Recurrent Falls over Three Years among Older Adults Age 70+: Associations with Physical and Mental Health Status, Exercise, and Hospital Stay.

We used the 2019-2021 U.S. National Health and Aging Trend Study (N = 3,063, age 70+) and multinomial logistic regression and generalized linear models with Poisson and log link to identify correlates of (1) recurrent falls (2 + falls) over 3 years (2019-2021); and (2) any subsequent fall among those who had a fall in 2019. We also examined the associations between falls and hospitalization in 2021. Results show that those with recurrent falls had greater physical/functional and psychological health problems in 2019, while single fallers over the 3 years were not significantly different from those without a fall. Exercise was associated with a lower likelihood of a subsequent fall among those who fell in 2019. Both a single fall and recurrent falls over the 3 years were associated with a higher risk of hospitalization in 2021. Multifactorial fall preventions including exercise and depression/anxiety treatment are needed to mitigate recurrent fall risks.

Increasing the Repertoire for Depression Care: Methods and Challenges of a Randomized Controlled Trial of Peer Support for Vulnerable Older Adults.

OBJECTIVE: Low-income White and older adults of color face barriers to depression care. Our purpose is to describe the methods and challenges encountered during the implementation of a randomized controlled trial to test the effectiveness of a peer support depression care intervention for low-income White and older adults of color during the COVID-19 pandemic. METHODS: Peer Enhanced Depression Care (Peers) is an 8-week community-based intervention that uses peer mentors who are trained and supervised to provide social support and self-care skills to depressed older adults. The effectiveness of the intervention in reducing depression will be evaluated by following a sample of older adults recruited in the community over a 12-month period. Target enrollment is 160 older adults. We hypothesize that participants randomized to the Peer Enhanced Depression Care intervention will experience greater decrease in depressive symptoms compared to participants randomized to the social interaction control. We provide lessons learned regarding the recruitment of BIPOC and White low-income older adults and peer mentors during the COVID-19 pandemic. RESULTS: Recruitment challenges occurred in primary care clinics that were unable to accommodate recruitment efforts during the pandemic. This led to focused outreach to community-based organizations serving older adults. Challenges to participant recruitment have included barriers related to stigma, distrust, as well as unfamiliarity with research. Peer mentor recruitment was facilitated by existing government-supported resources. CONCLUSIONS: This study will provide knowledge regarding the effectiveness, mechanism, and processes of delivering an informal psychosocial intervention such as peer support to a vulnerable older adult population.

Socially Assistive Humanoid Robots: Effects on Depression and Health-Related Quality of Life among Low-Income, Socially Isolated Older Adults in South Korea.

Using a mixed-method study design, we examined the effects of a socially assistive humanoid robot (SAHR), called Hyodol, on depressive symptoms and health-related quality of life (HRQOL) of low-income, socially isolated older adults (N = 180). Quantitative outcomes were assessed at baseline (before Hyodol deployment) and at 3 and 6 months after baseline. Results showed reduced depressive symptoms and improved HRQOL at 3 months; however, these positive effects did not extend to 6 months. Ten focus group participants perceived Hyodol to be a valuable companion especially during the COVID outbreak. These results suggest that while Hyodol may have provided companionship for some low-income, socially isolated older adults during home confinement, its effects on depression and HRQOL were limited. Further research is needed to assess long-term effects of SAHRs as appropriate tools for reducing social isolation and improving behavioral health among community-dwelling older adults.

Changes in Older Adults' Frequency of Going Outside between 2020 and 2021: Associations with Health Status and Environmental Factors.

OBJECTIVES: To examine the changes in the frequency of going outside among U.S. older adults between 2020 and 2021 (post-COVID vaccine) and correlates of those changes. METHODS: We used the 2019-2021 National Health and Aging Trend Study (NHATS) (N = 3,063, age 70+) and multinomial logistic regression to analyze associations of increased and decreased frequencies in going outside with physical, psychosocial, and cognitive health, environmental (COVID concerns and transportation) factors, and social media use as the independent variables. RESULTS: In 2021 compared to 2020, 13% and 16% of those age 70+ reported increased and decreased frequencies, respectively. Increased frequency was associated with social media use. Decreased frequency was associated with poor physical health, depression/anxiety, and perceived memory decline. COVID concerns and transportation problems, as well as female gender, age 90+, and being non-Hispanic Black, were also significant correlates of decreased frequency. CONCLUSIONS: Most U.S. adults age 70+ appear to have resumed their 2019 level of frequency of going outside in 2021 after the COVID vaccines became available; however, 16% reported decreased frequency of going outside in 2021 compared to 2020. CLINICAL IMPLICATIONS: Older adults with physical, mental, and cognitive health challenges need help to increase their frequency of going outside.

Older Adults' Frequency of Going Outside during the COVID-19 Pandemic: Associations with Physical Distancing, Health Status, and Fall Risk Factors.

Research shows significant health benefits of going outside in late life. Using the 2019 and 2020 National Health and Aging Trend Study and its 2020 COVID-19 supplemental survey (N = 3,857, age 70+), we examined changes in the past-month frequency of going outside one's home/building during the COVID-19 pandemic in 2020 compared to the same time in 2019. We found that 57.0% reported no change in the frequency of going outside, 32.0% went out less frequently, and 11.0% went out more frequently. Logistic regression models showed that decreased frequency was associated with higher frequency of going outside in 2019, avoidance of contact with those outside their household (AOR = 1.51, 95% CI = 1.10, 2.06), dementia diagnosis, mobility device use, self-rated health (AOR = .85, 95% CI = .75-.97), and being 90+ years of age, female, non-Hispanic Black or Hispanic, divorced/separated. Older adults are likely to benefit from going outside more often when they can safely do so.

My Precious Friend: Human-Robot Interactions in Home Care for Socially Isolated Older Adults.

OBJECTIVES: Using a friendship framework, we explored interactions between a multi-functional companion robot and older adults residing in a low-resource community in South Korea. METHODS: We conducted in-depth interviews with 12 older adults who kept a doll-shaped companion robot called Hyodol for 18 months on average. We applied the Framework Analysis Method to explore three types of friendship (i.e., friendships of utility, pleasure, and the good) that participants cultivated with the robot. RESULTS: The most common aspect of utility companionship reported by all participants was Hyodol's role as their health coach who reminded them to take medication and to exercise. Participants also found pleasure in playing with Hyodol and reported reduced feelings of loneliness. In the absence of other social supports, all participants also regarded Hyodol as a surrogate family member or human-friend, and interacted with Hyodol as such. CONCLUSIONS: Findings illustrated high acceptability of Hyodol among these socially isolated older adults especially during the global COVID-19 pandemic, suggesting that a humanoid like Hyodol could be complementary to homecare services for solo-living older adults. CLINICAL IMPLICATIONS: Well-designed robot interventions, as complements to existing aging service and clinical interventions, have a potential to improve health behaviors among socially isolated older adults.

Heroin and fentanyl overdose deaths among cases age 50+ in the National Poison Data System, 2015-2020.

CONTEXT: Illicit opioid use and heroin treatment admissions among individuals age 50+ have increased. Little research has, however, examined correlates of illicit opioid overdose deaths in this age group before or during the COVID-19 pandemic or the healthcare services used in these cases. METHODS: The sample included illicit opioid (heroin, fentanyl, or other synthetic, nonpharmaceutical opioids) poisoning cases age 50+ (N = 5576) in the National Poison Data System (NPDS), 2015-2020. Using descriptive statistics and logistic regression models, we report changes in overdose death rates during the study period and associations of death with healthcare service use, naloxone administration, and clinical and demographic characteristics. RESULTS: The 6-year average overdose death rate from illicit opioids among those age 50+ was 2.9%, increasing from 1.4% in 2015 to 4.0% in 2019 and 3.6% in 2020. Logistic regression results showed that exposure year was not a significant factor in the odds of overdose death; however, odds were significantly higher among cases that were not managed at any healthcare facility (HCF) (adjusted odds ratio [AOR] = 4.60, 95% confidence interval [CI] = 3.19-6.63) and lower among those who received naloxone therapy (AOR = 0.64, 95% CI = 0.45-0.92). The odds of death were also higher among cases involving exposure at own or another's home and co-use of prescription opioids, alcohol, and other illicit drugs. CONCLUSIONS: Although the NPDS did not show increases in illicit opioid overdose death rates among cases age 50+ in 2020 compared to 2019, overdose deaths were greater among cases that were not managed at HCF and did not receive naloxone therapy. Many appear to have died before they received any intervention to prevent death. Improved access to healthcare services and social support and access to naloxone therapy for older adults with opioid use problems are needed.

COVID-19 and Loneliness among Older Adults: Associations with Mode of Family/Friend Contacts and Social Participation.

OBJECTIVES: Given physical/social distancing due to COVID-19, we examined associations between self-reported loneliness and changes in contact with family/friends and mode of social participation among older adults. METHODS: Data came from the 2020 National Health and Aging Trend Study (NHATS) and its supplemental mail COVID-19 survey (N = 2,910 respondents who reported changes in loneliness during the COVID-19 outbreak). We fit a generalized linear model (GLM) with Poisson and log link using increased versus the same/decreased loneliness as the dependent variable and changes in frequencies of four modalities of contact with family/friends and social participation mode during COVID-19 as the independent variables. RESULTS: Approximately 19% of respondents reported feeling lonely on more days during COVID-19. GLM results showed that decreased in-person contact (AOR = 1.42, 95% CI = 1.17-1.73) and increased video call contact (AOR = 1.30, 95% CI = 1.01-1.66) with family/friends and on-line participation in clubs, classes, and other organized activities (AOR = 1.36, 95% CI = 1.04-1.77) were associated with higher odds of increased loneliness. CONCLUSIONS: Virtual interaction is not an effective substitute for in-person interaction for older adults and is associated with increased loneliness. CLINICAL IMPLICATIONS: : Innovative means of making virtual contacts more similar to in-person contacts are needed to decrease older adults' loneliness during COVID-19.

Telehealth Use Among Older Adults During COVID-19: Associations With Sociodemographic and Health Characteristics, Technology Device Ownership, and Technology Learning.

The COVID-19 pandemic ushered in rapid telehealth/telemedicine adoption. In this study, we (1) examined rates and correlates of telehealth (video call) use among those aged 70+, and (2) tested the significance of access to information and communication technology (ICT) device ownership and knowledge of how to use the internet and devices as telehealth-enabling factors. The Behavioral Model of Health Services Use served as the conceptual framework, and data came from the COVID-19 supplemental survey of the National Health and Aging Trend Study. Results show that telehealth use increased to 21.1% from 4.6% pre-pandemic. In logistic regression models without technology-enabling factors, older age and lower income were negatively associated with telehealth use; however, when technology-enabling factors were included, they were significant while age and income were no longer significant. Insuring that older adults have ICT devices and internet access may reduce health disparities and improve telehealth care delivery.