higher-than-average acceptability of the questionnaire in most of the Theoretical Framework of Acceptability domains was reported and self-reported implementation, completion, and documentation of all AFHS 4Ms improved. In open-ended responses, direct care providers described how the questionnaire was user-friendly and improved clinic visit efficiency. CONCLUSION: Direct care provider innovations help overcome real-world challenges, improving the effective implementation and delivery of evidence-based practices in a retail health clinic setting.
PURPOSE: The world's rapid aging has heightened demand for older adult medical services, driving the emergence of medical companions. The current study examined factors influencing job satisfaction among Shanghai's older...PURPOSE: The world's rapid aging has heightened demand for older adult medical services, driving the emergence of medical companions. The current study examined factors influencing job satisfaction among Shanghai's older adult medical companions to inform workforce stability strategies and aging-related policy upgrades. METHOD: Cross-sectional surveys ( = 146) were administered through stratified sampling across agencies, online platforms, and associations. Multivariate regression analyzed material (income, workload balance), social (professional recognition), and systemic factors (rights protections) using conservation of resources theory. RESULTS: Key determinants included income-workload balance, income level, social recognition, and rights violations (all < .005). More than 68% reported high satisfaction (mean = 4.12/5). CONCLUSION: Systemic support mechanisms-standardized compensation, rights protections, and professional certification-are critical for workforce retention. This study further highlights that, unlike Western patient navigator models where institutional safeguards are well established, policy adaptation in East Asia must begin with strengthening rights protection and recognition to provide a foundation for subsequent professionalization.
PURPOSE: To evaluate the current status of advance directives (ADs) among older adults with end-stage renal disease (ESRD) and identify potential contributing factors. METHOD: A quantitative, comparative, and correlation...PURPOSE: To evaluate the current status of advance directives (ADs) among older adults with end-stage renal disease (ESRD) and identify potential contributing factors. METHOD: A quantitative, comparative, and correlational design was used. Older adults with ESRD were recruited from a teaching hospital in Taiwan between October 2023 and October 2024. Structured questionnaires were used to assess quality of life, knowledge, attitudes, subjective norms, and behavioral intention to complete ADs. Data were analyzed to identify factors associated with the intention to complete ADs. RESULTS: A notable proportion of older adults with ESRD expressed an intention to complete an AD. Participants with one or two comorbidities were more likely to report this intention. Positive attitudes toward ADs and supportive subjective norms were also associated with greater intention to complete ADs. In contrast, knowledge and quality of life did not appear to significantly influence intention. CONCLUSION: Comorbidities, attitudes, and subjective norms are key influencers of intention to complete ADs.
PURPOSE: To assess health literacy levels and identify factors influencing them among community-dwelling older adults with pre-frailty. METHOD: This cross-sectional study enrolled 254 participants in community health ser...PURPOSE: To assess health literacy levels and identify factors influencing them among community-dwelling older adults with pre-frailty. METHOD: This cross-sectional study enrolled 254 participants in community health service centers in five cities in Zhejiang Province, China. Health literacy was assessed using the Short-Form Health Literacy Questionnaire. Data were analyzed using descriptive statistics, tests, analysis of variance, Pearson's correlation analysis, and hierarchical linear regression analysis. RESULTS: Mean age of participants was 72.44 years ( = 5.8 years). Mean health literacy index score was 28.72 ( = 5.38). Higher health literacy was significantly associated with younger age ( = .007), higher educational attainment (junior high school: = .031; senior high school: = .002; college or higher: < .001), smart-phone use ( = .009), regular exercise ( = .011), and social engagement ( = .002). Health literacy showed significant negative associations with three or more chronic diseases ( = .031) and psychological distress ( < .001). CONCLUSION: The study revealed significantly low health literacy among older adults with pre-frailty. Health care professionals should adopt targeted interventions focusing on individuals with low health literacy. Future research could develop and evaluate targeted interventions to examine the effects of health promotion on health literacy in community-based populations of older adults with pre-frailty.
PURPOSE: To examine fall-related medications and fall risk as predictors of fall-related hospitalizations among a cohort of community-dwelling older adults in the southern tier of New York State. METHOD: Participants com...PURPOSE: To examine fall-related medications and fall risk as predictors of fall-related hospitalizations among a cohort of community-dwelling older adults in the southern tier of New York State. METHOD: Participants comprised 8,499 patients from 14 primary care practices within a large community hospital system. Bivariate and multivariate analyses were conducted to examine associations between fall-related medications and fall risk, and their interactions as predictors of fall-related hospitalizations. RESULTS: There was a statistically significant association between fall risk and Fall Risk Medication Score (FRMS) with a cut-point ≥6 (χ = 85.145, < .001), with a weak but significant positive correlation (φ = 0.100, < .001). Older adults who had fall risk were 1.738 times more likely to have a FRMS ≥6 (95% confidence interval [CI] [1.544, 1.956]). Similarly, there was a statistically significant association between fall risk and FRMS with a cut-point ≥10 (χ = 68.953, < .001), with a weak but significant positive correlation (φ = 0.090, < .001). Older adults who had fall risk were 2.348 times more likely to have a FRMS ≥10 (95% CI [1.909, 2.887]). In logistic regression analyses, the interaction between fall risk and FRMS was a significant predictor of hospitalization when controlling for age and sex ( < .001); however, FRMS did not significantly improve the model over fall risk alone. CONCLUSION: Current tools for assessing and weighing the personal, environmental, and pharmacological factors that influence the likelihood of falls among older adults could be significantly improved through larger cohort studies using significant endpoints, such as fall-related hospitalizations.
PURPOSE: Dietary supplements are commonly used by older adults for concerns such as memory loss or to slow the progression of Alzheimer's disease. However, these agents are not regulated by the U.S. Food and Drug Adminis...PURPOSE: Dietary supplements are commonly used by older adults for concerns such as memory loss or to slow the progression of Alzheimer's disease. However, these agents are not regulated by the U.S. Food and Drug Administration. Furthermore, there are limited long-term studies evaluating safety and efficacy, especially in older adults. The intent of the current article is to review the recent literature on commonly used dietary supplements in older adults to reduce the risk of cognitive decline and dementia. METHOD: Systematic reviews and/or meta-analyses published within the past 10 years were reviewed to provide recommendations on the use of dietary supplements for brain health. RESULTS: There is limited evidence supporting the efficacy of commonly used dietary supplements but there are germane safety concerns that need to be considered by the interprofessional team. CONCLUSION: Future research should prioritize standardized dosing, diverse older adult populations, and long-term outcomes focusing on efficacy and safety.
PURPOSE: The current systematic review examined how community-based physical activity (PA) interventions for Latino older adults assessed intervention costs, health care utilization costs, and overall cost-effectiveness....PURPOSE: The current systematic review examined how community-based physical activity (PA) interventions for Latino older adults assessed intervention costs, health care utilization costs, and overall cost-effectiveness. METHOD: Five databases were searched for U.S.-based studies published from 2021 to 2025 that (a) assessed community-based PA interventions; (b) evaluated cost-effectiveness, reported intervention cost, and utilization data; (c) included populations aged ≥55 years; and (d) focused on Latino/Hispanic participants. Data were extracted on cost measurement methods, health care utilization metrics, and economic evaluation outcomes. RESULTS: Few eligible studies met full criteria, and most interventions reported general program costs, whereas only a few incorporated health care utilization or conducted formal cost-effectiveness analyses. Programs that measured PA improvements generally demonstrated favorable cost patterns but lacked standardized reporting. Among the few interventions that included Latino participants, results were typically reported in combination with other racial or ethnic groups, limiting the ability to interpret cost and cost-effectiveness outcomes specific to Latino older adults. CONCLUSION: The limited and inconsistent economic evaluation of community-based PA programs for Latino older adults highlights the need for more studies to evaluate intervention, utilization costs, and cost effectiveness reporting. Strengthening economic evaluations can guide resource allocation, support culturally tailored program development, and promote translating trial-based evidence into practical public policy for healthy aging.
PURPOSE: To investigate the effect of home-visit cognitive function training among National Long-Term Care Insurance (LTCI) beneficiaries with dementia in Korea. METHOD: We performed propensity score matching and differe...PURPOSE: To investigate the effect of home-visit cognitive function training among National Long-Term Care Insurance (LTCI) beneficiaries with dementia in Korea. METHOD: We performed propensity score matching and difference-in-differences analysis over data from the National Health Insurance Service. The experimental group ( = 215) received home-visit cognitive function training for dementia for ≥6 months. Participants in the control group received general home-visit care. RESULTS: Physical function score increased significantly according to the time effect; the interaction term between time (at 12 months) and home-visit cognitive function training was significant. The interaction term was not significant for cognitive function. CONCLUSION: Home-visit cognitive function training had a partial effect among LTCI beneficiaries with dementia in Korea. Health care workers specializing in dementia should be educated as professionals who provide nonpharmacological intervention programs.
PURPOSE: To examine factors influencing use of mobile health applications (apps) among older adults using the Technology Acceptance Model (TAM). METHOD: Data from the University of Michigan National Poll on Healthy Aging...PURPOSE: To examine factors influencing use of mobile health applications (apps) among older adults using the Technology Acceptance Model (TAM). METHOD: Data from the University of Michigan National Poll on Healthy Aging ( = 1,013 adults aged ≥65 years) were analyzed. Descriptive statistics and chi-square tests identified demographic factors associated with mobile health app use. Informatics experts categorized reasons for use and non-use via TAM constructs, perceived usefulness (PU) and perceived ease of use (PEOU). RESULTS: Only 27.2% of participants used mobile health apps. App use correlated with demographics and home internet accessibility, although the effect sizes were small. PU motivators included tracking health and seeking information. Barriers to PU and PEOU included lack of interest, awareness, and discomfort with technology. CONCLUSION: Addressing PU and PEOU is essential to improve app adoption among older adults. Nurses can enhance adoption by promoting digital literacy and supporting user-centered app design with simple navigation and larger fonts.
PURPOSE: To examine the association between serum 25-hydroxyvitamin D3 (25[OH]D3) levels and depressive symptoms among rural older adults in South Korea and explore implications for gerontological nursing. METHOD: The cu...PURPOSE: To examine the association between serum 25-hydroxyvitamin D3 (25[OH]D3) levels and depressive symptoms among rural older adults in South Korea and explore implications for gerontological nursing. METHOD: The current cross-sectional study used 2022 national survey data from 456 rural adults aged ≥65 years. Depressive symptoms, measured using the Patient Health Questionnaire-9 (PHQ-9), and vitamin D status (<20 ng/mL vs. ≥20 ng/mL) were analyzed using adjusted logistic and linear regression. RESULTS: Vitamin D deficiency was significantly associated with greater odds of depressive symptoms (odds ratio = 2.59, < .001), and lower serum 25(OH)D3 levels were independently associated with higher PHQ-9 scores (β = -0.177, < .001). Female sex was also a significant predictor. CONCLUSION: Vitamin D deficiency may be a modifiable factor in depression screening. Including vitamin D assessment in gerontological nursing practice may support early identification and prevention in rural older adults.
PURPOSE: To investigate the prevalence of and factors associated with subjective cognitive decline (SCD) in middle-aged adults. METHOD: The current cross-sectional study used convenience sampling to recruit community-dwe...PURPOSE: To investigate the prevalence of and factors associated with subjective cognitive decline (SCD) in middle-aged adults. METHOD: The current cross-sectional study used convenience sampling to recruit community-dwelling adults aged 50 to 64 years. Data collected included demographics, disease characteristics, frailty, depression, sleep quality, and social support. A logistic regression model identified significant risk factors related to SCD. RESULTS: In total, 200 middle-aged adults participated in the study, with a 15% prevalence of SCD. Multiple logistic regression models revealed that chronic diseases, smoking, and poor sleep quality were significantly associated with increased SCD. Specifically, participants with chronic diseases (odds ratio [OR] = 2.99, 95% confidence interval [CI] [1.27, 7.04]), those who smoked (OR = 3.51, 95% CI [1.23, 10.02]), and those reporting poor sleep quality (OR = 3.18, 95% CI [1.36, 7.49]) had significantly higher likelihoods of experiencing SCD compared to their counterparts. CONCLUSION: This study identified significant associations among chronic disease status, smoking, and poor sleep quality and the presence of SCD among middle-aged adults. Although causal relationships cannot be established, findings highlight the need for greater attention to cognitive health in individuals with these risk profiles. Further longitudinal research is warranted to clarify temporal relationships and assess the potential value of targeted monitoring strategies in at-risk populations.
PURPOSE: The current study examined RNs' practical experiences in managing behavioral and psychological symptoms of dementia (BPSD) and delirium superimposed on dementia (DSD) in long-term care hospitals. METHOD: In-dept...PURPOSE: The current study examined RNs' practical experiences in managing behavioral and psychological symptoms of dementia (BPSD) and delirium superimposed on dementia (DSD) in long-term care hospitals. METHOD: In-depth, one-on-one interviews were conducted with 18 RNs-including charge nurses, head nurses, and general staff-at two long-term care hospitals. RESULTS: Nurses reported significant challenges in distinguishing and managing BPSD and/or DSD due to limited symptom-specific knowledge, overlapping clinical presentations in older adults, and resource constraints. Despite these barriers, they actively applied practical strategies to interpret symptoms and initiate appropriate interventions. CONCLUSION: Findings highlight the need for targeted education and structured clinical support to strengthen nurses' capacity to differentiate and manage BPSD and DSD. Enhancing institutional systems and interdisciplinary collaboration is essential to improving dementia care in long-term care hospitals.