Excessive or overprotective assistance toward older adults may inadvertently undermine their autonomy. Thus, understanding how older adults evaluate different helping behaviors is important for providing appropriate support. We surveyed 549 older Japanese adults recruited through an online panel who were able to complete a web-based questionnaire and examined their anticipated gratitude and perceptions of meddlesomeness toward five types of non-family and three types of family-provided helping behaviors, along with perceived cost, value, and genuine helpfulness. The results showed that the levels of anticipated gratitude and meddlesomeness varied depending on the type of helping behavior. Structural equation modeling was largely consistent with the Trait and State Levels of Gratitude Model, showing that individuals with higher trait gratitude perceived greater cost, value, and genuine helpfulness, which in turn were associated with higher gratitude toward helping behaviors. In addition, a post hoc exploratory analysis suggested that, for non-family helping behaviors, perceived meddlesomeness was especially high when the helping behavior was perceived as high in cost but low in value. These findings suggest that participants’ judgments of the cost, value, and genuine helpfulness of assistance were associated with their gratitude and feelings of meddlesomeness.
The health of informal caregivers of older adults is an important public health concern. This study examines the gendered nature of informal caregiving and its association with physical and mental health outcomes among caregivers in India using a cross-sectional analysis of nationally representative data from the first wave of the Longitudinal Ageing Study in India (LASI). Women constituted nearly two-thirds of informal caregivers and reported moderate (43.1% vs 36.0%) and poor (19.0% vs 18.8%) self-rated health more frequently than men. Women also had a higher prevalence of hypertension, diabetes and musculoskeletal pain, and were less likely to receive treatment for some chronic conditions. Depressive symptoms were more common among women (36.5% vs 29.5%), while sleep problems and major depressive episodes were reported by both men and women caregivers. Caregiving in India is gendered, and women experience a disproportionate burden of adverse health outcomes. The findings also highlight important health concerns among caregivers of both genders. Routine screening for physical and mental health problems, counselling, and community-based support services could help address the health needs of informal caregivers.
The purpose of this cross-sectional study was to explore older adults' perception of caregiver stress and their anticipation of becoming a caregiver (N = 723). Bivariate analyses revealed that perceived caregiving stress was higher among older adults who were females, White/Non-Hispanics, with chronic health conditions, who had experienced prior physical and financial caregiving burdens and was lower among those with just a high school degree. Multivariate analyses revealed that perceived caregiving stress levels remained higher only for those with past experience with physical caregiving, those with chronic health conditions, older females and White/Non-Hispanic older adults. The overall model was significant, F(13, 600) = 5.52, p < 0.001, and explained approximately 12% of the variance in caregiving stress (R 2 = 0.11, adjusted R 2 = 0.09). For anticipated caregiving, bivariate analyses indicated that older adults in the 60–69 years age group, those who were married, employed, without a disability, those who rated their physical health as good or very good, and those with past physical and financial caregiving burdens were significantly more likely to anticipate future caregiving roles. A likelihood ratio test indicated that the full multinomial logistic regression model fit was significant, χ 2(26) = 140.03, p < 0.001. The implications for caregiver preparedness and support are discussed.
Services delivered using digital technologies, including technology-enabled care services (TECS), have been proposed to help people age independently and well in their own homes. However, the uptake of digital services by older users appears uneven, suggesting that opportunities to assist people are being missed. A better understanding of older people’s attitudes towards digital technologies and TECS could help to address this issue. Evidence of the attitudes held by independent-living older people was gathered through a cross-sectional questionnaire survey of people aged 55 and over. The participants were residents of independent-living schemes and community-dwelling members of local communities. A total of 230 people completed the questionnaire. The participants’ responses were analysed in aggregate and in comparative terms, according to the ‘technology generation’ to which each participant belongs. The participants were generally positive about digital technologies and TECSs, which suggests that digital services play a role in supporting people in their ability to age well. Considering these results should aid in the development of effective TECS. However, participants also express misgivings about digital technologies; this was particularly marked in the case of the generation aged 75 and older. Generational differences suggest that different strategies are required that consider older people’s distinct opinions and experiences with technologies.
An age-friendly city supports older adults to engage in social life, and access services that cater for their specific needs for as long as possible while. At the same time, the direct involvement of older adults in the co-creation of age-friendly urban solutions remains limited. This study examines the age-friendliness of urban environments from the perspective of older adults living in five European cities using a participatory photovoice approach. The analysis is guided by the World Health Organization's eight age-friendly topics with the addition of one's financial situation. The study draws on qualitative data collected (photographs and comments) via a web-based application in 2023 and 2024, with 128 participants aged 65 years and over. The findings of this study explore the perspectives of older citizens on specific features of the physical, social and cultural environments that influence their well-being and ability to remain active citizens. Older individuals emphasised aspects such as the quality of infrastructure, walkability, aesthetics, inclusivity of social activities and the affordability and accessibility of services. This study demonstrates the value of participatory methods such as photovoice in capturing the lived realities of older residents. The findings offer critical insights to foster more inclusive, supportive age-friendly cities.
Recruiting older adults into cohort studies is an ongoing challenge. Although social media is increasingly used, older adults vary in their access to and comfort with digital technologies, necessitating traditional methods to complement online approaches. We use observational data embedded within the recruitment of the Beyond 50 cohort to compare targeted social media advertising with postal mailouts. Recruitment outcomes included gender distribution, response rate and cost per participant. A total of 1059 participants were recruited, of which 46.8% were female. Social media campaigns had an estimated reach of 63% of the local target population and resulted in a 0.4% response rate, of which 78% were female, at an average cost of A$4.84 per participant. Postal mailouts had an estimated reach of 11.9% of the local target population and resulted in a 4.4% response rate (4.2% female; 4.5% male), at an average cost of A$29.18 per participant. Despite higher costs, mailouts produced more efficient and gender-balanced recruitment when compared to social media. These findings highlight the importance of selecting the appropriate recruitment strategy to maximise recruitment reach, efficiency and gender equity when establishing cohorts of older adults. In addition, mailouts using a sampling frame may reduce selection and recruitment bias.
Age-friendly cities are an important initiative set out by the World Health Organization, with many researchers and policy makers aiming to create age-friendly environments to support ageing populations access and navigate the built environment. The present study examined the validity and reliability of the age-friendly cities and communities questionnaire (AFCCQ-UK) deployed across the UK in 2023–2024. The sample (n = 426) completed an online survey answering a 23-item measure and employing a life course perspective. The survey targeted people aged 18–60+ years through social media, mailing lists and word of mouth. The AFCCQ-UK demonstrates validity and reliability across two age groups (18–59, 60+ years), demonstrating that age-friendliness can be measured intergenerationally and that there is a moderately positive overall perception of age-friendliness. Data show no significant differences between groups suggesting the consistency of age-friendliness. Financial differences were observed to be of influence especially regarding the domains of (1) Social Participation and (2) Community Support and Health Services. Researchers in gerontology, urban planning and social policy will benefit from these findings, and because our towns and communities do not comprise of one specific age cohort, these findings can assist public service providers to clearly ascertain the needs and expectations of residents when attempting to rollout age-friendly initiatives.
In Japan, rapid population aging and the weakening of local communities have heightened the importance of promoting community participation among middle-aged and older adults. To this end, it is necessary to examine the psychological factors that facilitate such engagement. The present study aimed to investigate the association between generative concern and community participation, specifically focusing on involvement in community activities and interactions with neighbors. An online survey was conducted with middle-aged and older Japanese adults, and data from 540 participants (aged 50–87) were analyzed. Results from generalized linear models indicated that individuals with higher levels of generative concern reported greater involvement in community activities and more frequent interactions with neighbors, even after controlling for loneliness and demographic variables. Furthermore, exploratory analyses focusing on the interaction between generative concern and employment status revealed that the association between generative concern and community participation was particularly strong among participants who were not employed. These findings suggest that generative concern may serve as a psychological resource that promotes community participation among middle-aged and older adults in Japan, compensating for the loss of social roles that often accompanies retirement.
The world’s population is aging and older people largely want to remain in their own homes in the community. Many experts propose that technologies can help enable community living, but it is not clear how technologies are currently used. Prior research has tended to look at single technologies or urban contexts. This paper addresses two questions. How are technologies being used to help older people age in place in rural China? How does the domestic environment support or inhibit such use? Using a social technology framework and drawing on qualitative interviews and photo-documentation with 44 older people in three parts of rural China, this paper finds that older people use combinations of gerontechologies and general-purpose technologies, alongside assistive devices and household fixtures. These spread across several life domains, such as health, safety, mobility, social connections, and everyday activities. Complex combinations of technologies help retain older people’s agency at home. However, they also have costs to purchase and maintain, learn how to use, store, and in terms of privacy and self-perception. Home design and construction often inadequately supports older adults' use of technology, particularly for mobility and safety. Such problems need attention from governments, service providers, and older people themselves.
The purpose of this study was to explore older adults' (60+) perceptions and experiences of humour, whilst also examining how responses varied based on gender and well-being scores. Data for this study consisted of audio-recorded, transcribed interviews with 20 older adults. Qualitative coding of the interviews was used to extract themes that highlighted different experiences and perceptions of humour across men and women with varying well-being. The analysis identified six main themes: perceived importance and functionality of humour, older adults' interactions with humour, frequency of humour, acceptability and adaptability of humour, stereotypes and ageist jokes and the negatives of humour. The results suggest that humour plays a significant role in older adults' lives as a social function, a coping mechanism and a way of navigating the challenges of ageing. They also emphasise the complexities of humour in the lives of older adults, with gender, culture and well-being scores influencing their experiences and perceptions. Future research should involve a larger sample to further explore individual differences in older adults' humour experiences and perceptions, particularly investigating the potential of humour as an indicator of well-being.
Dementia has long been understood through biomedical frameworks that privilege brain pathology over lived experience. This article introduces dementism—a theoretical lens reframing dementia as a moral and social injustice rather than merely a medical condition. By exposing the four architectures of dementism—emotional reactions, social attribution, exclusion, and denial of humanness, this article argues for a paradigm shift in how society conceptualises cognitive decline. It invites an ontological debate: what if losing memory does not mean losing humanity? Dementism challenges the moral hierarchies embedded in care systems and proposes a justice-oriented vision for dementia research and policy reform.
Co-management models for older surgical patients evolved from the hospitalist movement and early orthogeriatric programs. Unlike reactive consultation, the co-management model, in which hospitalists or geriatricians share responsibility with surgeons for patient care throughout the hospital stay, may improve perioperative outcomes and patient experience. Despite heterogeneity in co-management models and limited high-quality evidence, it thus offers a promising framework for geriatric surgical care implementation. Unlike traditional consultation models, co-management ensures early and continuous medical oversight, optimizes perioperative management, including appropriate medication use, reduces complications, and enhances safe discharge planning. Several studies have demonstrated that co-management with various surgical teams, such as trauma surgery, vascular surgery, orthopedics, and neurosurgery, reduces mortality rates, improves satisfaction among both patients and healthcare providers, is cost-effective, and possibly shortens hospital stays. Nevertheless, challenges with co-management remain, including care fragmentation, communication issues, and increased workload for hospitalists or geriatricians. Successful implementation depends on institutional support, clearly defined roles, and appropriate patient selection. Given the growing complexity of hospitalized older adults, the co-management model represents a critical evolution in multidisciplinary surgical care, but further research is needed to establish best practices.
In 2007, the World Health Organization launched its ground-breaking publication Global Age-friendly Cities: A Guide in which the widely used eight topics of age-friendly cities and communities. A lot of emphasis was put on the self-proclaimed validation using the Vancouver Protocol with older people and other relevant stakeholders. Contrary to popular belief, the eight topics had not been validated until the year 2020. The lack of transparency surrounding the origins of the age-friendly topics, that were rooted in the North-American elder-friendly literature, has led to substantial consequences, including many failed attempts to validate the topics, many difficulties in developing valid measurement instruments, and robust discussion pieces criticizing these topics, for instance, the lack of consideration of financial aspects, as well as safety and security. In this article, the origins of the age-friendly topics are disclosed in an attempt to reconstruct the development process and the choices made by the people involved though a combination of investigative journalism and document analysis approaches. This piece reveals potential pathways and gaps that need to be addressed in the future overhauls of the age-friendly topics that will soon celebrate its 20th anniversary.
This article discusses the opportunities of working with an Advisory Group on intergenerational climate change research. We co-created creative workshops to explore and articulate climate change perceptions and future imaginaries between younger and older people in Wales, UK. This 12-month programme of research activities led to a bilingual (Welsh and English) and bespoke comic, and a follow-up project that co-created an intergenerational activity book. Using a research diary format, we show how to practically follow the Responsible Research and Innovation dimensions of inclusion, reflexivity, anticipation, and responsiveness during the data collection stage. The opportunities for co-creation discussed here relate to two main areas: imagining and communicating futures through intergenerational workshops; and the extent to which the Advisory Group were co-creators. The voices of four members of the Advisory Group and the work of comic book artist show the benefits of an early involvement of time, resource and trust in a group who are potential critics, advocates, and bridge-builders. We make four recommendations: the importance of time and imagination in intergenerational climate research; the value of Advisory Groups in improving participatory methods; the need for sustained community-university partnerships and that Advisory Groups should be involved from the very beginning of research.
Sigmoid volvulus usually occurs in frailer patients with comorbidities and can be associated with recurrence. Our exploratory study assessed long-term outcomes in this cohort. We retrospectively reviewed the records of patients admitted with sigmoid volvulus to two inner-city acute surgical units from 2016 to 2023, noting the clinical frailty scale (CFS), number of readmissions, treatment and 12-month mortality. Seventy-five patients met our criteria. The mean age was 74 years, and the median CFS was 5. Forty-eight percent of the subsequent readmissions were related to sigmoid volvulus. The 12-month mortality rate after initial presentation was 19%; this figure was 50% in patients with CFS > 7. Thirty-six percent of people were operated on, either during the first or a subsequent admission (only 3 of whom had CFS > 5), with 0% mortality. Higher mortality and functional decline were observed among patients who presented with sigmoid volvulus; however, short- to medium-term survival was better in operated patients, although this may be due to the selection basis. The subgroup of frail patients who underwent surgery was too small to meaningfully conclude outcomes in this subgroup. The high mortality rate among sigmoid volvulus patients with CFS > 7 may encourage a move towards early advanced-care planning and palliation, avoiding the burden of subsequent readmissions.
Loneliness is often experienced among nursing home residents and impacts their quality of life. This study explores possible variations in loneliness levels between 263 residents of public and private nursing homes in North Macedonia, including the relationship between independence levels, using the Katz index of independence in activities of daily living (Katz) index, and feelings of loneliness using the ‘De Jong-Gierveld loneliness scale’. This study revealed that 36.5% of older adults residing in nursing facilities reported experiencing minimal loneliness, while 11.8% reported experiencing severe loneliness. Regarding social loneliness, 27.0% of the residents reported a score of 0 (indicating no loneliness), whereas 22.8% reported significant social loneliness (scores of 4–5). In contrast, emotional loneliness exhibited a more balanced distribution, with 18.3% scoring 0 points and 13.0% scoring at the highest levels (scores of 5–6). The significant predictors can be grouped into two categories: 1. Structural factors: nationalities, educational level, and type of nursing home. 2. Social engagement factors: involvement in activities, frequency of visits, and contact via other means. Given the widespread prevalence of loneliness among older adults living in nursing homes, additional research is urgently needed to better comprehend how older adults interpret and experience this phenomenon.
Older adults are disproportionately targeted by cyberattacks owing to perceived vulnerabilities among this population. For individuals requiring assistance in addressing or understanding cybersecurity threats, specialized advocacy services may provide critical support. The qualitative study described in this article, explores the experiences of 12 cybersecurity advocates in the United States who work specifically with older adults. The participants engaged in activities aimed at promoting cyber hygiene, mitigating and responding to threats, and educating or representing clients. The findings highlight the motivations, attributes, and practices perceived as most effective in meeting the needs of older adults, as well as the role of technology in facilitating advocacy efforts. The study concludes with recommendations for enhancing advocacy practices and offers insights to inform the development of training materials designed to strengthen cybersecurity advocacy for older adult populations.
Team research demonstrates challenges in collaborative work, lack of generalizability across healthcare settings, and the importance of reflecting the context of care. Forty-four care workers were asked about what does work in their lived work experience in an urban retirement and assisted living community with skilled nursing care serving up to 700 residents daily. Inductively developed major and minor themes were compared to a theoretical model integrating group effectiveness, healthcare team configurations, and team delivery strategies. In the long-term care context, process elements predominated, and included communication, coordination, and psycho-social traits as features to optimize teamwork, with modulating influences from the social and policy context (state surveys and family complaints).
Disparities in access to health services for older adults in Colombia require monitoring. This study examines inequalities in access to health services among Colombian adults aged 60 and older from 2015 to 2023, using data from the Colombian National Quality of Life surveys. Levesque’s model was applied to evaluate the abilities to perceive, seek, reach, pay for, and engage with healthcare services. A composite score was used to aggregate these dimensions, reflecting overall access to health services. Stratified analyses were conducted to explore disparities by sex, region, residence, and income. The results indicate that access to health services varied over time, with notable discrepancies based on sex, region, residence, and income. Urban residents and individuals from higher-income households consistently experienced better access to healthcare services. Disparities persisted across the study period, with the greatest regional differences observed in 2023. These findings underscore the importance of addressing these inequalities to ensure equitable healthcare for Colombia’s aging population.
Delirium is a common but frequently misdiagnosed condition, particularly in patients with limited English proficiency. Language and other communication barriers can significantly affect assessments of mental status, leading to errors in diagnosis and management. A 94-year-old Cantonese-speaking male was hospitalized with a subdural hematoma after an unwitnessed fall. During his hospitalization, staff observed apparent altered mental status, poor attention, disorganized responses, and agitation. Given these findings, interventions such as restraints and antipsychotics were considered. However, the patient's language barrier had not been fully accounted for. Further evaluation using a professional Cantonese interpreter and a formal Confusion Assessment Method (CAM) instrument revealed that the patient was cognitively intact. His apparent inattention and disorganized thinking resulted from communication difficulties rather than delirium. Once appropriate language support was provided, his mental status was re-assessed and delirium was ruled out, and the planned interventions were held, preventing iatrogenic harm. Language barriers can significantly impact delirium assessments, leading to misdiagnosis and improper management. Using interpreter services combined with standardized delirium screening instruments is crucial in improving diagnostic accuracy of mental status assessment in non-English-speaking patients. As the aging population becomes more diverse, language-concordant care must be prioritized to ensure patient-centered care.
