Development of an intrinsic health risk prediction model for camera-based monitoring of older adults living alone.

The number of older adults in Korea is increasing, along with the number of depressed older patients. The causes of depression in older adults include social isolation with negligible interaction with others, irregular nutritional habits, and self-negligence, i.e., they do not engage in any activity. These factors, self-negligence, social isolation, and irregular nutritional habits, are defined as inherent health risks, and in this study, we detected them. These factors can only be derived through long-term monitoring, but the current monitoring system for older adults is severely limited as it focuses only on emergencies, such as "falls." Therefore, in this study, the goal was to perform long-term monitoring using a camera. In order to capture the physical characteristics of the older adults, the ETRI-Activity3D data were used for training, and the skeleton-based action recognition algorithm Posec3d was used. By defining 90 frames as the time taken for one action, we built a monitoring system to enable long-term monitoring of older adult by performing multiple action detection in one video. A reliable monitoring system, with 98% accuracy, 98% precision, 99% recall, and 98% F1, was successfully established for health monitoring of older adults. This older adult monitoring technology is expected to improve the quality of medical services in a medical environment as well as the objective, activities of daily living test, which does not depend on the observer through daily life detection.

The associations between caregivers' psychosocial characteristics and caregivers' depressive symptoms in stroke settings: a cohort study.

BACKGROUND: Studies have found that caregivers can influence stroke survivors' outcomes, such as mortality. It is thus pertinent to identify significant factors associated with caregivers' outcomes. The study objective was to examine the associations between caregivers' psychosocial characteristics and caregivers' depressive symptoms. METHODS: The analysis obtained three-month and one-year post-stroke data from the Singapore Stroke Study, which was collected from hospital settings. Caregivers' depressive symptoms were assessed via the Center for Epidemiologic Studies Depression instrument. Psychosocial characteristics of caregivers included subjective burden (Zarit Burden Interview), quality of care-relationship (a modified 3-item scale from the University of Southern California Longitudinal Study of Three-Generation Families) and expressive social support (an 8-item scale from Pearlin et al.). Mixed effect Tobit regressions were used to examine the associations between these study variables. RESULTS: A total of 214 caregivers of stroke patients hospitalized were included in the final analysis. Most caregivers were Chinese women with secondary school education, unemployed and married to the patients. Caregivers' subjective burden was positively associated with their depressive symptoms (Partial regression coefficient: 0.18, 95% CI 0.11-0.24). Quality of care-relationship (Partial regression coefficient: - 0.35, 95% CI - 0.63 to - 0.06) and expressive social support (partial regression coefficient: - 0.28, 95% CI - 0.37 to - 0.19) were negatively associated with caregivers' depressive symptoms. Caregivers' depressive symptoms were higher at three-month post-stroke than one-year post-stroke (Partial regression coefficient: - 1.00, 95% CI - 1.80 to - 0.20). CONCLUSION: The study identified subjective burden, quality of care-relationship and expressive social support as significantly associated with caregivers' depressive symptoms. Caregivers' communication skills may also play a role in reducing caregivers' depressive symptoms.

Examining the Influence of Social Interactions and Community Resources on Caregivers' Burden in Stroke Settings: A Prospective Cohort Study.

Since the introduction of the integrated care model, understanding how social interactions and community resources can alleviate caregivers' burden is vital to minimizing negative patients' outcomes. This study (n = 214) examined the associations between these factors and caregivers' burden in stroke settings. It used 3-month and 1-year post-stroke data collected from five tertiary hospitals. Subjective and objective caregivers' burdens were measured using Zarit burden interview and Oberst caregiving burden scale respectively. The independent variables examined were quality of care relationship, care management strategies for managing patients' behaviour, family caregiving conflict, formal service usage and assistance to the caregiver. Significant associations were determined using mixed effect modified Poisson regressions. For both types of burden, the scores were slightly higher at 3 months as compared to 1 year. Poorer care-relationship (relative risk: 0.81, 95% confidence interval (CI): 0.70-0.94) and adopting positive care management strategies (relative risk: 1.05, 95% CI: 1.02-1.07) were independently associated with a high subjective burden. Providing assistance to caregivers (relative risk: 2.45, 95% CI: 1.72-3.29) and adopting positive care management strategies (relative risk: 1.03, 95% CI: 1.02-1.04) were independently associated with a high objective burden. Adopting positive care management strategies at 3 months had a significant indirect effect (standardised ß: 0.11, 95% CI: 0.01 to 0.20) on high objective burden at one year. Healthcare providers should be aware that excessive care management strategies and assistance from family members may add to caregivers' burden.

Activity Patterns Associated With Health Status in Later Life Among Singaporeans.

Research on activities overlooks the possibility that older adults engage in different activities contemporaneously. To address this gap, we used latent class analyses to identify activity patterns and then examined demographic and health correlates of these patterns among a nationally representative sample of older adults in Singapore. We identified four classes of activities: the family-focused instrumental activity (FIA) class, the social leisure activity (SLA) class, the multidynamic activity (MDA) class, and the passive activity (PA) class. Furthermore, the MDA members showed higher scores in their mental health. Worse physical functioning and higher depression scores also increased the likelihood of being in the FIA and PA groups. Significant demographics such as gender, ethnicity, marital status, education, employment, house type, and income were related to heterogeneity in older adults' activity patterns. Service providers might consider the impact of certain significant demographic and health-related correlates when planning programs to ensure greater reach and access.

Foreign Domestic Workers and Eldercare in Singapore: Who Hires Them?

In Singapore, policy makers expect families to remain actively involved in the care of their frail older relatives, as manifestly expressed in its Many Helping Hands approach to long-term care. To enable families to fulfill this expectation, the government has enacted policies that encourage the hiring of foreign domestic workers (FDWs) to complement or supplement informal caregiving efforts. Using the Andersen Behavioral Model, we were interested in identifying caregiver and care receiver characteristics that might predict the hiring of FDWs. With data from a convenience sample of 488 informal caregivers, we ran logistic regression regressing the hiring of an FDW on various predisposing, enabling, and need factors. Of interest, enabling factors such as household income, housing type, and educational level were predictive of hiring an FDW in the home. Only one need factor, time spent in caregiving, was predictive of the increased likelihood to hire an FDW. Policies that encourage the marketization of care are likely to favor those with financial means and inadvertently ignore the caregiving burdens of lower income families. In addition, we suggest research and policies to ensure the well-being and protection of FDWs who have become a key component of the long-term care policy and practice in Singapore.

Estimating the prevalence of problem gambling among older adults in Singapore.

This study examined the prevalence rates of problem gambling among older adults in Singapore. A stratified sampling method was used to select the nationally representative sample of 3010 older adults aged 55 years and above. The survey participants were of varying ethnicities living in the community, including Chinese, Malay, and Indian (and others). A structured questionnaire, including the Canadian Problem Gambling Index, gambling attitudes and behaviors, and demographic information was administered face-to-face at participants' homes, using one of the four language versions preferred by the participants. Among those who had gambled lifetime, 69.7% (or weighted population = 39.2%) gambled in the past 12 months and 2.2% (or weighted population = .9%) met the problem gambling criteria. Individuals with problem gambling were likely to have started gambling at an younger age and to have gambled in activities characterized by continuity and no set money limits. Future research should examine changes in gambling behaviors of older adults over time in non-Western societies.

Maximizing a nurturing care style for persons with dementia: a person-centered analysis.

BACKGROUND: Our aim was to structure the configuration of family caregivers' management strategies for the person with dementia (PWD) and to examine factors differentiating caregiving styles. METHODS: Using a latent class analysis on the data (N = 338) collected from an ambulatory dementia clinic of a tertiary hospital and the local Alzheimer association, we classified overall patterns of caregivers' dementia management strategies into three domains: criticism, encouragement, and active management. As determinants related to caregiving style, caregiver sociodemographics, caregiving experience, and health outcomes were tested while controlling for the PWD's characteristics. RESULTS: A hierarchical structure of dementia caregiving style was classified into three groups: passive class (33.24%), authoritarian class (29.12%), and nurturing class (37.65%). Caregiver's marital status, employment, reaction to PWD's memory and behavior problems, sense of competence, and perceived gains from caregiving were significantly associated with the caregiving styles derived. In particular, the authoritarian class perceived higher burden whereas the nurturing class was associated with greater gains. CONCLUSION: A better understanding of caregiver coping and caregiving style is critical to improving care for the PWD. Information on predictive factors related to more constructive coping strategies can be beneficial to design interventions for caregivers. Understanding caregiving styles may thus provide meaningful evidence for more efficient allocation of supportive resources to caregivers caring for the PWD.

The Lay Public's Understanding and Perception of Dementia in a Developed Asian Nation.

BACKGROUND: Early detection of dementia aims to improve treatment outcomes. However, poor perception and understanding of dementia are significant barriers. We aim to investigate the public's perception of dementia and identify variables associated with the different profiles of public perception. METHODS: A custom-designed questionnaire was used to assess laypersons' knowledge and perception of dementia during a health fair at a public hospital in Singapore, a developed Asian nation. Out of a sample of 370 subjects, 32 declined to participate (response rate = 91.4%). Latent class analysis (LCA) was used to identify meaningful subgroups of subjects from significant associations with multiple indicators of dementia awareness. Multinomial logistic regression was performed exploring variables associated with each of the subgroups derived from LCA. RESULTS: The majority of the study participants were female (66.9%), 65 years or older (71.1%), and ethnic Chinese (88.1%). LCA classified the study participants into 3 subgroups: Class 1 (good knowledge, good attitude), Class 2 (good knowledge, poor attitude), and Class 3 (poor knowledge, poor attitude), in proportions of 14.28, 63.83, and 21.88%, respectively. Compared to other classes, participants with good knowledge and good attitude towards dementia (Class 1) were more likely to know someone with dementia and understand the effects of the disease, be married, live in private housing, receive higher monthly income, and not profess belief in Buddhism, Taoism, or Hinduism. CONCLUSION: Our results show that the public in Singapore may not be ready for screening initiatives and early dementia diagnosis. Education efforts should be targeted at lower socioeconomic groups, singles, and those of certain oriental religions.

Gambling behavior and problems among older adults: a systematic review of empirical studies.

OBJECTIVES: With the rapid aging of the population and the increased availability of gambling facilities over the past three decades, older adults may gamble more and may be increasingly at risk for problem gambling (PG) or pathological gambling disorder (PGD). To facilitate a better understanding of gambling behavior among older adults that will inform preventive strategies, this article systematically examined empirical studies on issues related to older adults' gambling. METHOD: This article reviewed 75 empirical studies including data on the distribution and determinants of PG and PGD and the outcomes of gambling. RESULTS: This review used the broad term of "disordered gambling" as a means to explain a continuum of problems caused by PG and PGD. The analyses covered seven topics concerning older adults' gambling behaviors: Participation rates for gambling, prevalence rates of disordered gambling, motivation for initially beginning to gamble, risk and protective factors for disordered gambling, and negative and positive health outcomes from gambling. DISCUSSION: Based on research gaps identified in the review, this article proposes six recommendations for future studies focusing on well-being of older adults who gamble, research method issues, and taking into account older adults' inspirations and adjustment to the aging process in the 21st century.

Understanding patterns of service utilization among informal caregivers of community older adults.

PURPOSE: The article seeks to identify patterns of service utilization among informal caregivers of frail older adults. In particular, the study examined determinants that explain heterogeneous variations in caregivers' service use patterns. METHODS: Using a latent class analysis (LCA) on the 2004 National Long-Term Care Survey and Informal Caregiver data (n = 1,908), this study classifies overall patterns of caregiver service utilization: financial information, support group, respite service, day care or senior center, personal or nursing care, housework, meal delivery, transportation, house modification, and assistive devices. With an emphasis on caregivers' service use patterns and social network derived from the Network Episode Model, the modified Andersen model guides determinants of these patterns. RESULTS: The LCA classified a hierarchical structure of service use patterns: multiple service users, selective in-home service users, and light service users. Caregivers' network compositions signified heterogeneity in service use patterns. Care recipient- and caregiver-related needs contributed to distinguishing service use patterns. IMPLICATIONS: Differentiation of services may be important for meeting caregivers' needs and distributing program resources by identifying target populations for intervention. This typology process may tailor specific interventions to better support caregivers.

An empirical typology of lifetime and current gambling behaviors: association with health status of older adults.

PURPOSE: Despite the low prevalence of gambling problems, older adults experience poorer health status given certain vulnerabilities associated with aging. Thus, we aimed to classify lifetime (LPG) and current (CPG) problem gambling patterns, identify determinants of gambling patterns, and examine their association with current health status. METHODS: Using older adult gamblers (n = 489) in the Gambling Impact and Behavior Study, Latent Class Analysis classified LPG and CPG subgroups based on 10 DSM-IV criteria: preoccupation, tolerance, withdrawal, loss of control, escape, chasing losses, lying, illegal acts, relationship impairment and financial bailout. RESULTS: A two-class solution was the best fitting for LPG and CPG groups. Except for illegal acts, the remaining criteria endorsed the distinguishing patterns. We observed 10.8% LPGs, 8.4% CPGs and 2.2% with both. Participation in religious services was protective of both groups. Gambling for excitement and to win money were related to CPG. Further, CPG was significantly related to worse self-rated health. IMPLICATIONS: Although problem gambling is strongly characterized by number and type of diagnostic criteria, findings support a focus to include targeted assessment of additional clinically meaningful gambling correlates. Research on the moderator of participation in faith-based communities on problem gambling is also warranted.

Structural relationships between social activities and longitudinal trajectories of depression among older adults.

PURPOSE: This study examines the structural relationships between social activities and trajectories of late-life depression. DESIGN AND METHODS: Latent class analysis was used with a nationally representative sample of older adults (N = 5,294) from the Longitudinal Study on Aging II to classify patterns of social activities. A latent growth curve model captured longitudinal changes in depression and tested the impact of social activities while controlling for residential relocation, health status, insurance, and sociodemographics. RESULTS: We found 3 different patterns of participation across 8 social activities. Specific activities of volunteering and exercise, self-perception of social activity level as "enough," and a higher participation level pattern were associated with lower initial status and longitudinal changes in depression. IMPLICATIONS: Assessing involvement in multiple social activities is important when using social activities to prevent and treat depression. Future work with improved measures can further clarify how specific activities may reduce risk for depression.

Who benefits from volunteering? Variations in perceived benefits.

PURPOSE: The purpose of this study was to document the benefits of volunteering perceived by older adults and to explain variation in these self-perceived benefits. DESIGN AND METHODS: This is a quantitative study of 13 volunteer programs and 401 older adults serving in those programs. Program directors completed telephone interviews, and older volunteers completed mailed surveys. Volunteer-level and program-level data were merged. RESULTS: Older volunteers reported a wide variety of benefits to the people they served, themselves, their families, and communities. More than 30% reported that they were "a great deal better off" because of volunteering, and almost 60% identified a benefit to their families. When considering only individual characteristics, lower-income and lower-educated volunteers reported more benefit. Yet, aspects of the volunteer experience, like amount of involvement, adequacy of training and ongoing support, and stipends, were more important in understanding who benefits from volunteering. IMPLICATIONS: These findings suggest that characteristics of volunteer programs can be strengthened to maximize the benefits of volunteering to older adults. These characteristics are more mutable by public policies and organizational procedures than individual characteristics. Focusing on the recruitment of lower socioeconomic status older adults may result in an increase in benefits from the growth of volunteering.

Contribution of residential relocation and lifestyle to the structure of health trajectories.

OBJECTIVE: Underlining ecological theories of aging, we assessed the impact of relocation, residential type, and individual lifestyle factors on the structure of health status overtime. METHODS: From the data of Longitudinal Study on Aging II, we included older adults aged 70 and older (N = 5,294). To analyze individual longitudinal trajectories of health outcomes, Latent Growth Curve Modeling (LGCM) was employed. RESULTS: LGCMs supported that older adults' residential relocation and health-related lifestyles were important in preserving better health outcomes. Multiple structural equations corroborated the causal chains in the multidimensionality of health structure. DISCUSSION: These findings suggest a necessity to design policies for older adults to create a synergy between housing and health care and to translate meaningful health-related lifestyles into diverse long-term care settings.

The quality of medical care for comorbid conditions of depressed elders.

OBJECTIVES: In light of large variation in the quality of medical care, this study assesses the extent to which medical care for depressed elders is consistent with systematic quality standards. METHOD: Using the Donabedian model, we assess factors related to two quality measures: medical service fit and medical provider contact. We assessed 110 depressed older adults with comorbid conditions through practical guidelines of medical services. RESULTS: We found large variation in the quality of medical care and differences between two quality measures. Structure (Medigap insurance and clinical factors) and process factors (medical professional visits, ER visits, and adequacy of informal care) influenced the quality of medical care. CONCLUSION: Emphasizing accuracy in quality measures, quality disparities by medical conditions call attention to the risky population with certain conditions targeted for closer follow-up. Appropriate medical care processes can enhance the quality.

A Latent Class Analysis (LCA) of problem gambling among a sample of community-recruited gamblers.

Problem gambling rates are relatively low (2%-4%), yet these gamblers experience multisystemic negative consequences, high comorbidity, and low treatment utilization. We aimed to characterize variations in gambling patterns to inform prevention and intervention efforts. Using community advertising, we recruited a diverse sample of lifetime gamblers (n = 312) for telephone interviews for a psychometric study of the newly developed Computerized-Gambling Assessment Module. Latent Class Analysis enumerated and classified gambling subgroups by distinctive gambling patterns, based on 8 composite scales functioning as validators of latent class membership (i.e., diagnostic gambling symptoms, reasons for gambling, gambling "withdrawal-like" symptoms, problem gambling perceptions, gambling venues, financial sources for gambling, gambling treatment/help-seeking, and religiosity/spirituality). Based on a distinguishing clustering pattern driven by 6 of 8 factors, we found a 6-class solution was the best-fitting solution. Gambling severity is most strongly characterized not only by symptomatology but also by the number of gambling treatment/help-seeking sources used.