BackgroundMemory impairment and depressive symptoms are common in aging adults, often leading to adverse health outcomes. While memory difficulties are strongly associated with depressive symptoms, whether functional social support mediates this relation is underexplored.ObjectiveWe examined the mediating role of functional social support and assessed moderated mediation by age group and sex. Analyses were adjusted for relevant sociodemographic, health, and lifestyle covariates.MethodsWe utilized three timepoints of data (baseline, 3-year follow-up, and 6-year follow-up) from 5,958 participants aged 45-85 years who were enrolled in the Canadian Longitudinal Study on Aging's Tracking Cohort.ResultsFunctional social support partially mediated the inverse association between memory and depressive symptoms (β^abpath = -0.02; β^c-primepath = -0.07; β^cpath = -0.08; all p < .05; proportion mediated = 0.25). We did not observe any moderated mediation. Interventions to enhance functional social support may strengthen the inverse association between memory and depressive symptoms.
Numerous papers in the "Reconstructing Person-Centeredness" supplement of the Journal of Applied Gerontology reference the perceived relationship between person-centeredness and quality dementia care, from fostering meaningful relationships and individualizing care, to practical applications of shared decision making and co-design of technologies and research measures. This article draws upon reflections from members of the Alzheimer's Association Early Stage Advisory Group regarding person-centeredness and quality dementia care. Their experiences, beliefs, and perspectives provide lived examples and context to three cross-cutting topics discussed throughout the supplement: relationships as underlying person-centeredness, the role of person-centered care in long-term and other healthcare settings, and person-centeredness and technology. By bridging first-hand narratives with academic inquiry, this article adds context to other papers in this supplement, and addresses the importance of person-centered dementia care from the perspective of those living with dementia.
BackgroundNo tool exists to assess whether research measures themselves are consistent with principles of person-centeredness.ObjectiveThis project developed a tool to assess the extent of person-centeredness employed in the development, content, and application of research measure development in the context of measures relevant to persons living with dementia and/or their caregivers.MethodsLiterature review and expert input informed the development of the tool; pilot testing assessed interrater reliability and rater acceptability.ResultsThe tool includes six criteria (each with three subcategories): Co-Creation, Accommodation, Incorporation, Biopsychosocial-Cultural Components, Pragmatism, and Systemic Focus. Kappa agreement was substantial or better (0.61-1.00) for most (16/18) subcategories and for all six criteria (0.74-1.00). Raters found the tool easy to understand and score and the criteria to be relevant and complete.ConclusionsThe resulting tool-named the Person-Centered Measure Evaluation Tool (PC-MET)-can reliably critique existing measures and guide the development of new measures.
Person-centeredness first emerged as a concept in dementia care in the 1980s. Nearly 40 years later, it has no universal definition, which limits operationalization and implementation of care and supportive services, measures, interventions, policy, and regulation for people with dementia. Thus, a scoping review of the current definitions of person-centeredness in US dementia care was conducted. Of the 71 included studies, there was considerable variability in elements/themes, complexity, and cited theories; the most common themes were needs and preferences, relationships, and personhood, all of which were present in at least half of the studies' definitions. Importantly, more than 150 articles that were reviewed did not contain a definition, despite including the term in their titles or abstracts. Further investigation in pursuit of a more nuanced conceptualization of person-centeredness that includes these key themes, while also addressing concerns about applicability to diverse cultures and contexts (e.g., organizations and systems), is recommended.
Singapore's rapidly aging population presents significant challenges for healthcare planning and long-term care provision. This study applies ARIMA time-series modeling to forecast the number of older adults in assisted living facilities between 2025 and 2035. Using historical population data, nursing home residency figures, and simulated indicators of disability and living arrangements, the model projects assisted living demand rising from 19,741 individuals in 2025 to 29,443 in 2035-a 49.2% increase. While forecasts are conservative due to reliance on informal care from family members and foreign domestic helpers, structural shifts such as smaller family sizes and reduced caregiver availability may drive demand higher. The methodology highlights the importance of accounting for disability prevalence and informal care. Findings underscore the need for strategic planning to expand assisted living infrastructure, workforce capacity, and planning frameworks. Singapore's case contributes to global literature by illustrating aging trajectories relevant to other developed societies.
BackgroundOlder U.S. veterans (≥65) experience disproportionately high rates of social isolation and loneliness, yet veteran-specific risk and protective factors remain underexamined.ObjectiveTo synthesize research on social isolation and loneliness among community-dwelling US veterans aged 65+, using the Social Connection Framework to identify structural, functional, and quality-based factors with implications for clinical practice and applied gerontology research.MethodsGuided by PRISMA-ScR, the review searched three databases (2004-2025), screened 6,835 articles, and peer-reviewed studies assessed social isolation or loneliness among veterans aged ≥65. Thirty-two studies met the inclusion criteria.ResultsMost studies examined a single domain: structural (38%), functional (34%), or quality (19%). Structural indicators reflected limited engagement and smaller networks. Functional factors emphasized perceived support and emotional trust. Quality factors aligned with wellbeing. Depression, anxiety, and PTSD were more common with low integration, whereas resilience aligned with emotional ties and perceived inclusion.
BackgroundDigital inclusion in later life is often measured as static user/non-user status, although older adults may enter, remain in, remain outside, or leave digital environments.ObjectiveTo examine whether digital-use transitions, particularly discontinuation, mark cognitive and depressive vulnerability.MethodsWe analyzed harmonized longitudinal data from CHARLS, ELSA, HRS, and SHARE. Adjacent-wave internet-use transitions were classified as persistent non-use, adoption, persistent use, or discontinuation. Cohort-specific forward, reverse, pre-transition, and marker analyses were pooled with random-effects methods where appropriate.ResultsAcross 250,379 transition intervals, discontinuation was preceded by lower cognition and more depressive symptoms, and was associated with lower subsequent cognition (β = -0.145) and higher depressive symptoms (β = 0.094) than sustained use. Adoption was associated with higher cognition and, on average, fewer depressive symptoms than persistent non-use. Baseline vulnerability predicted lower adoption and higher discontinuation. Adding discontinuation to baseline risk models produced only small gains in discrimination.
BackgroundEvidence on family caregivers of people with dementia in rural and remote areas remains limited, and burden levels and associated factors lack systematic quantitative synthesis.ObjectiveTo synthesize burden and associated factors.MethodsNine databases were searched through November 2025 following PRISMA. Quality was appraised with the Joanna Briggs Institute checklist. Comparable data were meta-analyzed; others were narratively synthesized.ResultsTwelve studies involving 1,416 caregivers were included. Pooled mean scores were 45.19 for the 22-item Zarit Burden Interview (95% CI 29.49-60.89) and 19.90 for the 12-item version (95% CI 12.98-26.82). Burden was associated with behavioral and psychological symptoms of dementia (r = 0.44, 95% CI 0.16-0.65), poorer caregiver mental health (r = 0.48, 95% CI 0.38-0.56), and longer dementia or caregiving duration (r = 0.29, 95% CI 0.13-0.43). Narrative synthesis implicated functional impairment, greater caregiving demands, lower self-efficacy, and economic disadvantage. Despite low-to-very-low certainty, findings indicate substantial, multifactorial burden and prioritize caregiver support.PROSPEROCRD420261277658.
ObjectiveEarly Alzheimer's disease (AD) is currently diagnosed using costly and invasive biomarkers. The Famous Faces Test (FFT) may detect (subtle) cognitive impairment earlier than standard neuropsychological tests. This review aimed to identify methodological variation across FFTs and evaluate their ability to detect early AD.MethodsFollowing PRISMA guidelines, four databases were searched. Studies were included if an FFT was used, participants were older adults or on the AD-continuum, cognitive performance-based data were reported, and the paper was a journal article or dissertation. Extracted information was clustered into stimulus characteristics, performance assessment, and participant characteristics.Results39 of 550 records met the inclusion criteria. Methodological heterogeneity was substantial. FFT performance was predominantly lower in AD-continuum individuals than in controls.ConclusionRecommendations for future studies using an FFT are provided, and evidence supporting its potential clinical sensitivity is reviewed. Longitudinal studies are needed to establish its utility in detecting early AD.
BackgroundLongitudinal evidence on frailty and subsequent arthritis in China is limited.MethodsWe analyzed 4,615 adults aged ≥45 years from the China Health and Retirement Longitudinal Study (2011-2020), excluding those with baseline physician-diagnosed arthritis. Multivariable logistic regression assessed associations of baseline pre-frailty and frailty with arthritis at follow-up. Sensitivity, discrimination, and exploratory subgroup analyses were performed.ResultsAt follow-up, 1,219 participants (26.4%) reported arthritis. Compared with robust participants, pre-frail (OR = 1.35, 95% CI: 1.14-1.59) and frail participants (OR = 1.63, 95% CI: 1.04-2.55) had higher odds of arthritis. Findings remained directionally consistent in sensitivity analyses. Adding frailty modestly improved discrimination (AUC: 0.588 vs. 0.599; ΔAUC = 0.011; P = 0.017). No interaction remained significant after multiple-testing correction.ConclusionPre-frailty and frailty were associated with higher odds of arthritis after 9 years, supporting frailty as a potential longitudinal risk marker, although its incremental discriminatory value was limited.
BackgroundSupporting people with dementia to live well at home requires balancing safety with emotional well-being. Although home modifications are promoted to enhance independence, their implications for subjective well-being remain unclear.ObjectiveThis study examined associations between home modifications, caregiving duration, and subjective well-being among community-dwelling older adults with dementia, informed by the Ecological Theory of Aging.MethodsUsing data from five NHATS waves (2015-2019), we conducted pooled cross-sectional regression analyses using repeated person-wave observations (N = 340 individuals; mostly 70-84 years, 54% women). Regression models assessed associations between home modifications, caregiving duration, and subjective well-being, including self-efficacy and positive affect.ResultsHome modifications were associated with lower levels of both self-efficacy and positive affect. Longer caregiving duration attenuated the negative association between home modifications and positive affect. Findings highlight that physical and social environments jointly shape adaptation experiences, underscoring the need for personalized, dignity-preserving dementia care.
BackgroundAdult day services (ADS) provide care and social support for adults with complex health needs, yet they remain an understudied long-term care sector whose impact on patient outcomes is unclear.ObjectiveTo inform an updated research agenda that supports a coordinated approach to measuring impact of ADS and gaps in services in an evolving policy landscape.MethodsWe convened 32 stakeholders in partnership with the National Adult Day Services Association. Following a pre-convening evidence review, a facilitated discussion took place. Rapid qualitative synthesis of notes was used to identify themes and consensus priorities.ResultsParticipants' priority was strengthening data infrastructure. They wished to leverage data to identify workforce shortages, implement evidence-based interventions, advance policymaker understanding of ADS, and address uneven reimbursements. The agenda prioritizes standardizing outcome measures, supporting workforce capacity, and translating research into policy. These stakeholder-informed priorities can guide research and policy to demonstrate impact and expand access to ADS.
Background Tobacco and cannabis co-use prevalence is rising, with older adults disproportionately impacted. Objective Assess tobacco and cannabis co-use by health and sociodemographic characteristics among adults 65+ years. Methods Using National Survey on Drug Use and Health nationally representative data (2021-2023), we estimated past-month tobacco and cannabis co-use prevalence among adults 65+ years ( N = 15,672). Multinomial logistic regressions examined associations between health and sociodemographic characteristics with past-month co-use, tobacco-only use, and cannabis-only use (vs. former use). Results One in six reported past-month use of either cannabis or tobacco (1.7% co-used). More chronic disease diagnoses was associated with lower co-use (e.g., one vs. none: adjusted relative risk ratio [aRRR] = 0.47). Co-use was higher among people with worse self-rated health (e.g., fair/poor vs. excellent/very good: aRRR = 2.73) and past-year mental illness (aRRR = 2.07). Conclusions Clinicians working with older adults should account for cannabis co-use in tobacco cessation and disseminate evidence-based cannabis information.
This study explored how immigrant family caregivers support older immigrant adults with limited English proficiency (LEP) in using primary and preventive care and how these roles shape caregivers’ lives. A qualitative phenomenological study was conducted with 32 immigrant family caregivers of older adults with LEP in the United States, purposively recruited from prior LEP-focused studies. Participants completed one interview, and data were analyzed using an interpretative phenomenological, descriptive thematic approach. Caregivers described extensive, often invisible work as decisionmakers, system navigators, interpreters, cultural brokers, and emotional and transportation support, frequently conflicting with employment and family obligations and contributing to strain, anxiety, depressive symptoms, and ambivalence about parents’ migration. Repeated communication problems and perceived disrespect fostered mistrust of healthcare institutions, shaping preventive care engagement. Immigrant family caregivers act as pivotal intermediaries who compensate for structural language and access barriers, underscoring the need for language-concordant, culturally responsive, caregiver-inclusive services and stronger work–care supports.
Background Family caregivers of persons living with dementia (PLWD) often experience significant psychological, financial, and social stress, increasing their risk for both mental and physical health problems. Objective This study examined factors associated with caregivers’ perceived pain in the context of dementia care. Methods This was cross-sectional study using baseline data from a dyadic clinical trial evaluating a behavioral sleep intervention for PLWD and their family caregivers. A total of 148 caregivers were included in the analytic sample. Descriptive statistics, bivariate analyses, and hierarchical linear regression were used to identify caregiver- and care recipient-related factors associated with caregiver pain. Results Most caregivers (84%) reported pain in the past week. In the final regression model, lower education, greater caregiver comorbidity, and poorer caregiver sleep quality independently predicted higher pain, explaining 30.6% of the variance and highlighting key caregiver health factors linked to pain.
BackgroundThe shortage of geriatric specialists in the United States has increased reliance on primary care providers to diagnose and manage dementia, yet many lack adequate training in geriatric care.ObjectivesTo examine how dementia and geriatric-focused Extension for Community Healthcare Outcomes (ECHO) programs influence provider knowledge, confidence, and clinical skills.MethodsA scoping review was conducted using PubMed, Google Scholar, and PsycINFO to identify studies published between 2015 and 2025. Eligible studies were based in the United States and reported provider level outcomes. Data were extracted from nine eligible studies and analyzed thematically.ResultsParticipation in ECHO programs was consistently associated with self-reported increases in provider knowledge of dementia diagnosis and management, greater perceived confidence in caring for older adults, and enhanced subjective communication and clinical skills. Several studies reported improvements in clinical decision-making, prescribing patterns, and interprofessional collaboration, though sustained practice change and patient-level outcomes remains infrequently documented.
Residential environments are critical factors influencing activity participation among older adults with disabilities. We examined whether living in senior housing (i.e., retirement communities or independent living) is associated with participation in social and physical activities and whether this association varies by perceived social cohesion. Data came from 3317 respondents in the 2019 National Health and Aging Trends Study who reported difficulty with self-care, mobility, or household tasks. Weighted logistic regression models showed that senior housing residents were more likely to participate in organized social events (OR = 1.45, p = .023) and physical activities (OR = 1.84, p = .001) than traditional housing residents, with no significant differences in volunteering or going out for enjoyment. Senior housing residents were more likely to participate in organized social events when they perceived higher social cohesion (OR = 2.69, p = .002). Findings highlight that senior housing may support activity engagement among older adults with disabilities, with social cohesion further facilitating participation in organized events.
The need for long-term care (LTC) services in Canada is growing, making it increasingly important to recruit and retain staff in LTC homes. Existing research has revealed a significant link between job satisfaction and intention to leave, making this a critical area of study to inform the development of effective policy interventions. This paper draws from text-based responses from 724 nurses, 154 allied health professionals, and 89 managers working in LTC homes across Atlantic Canada regarding the most important factors that contribute to their job satisfaction. We find that a collaborative team environment is the most important consideration for job satisfaction. We also note significant differences in responses across job function: allied health professionals value resident-based factors more often than the other groups, followed by nurses and then managers. Managers, meanwhile, prioritize general wellbeing and management/leadership more frequently than any other group.
This study uses data from the 2018 and 2020 waves of the China Longitudinal Aging Social Survey (CLASS) to examine the association between age identities and health among older Chinese adults. Findings show that a relatively younger age identity is significantly linked to better self-rated health. Mechanism analysis identifies three behavioral pathways: increased voluntary labor participation, greater digital inclusion, and more active social connections. These attitudes act as psychological assets that encourage proactive health behaviors. Subgroup analysis suggests that the health benefits of a relatively younger age identity are especially pronounced among younger seniors (aged 60-74), individuals with lower education levels, and those with stable housing. Situated in the context of a rapidly aging developing country, this study underscores the importance of psychosocial factors in shaping later-life health and offers implications for aging-related policy and intervention.
