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This book broadens the visioning on new care environments that are designed to be inclusive, progressive, and convergent with the needs of an aging population. The contents cover a range of long-term care (LTC) settings in a single collection to address the needs of a wide audience. Due to the recent COVID-19 pandemic, rethinking the spatial design of care facilities in order to prepare for future respiratory and contagious pathogens is one of the prime concerns across the globe, along with social connectedness and autonomy in care settings. This book contributes to the next generation of knowledge and understanding of the growing field of the design of technology, programs, and environments for LTC that are more effective in infection prevention and control as well as social connectedness. To address these issues, the chapters are organized in four sections: Part I: Home- and community-based care;Part II: Facility-based care;Part III: Memory care and end-of-life care;and Part IV: Evidence-based applied projects and next steps. (Re)designing the Continuum of Care for Older Adults is an essential resource for researchers, practitioners, educators, policymakers, and students associated with LTC home and healthcare settings. With diverse topics in theory, substantive issues, and methods, the contributions from notable researchers and scholars cover a range of innovative programming, environments, and technologies which can impact the changing needs and support for older adults and their families across the continuum of care. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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PURPOSE: To reduce the burden of Alzheimer's disease, the use of assistive technologies for patients and their informal caregivers is considered essential. However, these technologies are made as "one size fits all" instead of being tailored to accommodate people with varying degrees of cognitive impairment and those with diverse races/ethnicities. Thus, the aim of this survey was to determine whether the types of assistance needed most, and the technology used by those with cognitive impairment differed by race (White/non-Hispanics, Black or African Americans, and Hispanic/Latinos or Puerto Ricans) and severity of dementia (mild, moderate, severe). RESEARCH DESIGN AND METHODS: One hundred and eighty informal caregivers of people with different levels of severity of cognitive impairment and several different races/ethnicities filled out an online survey regarding assistance needed and technologies used. RESULTS: The results show that racial minorities considered the needs for assistance with Basic Activities of Daily Living as more important compared to White/non-Hispanics with mild dementia. Furthermore, Hispanic/Latinos or Puerto Ricans and White/non-Hispanics with severe dementia were shown to use technology that is designed to help with Instrumental Activities of Daily Living more than those with moderate dementia. Lastly, during COVID-19, devices to assist with walking, preparing meals and personal hygiene have been used significantly more by White/non-Hispanics with severe dementia compared to Hispanic/Latinos or Puerto Ricans. CONCLUSION: The results point to the need to design for those with severe dementia, regardless of race, and should focus on addressing needs related to both Instrumental and Basic Activities of Daily Living.
Developers of assistive technology should consider designing technology that can accommodate all severity levels of cognitive impairment.More research is needed to determine the usability of assistive technology that is designed for those with cognitive impairments.
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Background: It is widely recognized that technologies have the potential to contribute to high-quality long-term care for older people at home. Evidence from past RCTs partly confirms the positive effects of technology use, although results are mixed and various questions remain unanswered. Objective: This study aimed to demonstrate the beneficial mid and long-term effects of using aging-in-place technologies on quality of life (QoL) indicators like perceived safety, control, and participation (ATQoL scale) and other specific psychosocial outcomes (PIADS) as well as general health-related QoL (EQ-5D-5L Index value and Health today). Method: We conducted an RCT with 281 older people in Austria, Italy, the Netherlands, and Slovenia. Persons in the intervention group (n=143) obtained a bundle of smart home and assistive technologies which they used for 6 or 13 months in their private homes. Persons in the control group (n=138) received no intervention. Three hypotheses were tested with Generalized Linear Mixed Models. Results: We found slightly positive impacts of technology use on some of the specific QoL indicators for persons who used the technologies for 13 months and were relatively motivated and healthy. No, or even detrimental, effects emerged after 6 months. However, persons who used the emergency watch frequently perceived more favorable outcomes than those who used it rarely. Effects had small to medium standardized effect sizes. No effects emerged for the general health-related QoL measure. Conclusion: Despite study limitations (and the COVID-19 pandemic) we conclude that aging-in-place technologies can mitigate adverse age-related developments, and have stabilizing effects on the QoL of older persons. Our trial showed that outcome indicators that are closely related to technology use should be preferred to general indicators. Findings now have to be consolidated in meta-analyses to paint a clearer picture of the beneficial effects of technology use © 2022, Gerontechnology.All Rights Reserved.
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Senior housing with age-friendly design and elderly care services contributes to the health and well-being of older people. Previous research has evidenced that the immediate environment factors of senior housing, such as the design of housing features and facilities, have a direct bearing on the satisfaction and quality of life of older people. However, external environment factors, such as political, economic, and social ones that affect key stakeholders' behaviors in senior housing development, are relatively under-researched. Accordingly, this study aimed to explore the external environmental factors influencing the development of senior housing. Taking Hong Kong as case study, this study first commenced with a systematic review to identify the factors in political, economic, and social domains from global evidence. Following this, we interviewed local experts from academia, industry, and government to solicit their opinions on the relative importance of these factors. We then determined the factor rankings using the analytical hierarchy process method. The results showed that local experts perceived economic factors as the most critical ones in influencing senior housing development in Hong Kong, including land costs, funding from financial institutions, and government incentives. If policymakers tend to promote senior housing in densely populated cities like Hong Kong, the policies should be attractive for housing developers, such as land premium concessions and innovative financial channels for supporting the long-term development of senior housing. © 2023 by the authors.
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Western aging policies prioritize aging-in-place, often emphasizing informal care and support. However, organizing informal care at home gives rise to complicated and multilayered negotiations between people and their home environments. This negotiation involves sociocultural, economic, and spatial dimensions, impacting the so-called landscapes of care. Distance, both geographical and emotional, is a key factor in informal care. As the COVID-19 pandemic plunged us into a health crisis unprepared, governmental measures had to be implemented quickly. Older and at-risk persons especially had to keep distance from non-household members. These measures expectedly impacted the existing landscapes of care, especially regarding caring task divisions. This article discusses how landscapes of care were affected in Flanders (Dutch-speaking region of Belgium) during and shortly after its first lockdown. Sixteen in-depth, qualitative digital interviews were conducted as part of an interdisciplinary research project. They explored how social support and informal care networks of community-dwelling older adults might have changed during the pandemic. The findings indicate that informal care and support became more strictly and unilaterally organized within the families with a contraction of social support networks. Therefore, older people, although cared for, were forced into an organized social isolation at home.
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Care has become a popular topic of conversation in the context of Covid-19. But what will it take for the value of care to be realized when the use of "care " in corporate slogans inspires cynicism or when conflicting appeals to care dilute the concept's meaning? In this brief essay, Hastings Center postdoctoral fellow Mercer Gary suggests that building helpfully on the current interest in care as an ethical value and a form of work requires strengthening the conditions that make care possible. Two projects on which Gary is collaborating at The Hastings Center concern supporting older adults in aging in place, with one demonstrating the necessity of stable housing and the other highlighting how the labor of informal care providers is often assumed, but not provided for, in aging-in-place initiatives.
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Older adults (65+) are becoming primary users of emerging smart systems, especially homecare technologies. The current COVID-19 pandemic has created increased demand and pressure to speed up innovation with healthcare increasingly shifting from the clinic to the home. This acceleration in digital health has also given rise to increased potential risks related to privacy and security. This paper presents highlights of a literature review focused on privacy research involving older adults to inform research and development of home healthcare technologies as part of the National Research Council of Canada's Aging in Place Program. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
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Care has become a popular topic of conversation in the context of Covid‐19. But what will it take for the value of care to be realized when the use of "care” in corporate slogans inspires cynicism or when conflicting appeals to care dilute the concept's meaning? In this brief essay, Hastings Center postdoctoral fellow Mercer Gary suggests that building helpfully on the current interest in care as an ethical value and a form of work requires strengthening the conditions that make care possible. Two projects on which Gary is collaborating at The Hastings Center concern supporting older adults in aging in place, with one demonstrating the necessity of stable housing and the other highlighting how the labor of informal care providers is often assumed, but not provided for, in aging‐in‐place initiatives.
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OBJECTIVES: We seek to identify active coping strategies used by older adults to face the pandemic and to deal with daily stressors, and to clarify which factors had an effect on stress, positive emotions and depression in active and healthy community-dwelling older adults in the first and second year of the pandemic in Costa Rica. METHODS: Participants were living in their own homes in Costa Rica (n = 218, mean age 69.96, 82.1% women). Participants were interviewed by phone and answered an online survey, which included socio-demographic information, mental health variables such as stressors (perceived health and fear of COVID-19, illness, perception of pandemic gravity), loneliness (whether they felt lonely and how often they felt lonely), access to Information and Communication Technologies, socio-emotional coping variables, social participation and physical activity level during the pandemic. RESULTS: Positive socio-emotional indicators related to well-being such as self-efficacy, social support, perceived health and proactive behavior were high. Negative well-being indicators such as perceived stress, emotional COVID-19 fear and loneliness showed low values in the sample studied during both years. We found significant relations across the dependent variables (perceived stress, positive emotions and depression) by studying the psychological well-being coping strategies. CONCLUSIONS: Findings highlight the importance of coping strategies and social participation in the capacity of older adults to mitigate the negative psychological consequences of crisis situations and provide evidence of "aging in place".
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COVID-19 , Social Participation , Humans , Female , Aged , Male , COVID-19/epidemiology , Aging/psychology , Loneliness/psychology , Social Support , Adaptation, PsychologicalABSTRACT
For varying reasons, our world is experiencing increasing life expectancies and decreasing birth rates, which has led to a generational shift in population distribution. The Government of Canada predicts that in the year 2030, over 9.5 million (23%) Canadians will be 65 years or older. For this growing demographic of older adults, intelligent home health technologies have been proposed as one beneficial avenue to support and maintain an individual's health and wellness as they begin experiencing aging-related health effects. However, many ethical concerns have been raised regarding the design and deployment of intelligent home healthcare technologies in aging- in-place settings such as long-term care and nursing homes. This paper presents a revised participatory design methodology to identify aging-in-place stakeholders' ethical concerns with two Ambient Assistive Living (AAL) devices. The main objective of this paper is to develop and test a participatory design research method that is well suited for older adults living in long-term care settings, which is currently lacking. Developed by an interdisciplinary team of engineers and social science researchers, this paper presents the participatory method that was designed and tested in a long-term care facility by collaborating with a mix of aging-in-place stakeholders, including older adults and healthcare professionals. By interweaving interactive activities, hand-written tasks, and discussions throughout the data collection process, the methodology successfully identified stakeholders' ethical concerns with the devices. © 2022 IEEE.
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What is the impact of housing adequacy on recent home modification, controlling for demographics and housing characteristics? This study examined home modifications of households with a member aged 65 or older, focusing on relationships between selected demographic and housing variables and home modification. Binary logistic regression analysis was used on a sample of 6,627 homeowners from the newly released 2019 American Housing Survey (AHS) dataset. This analysis of the 2019 AHS data is important because of its pre-COVID pandemic era perspective in terms of home modifications and older adults aging in place. Results showed that recent housing modifications were significantly affected by select demographic and housing factors.
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Purpose>This conceptual paper aims to describe aging all over the place (AAOP), a federative framework for action, research and policy that considers older adults’ diverse experiences of place and life trajectories, along with person-centered care.Design/methodology/approach>The framework was developed through group discussions, followed by an appraisal of aging models and validation during workshops with experts, including older adults.Findings>Every residential setting and location where older adults go should be considered a “place,” flexible and adaptable enough so that aging in place becomes aging all over the place. Health-care professionals, policymakers and researchers are encouraged to collaborate around four axes: biopsychosocial health and empowerment;welcoming, caring, mobilized and supportive community;spatiotemporal life and care trajectories;and out-of-home care and services. When consulted, a Seniors Committee showed appreciation for flexible person-centered care, recognition of life transitions and care trajectories and meaningfulness of the name.Social implications>Population aging and the pandemic call for intersectoral actions and for stakeholders beyond health care to act as community leaders. AAOP provides opportunities to connect environmental determinants of health and person-centered care.Originality/value>Building on the introduction of an ecological experience of aging, AAOP broadens the concept of care as well as the political and research agenda by greater integration of community and clinical actions. AAOP also endeavors to avoid patronizing older adults and to engage society in strengthening circles of benevolence surrounding older adults, regardless of their residential setting. AAOP’s applicability is evidenced by existing projects that share its approach.
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Public library systems' websites were often the sole means for older patrons to access library services and programming during the COVID-19 pandemic. This study integrated Pauwels' (2012) framework to analyze 25 Ontario public library systems' websites for evidence of their available programming for older adults during the early months of COVID-19. The 640 identified programs for older adults revealed a number of patterns, including issues regarding visibility and representation of older patrons on library websites as well as assumptions surrounding older adults' access to technologies. Discussions consider three implications for public libraries as they reopen and create new virtual spaces "postpandemic": questioning (re)distributions of resources that support both virtual and in-person services, questioning implicit assumptions that digital connection will foster social connection, and questioning the effects of the library as a virtual space on feelings of social connectedness.
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The concept of acute hospitalization at home has been described for over 3 decades. Its scope, however, was largely limited to small experimental trials and pilot studies. The Covid-19 pandemic changed these circumstances. The convergence of the critical need for acute hospital beds along with the growing sophistication and comfort in virtual monitoring facilitated the rapid deployment of hospitalization at home throughout many communities in the United States. Now in the waning times of the pandemic, community health leaders and health systems are questioning what the future role of home virtual hospitalization might be. Might this concept be relegated to only future times of critical bed shortage, or might it be part of a true change in community healthcare delivery.
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COVID-19 , Community Health Services , Delivery of Health Care , Hospitalization , Humans , Pandemics , United States/epidemiologyABSTRACT
This reprinted chapter originally appeared in Journal of Gerontological Social Work, 2020, 63[6-7], 702-705. (The following of the original article appeared in record 2021-00510-030.) In this letter, we present a case for why and how social workers who work with older adults should assess and respond to human-pet interaction;while important on a routine basis, given the current pandemic situation and subsequent increases in isolation experienced by older adults, it is especially crucial to be responsive to their relationships with pets as potential strengths, stressors or both. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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OBJECTIVE: The aim is to describe and reflect upon potentially pandemic-related impact on self-assessments of active ageing. As part of the baseline data collection in the Prospective RELOC-AGE (ClinicalTrials.gov NCT04765696) study, telephone interviews, including the University of Jyvaskyla Active Aging Scale (UJACAS) were conducted with 820 people 55 years or older listed with an interest of relocation at three housing companies in Sweden. Field notes alongside the interviews focused on two topics: (1) how respondents reasoned and replied to the questions included in the UJACAS; (2) whether there were specific items that seemed to be affected by the pandemic. RESULTS: For four items (Participating in events, Exercising, Maintaining friendships, Getting to know new people), recurrent comments indicated that respondents had been affected by the pandemic situation regarding one or more of the facets in UJACAS: will to act, ability to act, opportunity to act, or frequency or extent of doing the activity. Opportunities to act was most frequently commented on as a factor affected by restricted participation in activities. As Prospective RELOC-AGE is a longitudinal study focused on associations between housing, relocation and active ageing, it is imperative to consider the potential pandemic-related impact on baseline data in future analyses.
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COVID-19 , Aging , COVID-19/epidemiology , Humans , Longitudinal Studies , Middle Aged , Pandemics , Prospective Studies , Self-Assessment , Sweden/epidemiologyABSTRACT
Planning for aging populations has been a growing concern for policy makers across the globe. Integral to strategies for promoting healthy aging are initiatives for ‘aging in place’, linked to services and care that allow older people to remain in their homes and communities. Technological innovations—and especially the development of digital technologies—are increasingly presented as potentially important in helping to support these initiatives. In this study, we employed qualitative document analysis to examine and compare the discursive framing of technology in aging-in-place policy documents collected in three countries: The Netherlands, Spain, and Canada. We focus on the framing of technological interventions in relation to values such as quality of life, autonomy/independence, risk management, social inclusion, ‘active aging’, sustainability/efficiency of health care delivery, support for caregivers, and older peoples’ rights. The findings suggest that although all three countries reflected common understandings of the challenges of aging populations, the desirability of supporting aging in place, and the appropriateness of digital technologies in supporting the latter, different value-framings were apparent. We argue that attention to making these values explicit is important to understanding the role of social policies in imagining aging futures and the presumed role of technological innovation in their enactment.
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BACKGROUND: In the context of growing population ageing, technologies aimed at helping people age in place play a fundamental role. Acceptance of the implementation of technological solutions can be defined as the intention to use a technology or the effective use of it. Approaches based on the technology acceptance model (TAM) have been shown to have good predictive power for pre-implementation attitudes towards new technologies. OBJECTIVE: To analyze the degree of acceptability of the use of new technologies for ageing in place and the factors associated with greater acceptance in people older than 64 years. METHODOLOGY: A descriptive cross-sectional study was carried out. Sociodemographic, clinical and environmental variables, architectural barriers, social risk and quality of life, degree of autonomy, morbidity, and risk of falls were collected in a population sample over 64 years of age in a large region of western Spain. The degree of acceptance of the use of technologies was measured through a scale based on the TAM. RESULTS: Of the 293 people included in the study, 36.2% exhibited a high acceptability of new technologies, 28.3% exhibited a medium acceptability, and 35.5% exhibited a low acceptability. Of all the factors, age, education level, and living alone were significantly associated with high acceptance in the adjusted analyses. CONCLUSIONS: Younger age, a higher education level, and living alone are factors associated with a greater degree of acceptance of the use of technologies for ageing in place.
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Independent Living , Quality of Life , Aged , Aging , Cross-Sectional Studies , Humans , TechnologyABSTRACT
BACKGROUND: Stay-at-home orders and other public health measures designed to mitigate the spread of COVID-19 have increased isolation among persons with memory concerns (PWMCs: individuals diagnosed with cognitive impairment or Alzheimer disease or related dementias). The pandemic has also exacerbated challenges for family members who care for PWMCs. Although technology has demonstrated the potential to improve the social connections and mental health of PWMCs and their family caregivers (CGs), previous research shows that older adults may be reluctant to adopt new technologies. OBJECTIVE: We aimed to understand why and how some PWMCs and their CGs altered their use of mainstream technology, such as smartphones and fitness trackers, and assistive technology to adapt to lifestyle changes (eg, increased isolation) during the COVID-19 pandemic. METHODS: Using data collected in 20 qualitative interviews from June to August 2020 with 20 PWMCs and family CG dyads, we assessed changes in and barriers to everyday technology use following the implementation of COVID-19 mitigation strategies in the United States. Zoom videoconferencing was utilized to conduct the interviews to protect the health of the participants who were primarily older adults. RESULTS: Using qualitative thematic analysis, we identified 3 themes that explained motivations for using technology during a pandemic: (1) maintaining social connections, (2) alleviating boredom, and (3) increasing CG respite. Results further revealed lingering barriers to PWMC and CG adoption of technologies, including: (1) PWMC dependence upon CGs, (2) low technological literacy, and (3) limitations of existing technology. CONCLUSIONS: This in-depth investigation suggests that technology can provide PWMCs with more independence and offer CGs relief from CG burden during periods of prolonged isolation.
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Loneliness is an underestimated issue among older adults, especially for those who age in place. Some can fall into a routine of staying home and cutting themselves off from the outside world. Intuition Robotics found during beta testing of their social robot ElliQ that users interacted and confided in it more as they would with a living entity than a device. The more ElliQ greeted users and initiated conversations, the more they began to interact with ElliQ unprompted, forming a comradery. Having a social robot in their homes regularly proved to help alleviate their loneliness.