BACKGROUND AND OBJECTIVES:As the prevalence of multimorbidity among older adults is rising, challenges regarding their end-of-life healthcare choices are increasingly relevant. To address knowledge gaps regarding decision-making, we explored how older adults with multimorbidity, their relatives and involved healthcare professionals experienced end-of-life healthcare choices, how their experiences related to each other and how these choices occurred in interactions between them over time. RESEARCH DESIGN AND METHODS:We conducted a multiperspective, longitudinal, interview and observation study with a phenomenological and ethnographic approach. We followed nine six-month patient trajectories with eleven relatives and 58 healthcare professionals and conducted 73 observations of patient-healthcare professional interactions and 63 interviews. RESULTS:The meaning of end-of-life healthcare choices of older people with multimorbidity was essentially understood as an ongoing, entangled, existential and relational process, shaped by, yet also transcending, healthcare contexts. This process was characterized by four tensions: (i) the experience of not having a choice, but making decisions nonetheless; (ii) the existential experience and the medical gaze; (iii) the importance of relatives and their limited role in healthcare; and (iv) navigating fragmented healthcare with interrelated conditions. DISCUSSION AND IMPLICATIONS:Healthcare professionals' limited insight into patients' and relatives' personal, existential perspectives and relational contexts calls for a better exploration of their lifeworld to ensure the best possible alignment of healthcare decisions with patients' and relatives' needs and values. Older adults with multimorbidity are inadequately supported by fragmented healthcare systems, and efforts to improve this should consider existential, relational and systemic factors.
BACKGROUND AND OBJECTIVES:Hospital-to-home transitions constitute vulnerable periods during which health systems increasingly rely on unpaid care partners to help care recipients execute discharge plans. We examine how mutuality and incongruence within care partner-care recipient dyads may shape discharge preparedness and dyadic self-efficacy during care transitions. RESEARCH DESIGN AND METHODS:We conducted a secondary qualitative analysis of PROJECT ACHIEVE focus groups and key informant interviews with 248 participants (138 care recipients, 110 care partners) across six U.S. health systems, examining their experiences of hospital-to-home transitions. A multidisciplinary team conducted thematic analysis and compared themes across stakeholder groups, guided by Social Cognitive Theory and Interdependence Theory. RESULTS:Care recipients and care partners shared goals but often differed in their appraisals of discharge readiness and post-discharge roles. Three domains of incongruence emerged: (1) preparedness for transitions home, as care recipients prioritized going home despite ongoing symptoms while care partners worried about premature discharge and inadequate training; (2) burdensomeness and struggle for independence, as care recipients desired to preserve autonomy while care partners absorbed the emotional and practical strain of supporting such desires; and (3) role changes and evolving relational identities, as spouses and adult children assumed caregiving roles that disrupted prior identities in the relationship. Lower mutuality was linked to reduced dyadic self-efficacy and, consequently, increased risk of readmission. DISCUSSION AND IMPLICATIONS:Findings highlight dyadic incongruence as a target for intervention in care transitions. Care strategies that assess care recipient-care partner mutuality may enhance dyadic self-efficacy and improve post-discharge outcomes.
BACKGROUND AND OBJECTIVES:Limited Medicare literacy contributes to suboptimal plan selection and disparities in coverage outcomes among older adults, particularly in historically underserved communities. This study examined Medicare enrollment literacy, information access, and decision-making experiences among first-time Black Medicare beneficiaries in Southeast Queens, New York, using a convergent mixed-methods design. RESEARCH DESIGN AND METHODS:Quantitative data were collected through a community-based survey of first-time Medicare beneficiaries (N = 93). Descriptive statistics assessed Medicare literacy across a 15-item scale and examined information sources, decision support, and plan selection patterns. Qualitative data were obtained through three focus groups and four individual interviews (N = 16) with community navigators and Medicare enrollment professionals and were analyzed using thematic analysis. Document analysis examined the clarity, readability, and cultural relevance of commonly used Medicare materials. RESULTS:More than half of participants demonstrated low Medicare literacy, and fewer than half reported confidence in comparing plans, understanding coverage differences, and estimating out-of-pocket costs. Most participants received assistance with enrollment decisions. Qualitative findings identified five themes: complexity and information overload, reliance on informal support networks, digital navigation barriers, confusion about coverage and costs, and the importance of trust and culturally relevant communication. Document analysis indicated that many materials were complex and relied heavily on insurance terminology, with limited cultural tailoring. DISCUSSION AND IMPLICATIONS:Limited Medicare literacy reflects both individual knowledge gaps and systemic barriers. Enhancing culturally responsive outreach, simplifying materials, and expanding community-based decision support may improve equitable enrollment outcomes.
BACKGROUND AND OBJECTIVES:Understanding the factors that enable or hinder successful implementation is essential for improving patient outcomes. Hospital in Home (HiH) programs provide hospital-level care in patients' homes to reduce hospitalization, enhance satisfaction, and improve resource use. Within the Veterans Health Administration (VHA), 14 sites have implemented HiH programs, yet limited research has examined implementation within a large integrated system. This study identifies factors that can support or hinder HiH implementation. RESEARCH DESIGN AND METHODS:We conducted interviews with 48 key informants across 14 VHA HiH sites. Guided by the Consolidated Framework for Implementation Research (CFIR) 2.0, we applied directed content analysis using a priori constructs, then developed site-level matrices to summarize findings and compare patterns across sites. RESULTS:We identified 18 CFIR constructs-nine that primarily facilitated implementation and nine mixed factors that acted as both facilitators and barriers. Key facilitators included two Individual-level factors (HiH lead capability and motivation, team motivation), one Innovation factor (relative advantage of HiH), and four Implementation Process factors (planning, teaming, reflecting and evaluating, adapting). Mixed factors were mostly within the inner setting, reflecting medical center context, along with two Individual-level mixed factors (leader and recipient motivation). DISCUSSION AND IMPLICATIONS:HiH programs hold strong potential to transform care for older adults, but success depends on addressing barriers and leveraging facilitators, particularly within the inner setting. Understanding key implementation determinants can enhance adoption, improve outcomes, and strengthen healthcare delivery.
BACKGROUND AND OBJECTIVES:Epistemic injustice, introduced by philosopher Miranda Fricker in 2007, refers to harm affecting individuals as knowers because of social prejudices and stereotyping. This leads to the partial or complete exclusion of certain individuals from knowledge building. People living with dementia are particularly vulnerable because cognitive impairments may reinforce assumptions about reduced credibility, marginalising their voices in clinical, social and family contexts and limiting opportunities to exercise epistemic agency. This research examines how people living with dementia experience epistemic injustice in everyday life and how it shapes their participation as knowers in clinical, social, and family contexts. RESEARCH DESIGN AND METHODS:A qualitative study using semi-structured interviews with a conversational approach was conducted. Participants (N = 15) with a dementia diagnosis were interviewed in their homes or nursing homes. Interviews were audio-recorded, transcribed, and analysed thematically to identify recurring patterns and meanings. RESULTS:Three interconnected domains were identified: epistemic marginalisation in clinical encounters, everyday negotiation of competence and agency, and epistemic invalidation and silencing in interpersonal relationships. Participants often perceived these experiences as appropriate or expected rather than unjust, reflecting internalised stigma. Many felt their perspectives were no longer recognised as valuable, leading to withdrawal from care and communication and fewer opportunities to contribute their knowledge. DISCUSSION AND IMPLICATIONS:Epistemic injustice extends beyond healthcare, affecting everyday and family interactions by progressively limiting opportunities for people living with dementia to participate as credible knowers. Its normalisation fosters self-silencing, perpetuating disempowerment and social exclusion.
BACKGROUND AND OBJECTIVES:The labor force participation rate among older American adults has steadily increased since the mid-1990s, reflecting delayed and potentially constrained retirement decisions that may have implications for the health and well-being of an aging workforce. This study investigates whether job lock-defined as continuing to work out of necessity, despite a desire to retire-predicts subsequent adverse health outcomes. RESEARCH DESIGN AND METHODS:Using longitudinal data from workers aged 50 and older in the Health and Retirement Study (n = 5,217), generalized estimating equation models examined the association between baseline job lock and mental and physical health outcomes more than 6 years. RESULTS:Job lock was highly prevalent, affecting 77% of respondents. Over follow-up, those reporting job lock at baseline had significantly higher odds of fair or poor self-rated health (OR 1.47, 95% CI [1.26, 1.71]), elevated depressive symptoms (OR 1.50, 95% CI [1.29, 1.75]), psychiatric problems (OR 1.34, 95% CI [1.10, 1.63]), and elevated weight status (obese: OR 1.22, 95% CI [1.06, 1.40], overweight: OR 1.29, 95% CI [1.12, 1.47]), even after adjustment for sociodemographic, financial, and behavioral confounders. These associations were even stronger among those who remained employed through the end of follow-up. Findings were similar among workers aged 62 and older at baseline, for whom job lock was additionally linked to increased likelihood of heart disease (OR 1.25, 95% CI [1.03, 1.53]). DISCUSSION AND IMPLICATIONS:These findings highlight the need to reduce financial and insurance-related barriers to retirement and strengthen supports for workers to accumulate adequate resources for a sustainable transition out of the workforce.
BACKGROUND AND OBJECTIVES:Psychosocial interventions support informal caregivers of people with dementia, but their impact on anticipatory grief and related health outcomes remains unclear. This review examines the effectiveness of different psychosocial approaches in addressing these outcomes. RESEARCH DESIGN AND METHODS:A systematic review and meta-analysis were conducted following PRISMA guidelines and registered in PROSPERO (CRD42024629388). Eight databases were searched from inception to January 10, 2025. Two reviewers independently screened studies, assessed bias, and extracted data. Leave-one-out sensitivity and subgroup analyses addressed heterogeneity. Evidence quality was assessed using the GRADEpro Guideline Development Tool. RESULTS:Eleven interventional studies were included. Psychosocial interventions (n = 6) had no significant short-term (<1 month: SMD = -0.57, 95% CI: [-1.14, 0.01], p = .05, I2 = 85%) or medium-term (1-6 months; SMD = -0.76, 95% CI: [-1.99, 0.46], p = .22, I2 = 88%, n = 3) effect on anticipatory grief but showed improvement in the long term (≥6 months; MD = -0.41, 95% CI: [-0.62, -0.20], p = .0001, I2 = 0%, n = 2). Short-term reductions in depression were also observed, with no significant effects in other outcomes. Subgroup analyses did not identify frameworks or delivery methods linked to better outcomes. The GRADEpro rated the evidence as "Low" to "Very Low." DISCUSSION AND IMPLICATIONS:Overall, psychosocial interventions have limited short- and medium-term impact on anticipatory grief. Individual, technology-mediated cognitive-behavioral approaches may improve anticipatory grief in long term, but evidence is limited. Further research should clarify the concept of anticipatory grief and evaluate interventions in large, rigorous RCTs. CLINICAL TRIAL REGISTRATION NUMBER:CRD42024629388.
BACKGROUND AND OBJECTIVES:Speaking up about quality and safety issues can protect older people and support learning in health and social care systems. In aged care, staff work in diverse roles to deliver care to residents with complex care needs. This meta-ethnography aimed to synthesise evidence on staff experiences of raising concerns about quality and safety in long-term residential aged care. RESEARCH DESIGN AND METHODS:We included qualitative studies examining staff experiences of speaking up, incident reporting, and whistleblowing. Five databases were searched. The seven phases of meta-ethnography were used to translate first and second order constructs into third order constructs and a line-of-argument synthesis. RESULTS:Thirteen articles of 11 studies were synthesised to reveal four third order constructs: 1. Sensemaking a concern, 2. Organisational cultures determine how they are voiced, heard and respond to, 3. Systemic resources shape and constrain possibilities for voicing, and 4. Normalisation of poor care and loss of moral agency in organisations that respond with indifference. Raising concerns was a dynamic, recursive process encompassing phases of recognising, voicing, and organisational responding. Where quality and safety issues were normalised, individualised, or met with limited action, staff described moral distress, disengagement, and, in some cases, exit from the organisation or sector. DISCUSSION AND IMPLICATIONS:Raising concerns in residential aged care is a dynamic process shaped by interrelated individual, organisational and systemic factors. Speaking up interventions need to go beyond skills training to address phases of recognising care quality issues and how organisations respond when they are raised.
BACKGROUND AND OBJECTIVES:Person-centered care (PCC) has shaped dementia care reforms and informed innovative long-term care models such as care villages. Recreational activities are often seen as a site where PCC is enacted, yet little empirical work has examined how participation in structured activities is enabled, mediated, and constrained through everyday social, relational, and organizational dynamics. This study examines how participation in structured group activities was produced in a care village. RESEARCH DESIGN AND METHODS:An ethnographic study was conducted in Canada's first publicly funded care village, drawing on 100 hours of participant observation, 12 staff interviews, and informal resident conversations. Data were analyzed using qualitative content analysis. RESULTS:Participation varied across activity types and residents' fluctuating comfort, stamina, and readiness. For many residents, participation was not simply an individual decision, but was scaffolded through staff invitation, accessible information, relational familiarity, and individualized encouragement. It also depended on logistical and organizational conditions, including preparation, transportation, staffing coordination, and role boundaries. These findings show that participation was relationally and organizationally produced rather than simply a matter of resident preference or program design. DISCUSSION AND IMPLICATIONS:Structured activities can support meaningful engagement when sustained by relational, logistical, and organizational work. The findings clarify how PCC commitments such as choice, autonomy, and inclusion are enacted through activity systems, while highlighting the labor-intensive conditions required for more equitable participation. These insights have implications for staffing, coordination, and activity provision in care villages and long-term care settings.
BACKGROUND AND OBJECTIVES:A sense of Home is an important part of wellbeing for all peoples, and there are unique dimensions to Home for Indigenous elders. Yet, there is a dearth of literature exploring the experiences and perspectives of Indigenous peoples in aged residential care (ARC) settings, and even less so from the perspectives of Indigenous elders themselves. The objective of this scoping review is to investigate and synthesise literature on Indigenous conceptualisations of Home and Home features in ARC settings from Indigenous elders' perspectives. RESEARCH DESIGN AND METHODS:This scoping review was conducted through a systematic search of qualitative research from PubMed, PsycInfo, Scopus, Web of Science and Google Scholar databases. A framework considering Home holistically across physical, emotional, mental and spiritual domains was used to analyse findings. RESULTS:Fifteen articles met the eligibility criteria for review. Indigenous elder's spoke to several significant features of Home in ARC settings related to Cultural Home, Physical Home, Emotional/Psychological Home and Relational/Social Home. DISCUSSION AND IMPLICATIONS:Indigenous peoples have differential access to ARC settings as well as unique desires, attitudes and aspirations for thriving in ARC settings. They further bring embodied and rich knowledges into their environments as eminent holders of intergenerational knowledges and cultural practices. Research has demonstrated that homelike environments are favourable in ARC settings. This review advocates for aged care systems to embed culturally relevant care and home practices that prioritise relationality and Indigenous knowledge at the core of service design and delivery.
BACKGROUND AND OBJECTIVES:To explore age-specific insights into how older adults understand and decide about health screening, using dementia screening as a critical case. RESEARCH DESIGN AND METHODS:Participants were 44 community-dwelling older adults in Singapore (ages 64-87). Six focus group discussions (FGDs) were conducted. Audio recordings were transcribed, standardized into English, and verified through independent bilingual checks. Data were analyzed using a hybrid inductive-deductive thematic analysis grounded in Health Belief Model constructs. RESULTS:Six main themes with twelve subthemes were identified from the analysis. Dementia understanding described participants' general awareness of dementia and confusion between normal ageing and cognitive impairment. Risk perceptions included perceived severity and susceptibility, with many viewing dementia as an inevitable part of ageing rather than something preventable. Perceived benefits encompassed early detection, improved awareness, and protection of family members through future planning. Perceived barriers involved both practical and psychological factors, including financial cost, accessibility, fear of diagnosis, and concerns over autonomy loss. Perceived support highlighted the influence of family encouragement, community resources, and spiritual faith in motivating or discouraging screening decisions. An emergent theme of self-ageism reflected internalized beliefs that screening was unnecessary, inappropriate, or futile in later life. DISCUSSION AND IMPLICATIONS:Dementia screening, as a critical case, revealed how self-ageism, alongside conventional HBM constructs, shapes older adults' screening intentions, underscoring the need for inclusive health communication for aging populations.
BACKGROUND AND OBJECTIVES:This study examined racial/ethnic and language-based differences in the Adult Protective Services (APS) process using the standardized Identification, Services, and Outcomes (ISO) Matrix tool to measure maltreatment identification during investigation, services, and outcomes post-intervention. RESEARCH DESIGN AND METHODS:Data from two California county APS programs for adults aged 65 and older (n = 1,330) were analyzed. Measures included maltreatment allegations (self-neglect, neglect by others, financial abuse, emotional abuse, physical abuse), pre-test ISO Matrix scores, substantiation decisions, service types, and change in ISO Matrix scores from pre-test to case closure. Logistic regression models produced odds ratios (OR) by language (reference: English) and race/ethnicity (reference: White), adjusted for multiple comparisons. RESULTS:After adjustments, only financial abuse allegations were significantly higher among Black/African American clients than White clients. Emotional abuse pre-test scores were lower for Asian (OR: 0.45), Hispanic (OR: 0.39), and higher for non-English-speaking (OR: 2.18) clients, while self-neglect scores were lower among non-English speakers (OR: 0.57). There were no differences in substantiation decisions, service types, or ISO Matrix change scores across language or racial/ethnic groups. Change scores were influenced by client engagement and initial severity. DISCUSSION AND IMPLICATIONS:This study, one of the first to use a standardized tool to assess APS disparities, found equitable substantiation and service provision across race and language groups. Financial abuse allegations were more frequently reported among Black/African American clients, consistent with previous research. Emotional abuse varied by race and language, suggesting avenues for future research on cultural factors in abuse perception.
BACKGROUND AND OBJECTIVES:Driving retirement is a significant life transition for older adults (aged 65 and older), which has been associated with negative psychosocial and health outcomes. RESEARCH DESIGN AND METHODS:This qualitative study explores eight older adults' plans, feelings and support needs when stopping driving. After focus groups were conducted, participants were categorised according to Adler and Rottunda's (2006) groupings - Proactives, Reluctant Accepters and Resisters-to examine their nuanced perspectives. Using thematic analysis, key themes were established across groups. RESULTS:Three primary factors prompted participants across all groups to begin thinking about retiring driving, including; Medical Reasons, Safety Reasons and Licencing Barriers. Feelings around driving retirement were predominately negative across groups, with exception of Acceptance, however differences between groups were observed where Proactives tended to discuss their feelings in past tense whereas Resisters discussed feelings in present tense. Using the Social Ecological Model, participants across groups highlighted the strong need to enhance support systems at interpersonal, environmental and policy levels, with a notable absence of discussions regarding individual level supports. DISCUSSION AND IMPLICATIONS:Findings of this study suggests that driving retirement in older adulthood may be better conceptualised as a phase-based transition, rather than categories. This phase-based approach could better inform clinicians to assist older drivers' in navigating their driving retirement transition by integrating early readiness assessments, phase-specific interventions and post-retirement emotional support. Future research should aim to further explore evidence-based interventions at the individual level that support older adult pre- and post-driving retirement to facilitate a smoother transition whilst promoting well-being.
In health care settings, immigrant older adults who are not fluent in English may not be able to fully express their problems, even with a translator, because there are important phrases about health problems in their native language that do not directly translate to concepts in English. This issue is particularly important for immigrant older adults, especially recent immigrants, who might experience limited English proficiency and rely heavily on health care services. For example, Chinese expressions, such as "" and "," and Spanish idioms, such as "sentirse agüitado" and "achicopalado," roughly translate to different types of emotional distress but do not have accurate English translations. These linguistic barriers affect both psychological and physical health outcomes. This paper briefly describes different types of culturally-embedded metaphors, idioms, and linguistic framing commonly used by immigrant older adults in the US, especially those who speak Mandarin and Spanish. We then highlight that even with a good translator, these phrases lead to barriers in effective healthcare services. As a result of these translational issues, immigrant older adults may experience misdiagnoses and improper treatments, thereby decreasing patients' willingness to seek help. We highlight the need for more research on this issue of culturally based descriptions of health issues, particularly psychological distress. While prior research documents these barriers, it does not provide direct causal evidence of how these concepts influence diagnosis and treatment outcomes. Doing so would provide a better understanding of how linguistic factors affect mental and physical health, guiding more inclusive, culturally sensitive solutions.
BACKGROUND AND OBJECTIVES:Naturally Occurring Retirement Communities (NORCs) are buildings and neighborhoods that house a large proportion (≥30%) of older adult residents. This study explored how residents experience aging in place within the built environments of NORCs, to inform age-friendly design, and aging in place interventions. RESEARCH DESIGN AND METHODS:A qualitative case study was conducted across four NORC sites in Toronto, Canada. Data sources included resident focus groups, open-ended survey responses, and observational field notes (i.e. windshield surveys). This secondary analysis followed a case-based, deductive approach guided by the built environment domains of the World Health Organization's Age-Friendly Cities Framework: outdoor spaces and buildings, housing, and transportation. RESULTS:Two condominiums, one housing co-operative, and one social housing residence were examined. Residents' experiences were coded into eight interrelated sub-themes spanning the three domains: access to greenspace and public amenities, accessible outdoor infrastructure, safety and belonging, affordability and maintenance, building design, building governance, driving cessation, and transit costs. Findings demonstrated that aging in place was shaped not only by physical accessibility, but also by how the built environment fostered opportunities for social connection, agency, participation, and everyday interaction within shared spaces. DISCUSSION AND IMPLICATIONS:The built environment affects older adults' ability to age in place. NORC-based programs can be a catalyst for changes and optimizations to the built environment, creating spaces and places that are designed with the community and its residents in mind.
BACKGROUND AND OBJECTIVES:Understanding the quality of older adults' end-of-life care is essential for informed decision-making and practitioner accountability. However, retrospective appraisals provided by proxies may be shaped by their relationship to the decedent. Failure to adjust for proxy relationship status may generate misleading characterizations of the quality and social patterning of end-of-life care. We examine how proxy reporters (spouse, daughter, son, other relative, other non-relative, and paid caregiver) differ in their appraisals of the decedent's care in the last month of life. RESEARCH DESIGN AND METHODS:Data are from 12 waves (2011-2022) of the National Health and Aging Trends Study (n = 3,229). We use binomial and multinomial logistic regression to evaluate proxy status differences regarding ten dimensions of care in the last month of life, reported by NHATS decedents' proxies: overall quality; adequately treated breathing problems, pain, and sadness/anxiety; care coordination; decisions made with patient input; care concordant with patient wishes; informed about care; personal care needs met; and respectful treatment. Models were adjusted for death context and decedent characteristics. RESULTS:Paid caregivers are more likely than family members to offer positive appraisals on all ten outcomes. Paid caregivers differ from other non-family proxies with respect to care delivery, but not symptom management. Family members differ slightly from one another, with spouses offering more critical assessments of patient/family input and receipt of care concordant with wishes. Daughters and other relatives offered superior overall appraisals, relative to sons. DISCUSSION AND IMPLICATIONS:Researchers, practitioners, and policymakers should recognize that the proxy's relationship to decedent may influence their appraisals of end-of-life care.
BACKGROUND AND OBJECTIVES:Informal caregivers of older adults often experience poorer lifestyle behaviors and elevated risks of physical and mental health problems. This systematic review and meta-analysis evaluated the effects of lifestyle interventions on behavioral, mental, and physical health outcomes among caregivers of older adults, and explored whether intervention characteristics influenced outcomes. RESEARCH DESIGN AND METHODS:Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO [anonymized for review]), a systematic search was conducted using PsycINFO, MEDLINE, and EMBASE up to 11 July 2025. Randomized controlled trials were included. Pooled estimates were calculated using random-effects meta-analysis. Risk of bias was assessed using the Revised Cochrane Risk of Bias tool. RESULTS:Twenty-one studies (N = 2,099) were identified, with 17 included in meta-analysis. Most interventions focused on physical activity, with few addressing sleep or nutrition and none targeting smoking or alcohol use. Pooled estimates derived mainly from physical activity interventions suggested a small reduction in depressive symptoms (SMD = -0.34, 95% CI -0.47 to -0.20). Subgroup analyses suggested reductions in depressive symptoms reached statistical significance only in hybrid physical activity interventions combining in-person sessions with technology-supported monitoring, but not in telephone-based or in-person formats. Most studies were rated as high risk of bias. DISCUSSION AND IMPLICATIONS:Preliminary findings, largely derived from physical activity interventions, suggest a small reduction in depressive symptoms, with no consistent effects for physical activity, sleep quality, caregiving burden, stress, or self-rated health. The evidence is limited in scope and methodological rigor. Future research may benefit from targeting a broader range of lifestyle behaviors.
BACKGROUND AND OBJECTIVES:Although gender affirmation is a social determinant of health for transgender and gender-diverse people, reviews have predominantly focused on the medical domain and on younger populations. We conducted a scoping review by mapping peer-reviewed studies on 4 domains of gender affirmation among transgender and gender-diverse people in middle age and late life. RESEARCH DESIGN AND METHODS:Using the Joanna Briggs Institute's scoping review methodology and PRISMA-ScR reporting guidelines, we conducted a literature search of the following databases: MEDLINE, Social Work Abstracts, CINAHL PLUS from EBSCOhost, APA PsycINFO, ASSIA, Sociological Abstracts from ProQuest, and SCOPUS. Of the 1,339 studies identified, 58 were included in this review. We used a hybrid thematic content analysis to synthesize the key findings. RESULTS:The participants reported both gender-affirming and non-affirming experiences in (a) the psychological domain, which includes identity confusion, dysphoria, internalized stigma, and self-acceptance and identity realization in later life; (b) the social domain, which encapsulates decisions to conceal or disclose their gender identity, experiences of rejection or support, and community engagement and advocacy actions; (c) the medical domain, which concerns access to and experiences with gender-affirming care and non-affirming services in healthcare; and (d) the legal domain, which involves pursuing gender recognition, navigating legal documentation, and facing systemic barriers in end-of-life planning. DISCUSSION AND IMPLICATIONS:This review highlights the multi-dimensional needs associated with gender affirmation and the systemic barriers faced by transgender and gender-diverse adults in middle age and late life. It provides insight into gender-affirming experiences that can inform more age-friendly and gender-affirming care.
BACKGROUND AND OBJECTIVES:Family members are a central source of care and support in later life, yet older adults in the United States increasingly live apart from non-resident kin, raising questions about how geographic dispersion shapes relational dynamics. RESEARCH DESIGN AND METHODS:Using nationally representative data from the Panel Study of Income Dynamics and its Disability and Use of Time supplement, this study develops a multidimensional typology of family relationship configurations among adults aged 60 and older. Latent class analysis of contact, reciprocal support, and emotional affinity identifies 4 distinct profiles: harmonious but detached, isolated, strained givers, and tight-knit. We then examine how structural features of non-resident kin networks-including geographic proximity, number and type of nearby relatives, and relatives' socioeconomic resources-predict membership in these profiles. RESULTS:Results show that proximity to multiple kin, particularly parents, children, and siblings, strongly shapes the likelihood of belonging to tight-knit or strained families, while greater dispersion contributes to isolation or emotionally positive but low-contact ties. The availability of financially stable kin further differentiates profiles, with higher-income relatives linked to less exchange-based configurations. DISCUSSION AND IMPLICATIONS:By moving beyond simple measures of co-residence or "any nearby kin," this study demonstrates the diversity of older adults' family experiences. Our findings highlight that geographic proximity operates within a broader network ecology: the presence of multiple nearby kin, the types of relatives who live close, and the relative economic resources of family members all contribute to whether older adults experience cohesive, strained, or weak family ties.
