Subjective Aging and Basic Activities of Daily Living: Moderation by Health Care Access and Mediation by Health Care Resources.

Subjective aging in older adults is associated with a decline in basic activities of daily living (bADL), although this is less well studied with increasing age cohorts by their healthcare resources (HCR) and healthcare access (HCA) controlling for sociodemographics. We aimed to address this gap in knowledge by analyzing the National Health and Aging Trends round 11 data set on 3303 older adults aged 70 to above 90, comprising 42% male and 58% female by age cohort (middle-old -70-79, n = 1409; older-old -80-89, n = 1432, oldest-old- 90 plus, n = 462). Results of mediation-moderation analysis show the subjective aging whole model comprising subjective cognitive decline, HCR, HCA, and sociodemographic to predict a decline in bADL with increasing age to be higher among the older-old age (80-89) compared to the middle-old age (70-79) or oldest-old (90 years +) cohorts. These findings suggest a "doughnut" effect by which the older-old age cohort of 80-89 may be coping less well with their bADL, while the oldest-old may have adapted to functional loss in their everyday living and/or comprises adults who may have passed a mortality selection despite a more significant burden of comorbidity.

Social networking older adults with mild cognitive impairment: Systematic review protocol on their use of information and communication technology.

This systematic review will identify and synthesize the emerging evidence on older adults with Mild Cognitive Impairment (MCI) utilizing Information and Communication Technology (ICT) to maintain, restore, or augment social networks. The systematic review will consider the evidence on contextual and personal factors of older adults with MCI and their ICT use for social connectedness. The evidence searches will be implemented in PsycINFO, Academic Search Complete, Medline, PubMed, and manual searches. We shall review articles that were published between January 2010 and October 2023 in English and on Information and Communication Technology utility in social networking among older adults with MCI. The process of article selection will be conducted through title screening, abstract screening; and full article screening, following the Population, Intervention, Control, Outcomes (PICO) criteria. Given that all the studies included in this review are publicly accessible and have already obtained ethical approval from their respective institutions, there is no obligation for us to seek additional ethical clearance for our systematic review. We plan to share the outcomes of the systematic review through online presentations and dissemination within the research community. The findings from this review will identify the extent of empirical evidence on older adults with MCI utilizing ICTs to maintain, restore or augment their social networks. This review will provide evidence for contextual and personal factors in older adults with MCI for the social networks with ICT use. This review will propose practical implications for the effective utilization of ICT by older adults with MCI.

Systematic Review: HIV, Aging, and Housing-A North American Perspective, 2012-2023.

Advances in anti-retroviral therapy (ART) have decreased mortality rates and subsequently led to a rise in the number of HIV-positive people living longer. The housing experiences of this new population of interest-older adults (50 years and older) living with HIV-are under-researched. Understanding the housing experiences and unmet needs of older people with HIV can better provide comprehensive care services for them. This study's systematic review evaluated the peer-reviewed literature reporting housing access/insecurity/assistance/options, housing impact, and unmet needs of older individuals living with HIV in North America from 2012 to 2023. Furthermore, Latent Semantic Analysis (LSA), a text-mining technique, and Singular Value Decomposition (SVD) for text clustering were utilized to examine unstructured data from the abstracts selected from the review. The goal was to allow for a better understanding of the relationships between terms in the articles and the identification of emerging public health key themes affecting older adults living with HIV. The results of text clustering yielded two clusters focusing on (1) improvements to housing and healthcare services access and policies and (2) unmet needs-social support, mental health, finance, food, and sexuality insecurities. Topic modeling demonstrated four topics, which we themed to represent (1) a holistic care approach; (2) insecurities-food, financial, sexuality, and other basic needs; (3) access to housing and treatment/care; and (4) homelessness and HIV-related health outcomes. Stable housing, food, and healthcare services access and availability are critical elements to incorporating comprehensive, holistic healthcare for older adults living with HIV. The aging population requires high-priority policies for accessible and equitable healthcare. Clinicians and policymakers should address individual barriers, adopt a patient-centered approach, increase doctor visits, provide competency training, ensure long-term follow-up, involve families, and improve patient education in care management, contributing to HIV/AIDS geriatric care models.

The Role of Technology in Online Health Communities: A Study of Information-Seeking Behavior.

This study significantly contributes to both theory and practice by providing valuable insights into the role and value of healthcare in the context of online health communities. This study highlights the increasing dependence of patients and their families on online sources for health information and the potential of technology to support individuals with health information needs. This study develops a theoretical framework by analyzing data from a cross-sectional survey using partial least squares structural equation modeling and multi-group and importance-performance map analysis. The findings of this study identify the most beneficial technology-related issues, like ease of site navigation and interaction with other online members, which have important implications for the development and management of online health communities. Healthcare professionals can also use this information to disseminate relevant information to those with chronic illnesses effectively. This study recommends proactive engagement between forum admins and participants to improve technology use and interaction, highlighting the benefits of guidelines for effective technology use to enhance users' information-seeking processes. Overall, this study's significant contribution lies in its identification of factors that aid online health community participants in the information-seeking process, providing valuable information to professionals on using technology to disseminate information relevant to chronic illnesses like COPD.

Social Connectedness Resource Preferences of Older Adults in Assisted Living: A Scoping Review Based on the WHO-ICF Framework.

The current scoping review identified emerging evidence on social connectedness resource preferences of older adults in assisted living facilities (ALFs) and the community. A literature search was performed using several databases. We included review articles published between January 2000 and September 2022 in English and related to social connectedness resources in ALFs and the community. Of 134 titles and abstracts, eight studies were included. Study participants comprised 2,482 older adults from 233 ALFs in the United States. Themes were framed using the World Health Organization's International Classification of Functioning, Disability, and Health. For social activities, older adults preferred facility-based recreation and leisure resources. For community social connectedness, residents preferred participation in civic life activities. Participants of older age preferred facility resources, whereas those of younger age preferred more demanding physical activities. Those from larger enrollment facilities preferred facility-based resources compared to community resources. For moderately and less active residents, participation was limited to less demanding activities. Older adults' preferences varied based on age, physical limitations, and size and location of the facility. Findings suggest opportunities for further research on developing ALF- and community-based resources for older adults' social well-being and quality of life. [Journal of Gerontological Nursing, 49(9), 35-42.].

The Role of Physical Activity and Community Engagement in Understanding Mental Health Among Community-Dwelling Seniors.

Caregivers and health practitioners are often looking for good intervention techniques to help community-living older adults to improve their mental health. This study examined the relationship between physical activity and community engagement and their effect on mental well-being among older men and women. Data from National Health and Aging Trends Study from the years 2018 to 2020 were used to explore and test the posited relationships. Partial least-squares structural equation modeling was used to test the developed model that focused on the relationships among physical activity and mental well-being when controlling for demographics in older adults. Social interactions added importance to well-being among older men and women. Physical activity factors and community engagement all together have a positive impact on an older adults' mental well-being. This study provides statistically significant empirical evidence that older adults who are physically active and involved in the community exhibit greater mental well-being than those who isolate themselves.

Dementia and COVID-19 among Older African American Adults: A Scoping Review of Healthcare Access and Resources.

African American/Black communities comprise 12.2% of the U.S. population, with a COVID-19 infection rate of more than 18% and marginal access to healthcare services. This scoping review synthesizes the emerging evidence on healthcare accessibility among older African American adult communities with dementia and COVID-19, as well as the resource requirements for this population during the pandemic. Searches of different databases for empirical studies and other sources on dementia and COVID-19 among older African American adults yielded 13 studies that met the following inclusion criteria: (a) focus on dementia and COVID-19, (b) sampled older African American adults, (c) investigated healthcare accessibility and resources, and (d) published between 2019 and 2022. Following the initial selection of the studies, eight were selected for relevance based on the Population, Concept, and Context (PCC) inclusion and exclusion criteria. Thematic analysis indicated that older African Americans with dementia and COVID-19 experienced longer delays in accessing timely healthcare, including transportation, intensive care units (ICUs), and mechanical ventilation. They also had reduced healthcare resources associated with a lack of health insurance, low financial resources, and an increased length of hospital stay, which further aggravated the negative effects of comorbid dementia and COVID-19 infections. Evidence showed that racial and age disparities affected older African American adults with dementia and COVID-19, resulting in lower healthcare access and marginal resources. This is consistent with historical and systemic inequities in meeting the healthcare needs of people of color in the United States, which was compounded for older African Americans during the COVID-19 pandemic.

Subjective Functional Difficulties and Subjective Cognitive Decline in Older-Age Adults: Moderation by Age Cohorts and Mediation by Mentally Unhealthy Days.

Background and Objectives: Despite the expected positive association between subjective functional difficulties (SFD) and subjective cognitive decline (SCD), their mediation by mentally unhealthy days (MUDs) is under-studied. Moreover, few SCD studies have examined affective reactivity to functional difficulties by age cohort. This study examined the mediation effect of MUDs on the association between SFD and SCD by age cohorts' moderation among older adults. Methods: Using a cross-sectional design approach, we used the 2019 BRFSS dataset on 13,377 older adults aged 65 to ≥80 (44% males and 56% females). Results: The bias-corrected percentile bootstrap with 5000 samplings revealed that MUDs partially mediate the relationship between SFD and SCD (14.12% mediation effect), controlling depressive symptoms, education, income levels, and race. Age cohorts moderated the relationship between SFD and SCD and between SFD and SCD but not between MUDs and SCD. The predictive effects of the path from SFD to MUDs and from MUDs to SCD were stronger in the younger-old (65-69) than the middle-old (70-79) and oldest-old (≥80) age cohorts. Worse SCD was associated with being Asian, in female older adults, and in those with lower education and income levels. Conclusions: These findings extend the chronic stress theory predictions that accentuated emotional vulnerability to subjective functional difficulties may magnify SCD, particularly in the younger-old age group. By implication, preventive SCD interventions should seek to support younger-old adults in their activities of daily life for successful aging transitioning into older-age cohorts.

Addressing Health Disparities in Public Health Through the Application of Data Science Software in the Last 5 Years: A Preferred Reporting Items for Structured Review and Meta-Analyses Structured Review.

The application of data science resources can enhance our ability to reduce health disparities affecting communities across the country. In this paper, we use the Preferred Reporting Items for Structured Review and Meta-Analyses methodology to conduct a thematic analysis of selected studies and identify micro and macro themes within the literature. The authors of this analysis reviewed articles that included data science software applications and their role in focusing efforts to address health disparities affecting the health of citizens in specific communities across the country. Abstracts were reviewed for research relevance after duplicates were removed, and documents were eliminated from consideration during the screening based on the exclusion criteria. At the conclusion of the structured literature review, the results emphasized the strong utility of geographically directed assessment. This highlights the need for the integration of geo- and statistical methodologies in the use of data science software for healthcare applications, which can be a useful means to identify locations where health disparities are present and can focus efforts to resolve these health disparities. Nurses, physicians, and health educators can be dispatched to the geographical areas where health disparities are most prevalent.

Subjective Aging Difficulties among Older Adults with Subjective Cognitive Decline.

In older adults, subjective cognitive decline (SCD) may progress to an early stage of dementia. Yet, its association with subjective daily functional difficulties in aging is less well studied by experiences of mentally unhealthy days (MUDs). Employing a cross-sectional design approach, we analyzed the Behavioral Risk Factor Surveillance System dataset on 7429 older adults with SCD (aged 65 to >80, 45% males, 55% females) to explore SCD in instrumental daily activities of living (SCD-IADLs) and healthcare access mediation by MUDs and moderated mediation by age cohort, controlling gender and education. The bias-corrected percentile bootstrap with 5000 samplings revealed that MUDs partially mediate the relationship between SCD-IADLs and healthcare access, with a 28.2% mediating effect. Age cohort moderated the relationship between healthcare access and MUDs, MUDs and SCD-IADLs. Specifically, the predictive effects from healthcare access to MUDs and MUDs to SCD-IADLs were more profound in the 70-74 age cohort.

Framing of COVID-19 in Newspapers: A Perspective from the US-Mexico Border.

The degree to which the media report a health emergency affects the seriousness with which the people respond to combat the health crisis. Engagement from local newspapers in the US has received scant scrutiny, even though there is a sizable body of scholarship on the analysis of COVID-19 news. We fill this void by focusing on the Rio Grande Valley area of the US-Mexico border. To understand the differences, we compared such local news coverage with the coverage of a national news outlet. After collecting the relevant news articles, we used sentiment analysis, rapid automatic keyword extraction (RAKE), and co-occurrence network analysis to examine the main themes and sentiments of COVID-19 news articles. The RAKE identified that county-specific news or local regulations are more prevalent among the key terms in The Monitor which are absent in USA Today. The co-occurrence network shows the coverage of the disruption of sports season in USA Today which is not present in The Monitor. The sentiment analysis presents fear emotion is more dominant in USA Today, but trust emotion becomes more prevalent in The Monitor news coverage. These findings show us that, although the subject of the health emergency is the same, local and national newspapers describe it in different ways, and the sentiments they convey are also not the same.

Insights into the antecedents of cyberchondria: a perspective from the USA.

This study establishes a theoretical framework for assessing antecedents of cyberchondria, which is a process of amplified anxiety about one's health because of excessive online health information seeking. We examined the framework through partial least squares structural equation modeling after collecting data through a cross-sectional online survey. This research contributes to the literature by (i) evaluating the roles of health anxiety (HA) and affective responses (AR) on cyberchondria; (ii) equipping health strategists with understanding about ways to tailor their educational and communication strategies to specific segments by importance-performance map analysis and necessary condition analysis. Finally, by (iii) providing strategic tactics to curb cyberchondria so that it becomes possible to attain a better patient outcome. Findings suggest that the existing association between intolerance of uncertainty and cyberchondria is serially mediated by HA and AR. For healthcare educators and practitioners, the findings of this research deliver a blueprint for effectively controlling cyberchondria.

Daily Living Subjective Cognitive Decline Indicators in Older Adults with Depressive Symptoms: A Scoping Review and Categorization Using Classification of Functioning, Disability, and Health (ICF).

(1) Background: This scoping review identifies subjective cognitive decline (SCD) indicators in ADLs and instrumental activities of daily living (IADLs) in older adults with depressive symptoms using the WHO International Classification of Functioning, Disability, and Health (ICF). (2) Methods: We searched Medline via Ebscohost, Pubmed, and PsycINFO for articles published on activities of daily living (ADL) indicators of SCD in older adults with depressive symptoms, published in English language journals from January 2011 to November 2021. Following the flow diagram, 2032 titles and abstracts were screened for relevance based on the Population, Concept, and Context inclusion and exclusion criteria. (3) Results: Eight articles provided evidence about the ADL indicators of SCD in older adults with depressive symptoms. The analysis yielded indicators based on low and high cognitively demanding tasks assessed on five different scales. Framed on the ICF categorization and coding system, the SCD-ADL indicators are personal care, mobility, and general tasks and demands; SCD-IADL indicators are mobility, general tasks and demands, learning and applying knowledge, domestic life, communication, major life areas, and community, social, and civic life. (4) Conclusion: Highly cognitively demanding activities present more difficulties for individuals with SCD, making IADLs a stronger predictor of SCD than ADLs.

Mechanisms of Social Interaction and Virtual Connections as Strong Predictors of Wellbeing of Older Adults.

Socially engaged older adults are less likely to decline in health and happiness and have a higher quality of life. Building upon this premise, examination was conducted on the domains of social determinants of health, specifically the social and community context per Healthy People 2030 objectives. These mechanisms of social interaction, in the form of group activities, community engagement, and virtual interactions via email or text message, were assessed using hierarchical regression analysis to find out their association with wellbeing, depression symptoms, and cognition of older adults. The data included a total of 4623 sample of older adults from the National Health and Aging Trend Study (NHATS) Round 8. The results showed that social support explained a 40.3% unique variance on wellbeing. The use of text message and email had a moderating effect on community engagement and self-reported depression level in older adults. Findings suggest that community programs, shared group activities, or technology training workshops can improve social interaction and support cognition and reduce depression in older adults. Directions for future research include examining human behaviors and perceptions and increasing technology training sessions to promote independence of older adults and increase their social connections. In addition, participant involvement in interventions would enhance the possibility of success of such endeavors.

The use of digital technology for social wellbeing reduces social isolation in older adults: A systematic review.

This systematic review emphasizes the need for technology use in older adults to reduce social isolation. With the advancement of technology over the years, the effectiveness of interventions based on its use can be examined to see how these can address the problem of social isolation and enhance social wellbeing. We focus on identifying how older adults can most benefit from affordable and accessible technology use and how the training and implementation of such interventions can be tailored to maximize their beneficial effect. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to select relevant studies. We analyzed 25 articles, performed a narrative analysis to identify themes, and quality of life indicators connected to technology use and wellbeing. Engagement of older adults at the community-level, following best practices from the Community-Based Participatory Research can facilitate effective practices to deliver technology based social isolation interventions and increase digital use self-efficacy in older adults. Mobile technology-based applications not only help families to stay connected, but also link older adults to resources in healthcare and encourage physical and mental well-being. Use of technology devices address cognitive, visual, and hearing needs, and increase digital use self-efficacy in older adults, particularly helpful during necessary social distancing or self-quarantine during the COVID-19 pandemic.

Exploring the factors in information seeking behavior: a perspective from multinational COPD online forums.

This research establishes a theoretical framework for evaluating antecedents of the information seeking behaviors of online forum participants with chronic obstructive pulmonary disease (COPD). We evaluated the proposed framework using partial least squares structural equation modeling (PLS-SEM) after gathering data using a cross-sectional survey. We subsequently assessed the framework using importance-performance map analysis (IPMA). Findings suggest that perceived ease of use does not singularly influence COPD forum users' information seeking behavior. IPMA analysis reveals that the opportunity to interact with other forum members creates the greatest impact on COPD forum users' mindsets, among all the indicators. For healthcare professionals, the results of this study provide a blueprint in terms of utilizing COPD online forums to foster recurrent associations among forum administrators and users and by creating a strong social and informational resource for COPD information seekers.

Ninety to Nothing: a PDSA quality improvement project.

Purpose The purpose of this paper is to present a case study of a successful quality improvement project in an acute care hospital focused on reducing the time of the total patient visit in the emergency department. Design/methodology/approach A multidisciplinary quality improvement team, using the PDSA (Plan, Do, Study, Act) Cycle, analyzed the emergency department care delivery process and sequentially made process improvements that contributed to project success. Findings The average turnaround time goal of 90 minutes or less per visit was achieved in four months, and the organization enjoyed significant collateral benefits both internal to the organization and for its customers. Practical implications This successful PDSA process can be duplicated by healthcare organizations of all sizes seeking to improve a process related to timely, high-quality patient care delivery. Originality/value Extended wait time in hospital emergency departments is a universal problem in the USA that reduces the quality of the customer experience and that delays necessary patient care. This case study demonstrates that a structured quality improvement process implemented by a multidisciplinary team with the authority to make necessary process changes can successfully redefine the norm.

Quantitative comparison of measurements of urgent care service quality.

Service quality and patient satisfaction are essential to health care organization success. Parasuraman, Zeithaml, and Berry introduced SERVQUAL, a prominent service quality measure not yet applied to urgent care. We develop an instrument to measure perceived service quality and identify the determinants of patient satisfaction/ behavioral intentions. We examine the relationships among perceived service quality, patient satisfaction and behavioral intentions, and demonstrate that urgent care service quality is not equivalent using measures of perceptions only, differences of expectations minus perceptions, ratio of perceptions to expectations, and the log of the ratio. Perceptions provide the best measure of urgent care service quality.

Quantitative comparisons of urgent care service providers.

PURPOSE: The purpose of this paper is to develop, validate, and use a survey instrument to measure and compare the perceived quality of three types of US urgent care (UC) service providers: hospital emergency rooms, urgent care centres (UCC), and primary care physician offices. DESIGN/METHODOLOGY/APPROACH: This study develops, validates, and uses a survey instrument to measure/compare differences in perceived service quality among three types of UC service providers. Six dimensions measured the components of service quality: tangibles, professionalism, interaction, accessibility, efficiency, and technical quality. FINDINGS: Primary care physicians' offices scored higher for service quality and perceived value, followed by UCC. Hospital emergency rooms scored lower in both quality and perceived value. No significant difference was identified between UCC and primary care physicians across all the perspectives, except for interactions. RESEARCH LIMITATIONS/IMPLICATIONS: The homogenous nature of the sample population (college students), and the fact that the respondents were recruited from a single university limits the generalizability of the findings. PRACTICAL IMPLICATIONS: The patient's choice of a health care provider influences not only the continuity of the care that he or she receives, but compliance with a medical regime, and the evolution of the health care landscape. SOCIAL IMPLICATIONS: This work contributes to the understanding of how to provide cost effective and efficient UC services. ORIGINALITY/VALUE: This study developed and validated a survey instrument to measure/compare six dimensions of service quality for three types of UC service providers. The authors provide valuable data for UC service providers seeking to improve patient perceptions of service quality.

Social media: the key to health information access for 18- to 30-year-old college students.

This work examines where 18- to 30-year-old college students seek health information on the Internet and how they determine site and message credibility. Using a qualitative methodology, five focus groups were conducted with 18- to 30-year-old college students, and transcripts were analyzed with MaxQDA text analysis software. The study revealed that 18- to 30-year-old college students have Internet health information source preferences, reasons for seeking health information on the Internet, and message design factors that improve their perception of site and message credibility. We conclude that the Internet and social media show great promise as effective health communication channels for 18- to 30-year-old college students and confirm that preferred Internet/social media sites can be utilized by health educators to present important risk management/disease prevention information to 18- to 30-year-old college students. In addition, message design factors can lend credibility to both sites and the health information delivered there.