Purpose: Pragmatic clinical trials are essential for moving evidence-based practices into routine care for people living with dementia, yet few early career researchers (ECRs) receive formal preparation to design or conduct such trials. Method: This methods-focused article synthesizes lessons learned by ECRs using pragmatic data sources across nursing, social work, neuropsychology, occupational therapy, and speech-language pathology. Guidance was organized on four principles: engaging partners across roles and care levels; including representative participants; attending to organizational strain and readiness; and learning from adaptations. Results: Case examples show how teams identify and use existing data, collaborate with care teams and families to collect data in a feasible manner, tailor methods to cultural and linguistic contexts, and balance fidelity with necessary flexibility during implementation. Conclusion: Situated within these principles, this methods-focused article offers practical direction to advance pragmatic trials in dementia care and supports early career development.
PURPOSE:The current integrative review examines anticipated stigma as a newer subdomain of stigma barrier to cannabis use disclosure among older adults and synthesizes current evidence on its implications for care delivery, patient safety, and provider engagement. METHOD:Using Whittemore and Knafl's integrative review framework, a systematic literature search was performed across CINAHL, PubMed, PsycINFO, and Scopus to identify peer-reviewed articles published from 2010 to 2025. These studies were screened and analyzed to assess their relevance to anticipated stigma, cannabis use, and disclosure among adults aged ≥60 years. RESULTS:Twenty-five studies met inclusion criteria. Results indicate that stigma, stemming from ageism, legal ambiguity, and provider bias, leads to nondisclosure of cannabis use. This concealment affects medication safety, therapeutic relationships, and health outcomes. CONCLUSION:Addressing anticipated stigma is essential for enhancing cannabis-related care for older adults. Future research should inform stigma-aware communication strategies and provider training programs that encourage disclosure and focus on patient-centered care.
PURPOSE:To examine the association between intergenerational support from children and successful aging among older adults. METHOD:Using data from 6,573 adults (aged ≥60 years) in the 2020 China Health and Retirement Longitudinal Study, intergenerational support was measured across three dimensions, and successful aging was defined according to Rowe and Kahn. Multivariate logistic regression analyzed their association, and a classification and regression tree (CART) model explored multi-factor interactions. RESULTS:Caregiving, higher financial support, and moderate monthly emotional contact were each significantly associated with greater odds of successful aging. CART analysis further revealed that although health and education served as foundational factors, their associations with successful aging were synergistically moderated by intergenerational support. CONCLUSION:Successful aging is closely linked to the interplay of individual characteristics and intergenerational support. Policies should therefore prioritize health promotion and educational investment while facilitating differentiated intergenerational support strategies.
PURPOSE:The current study aimed to assess the status and associated factors of fall risk perception among community-dwelling older adults in China, conceptualized within the Theory of Planned Behavior as a determinant of attitudes and intentions toward fall prevention behaviors, which could provide evidence for fall prevention strategies. METHOD:Between November 2023 and March 2024, a convenience sampling method was used to recruit older adults from a community in Quzhou, Zhejiang Province. Data were collected using a self-designed questionnaire and the Community Elderly Fall Risk Perception Scale. RESULTS:A total of 267 community-dwelling older adults participated in the current study, with a mean fall risk perception score of 62.12 (SD = 13.25). Univariate analysis revealed that age, educational level, household location, history of falls within the past year, vision condition, number of medications, use of walking aids, perceived physical health condition, fear of falling, and living situation, were significantly associated with fall risk perception among older adults (all p < .05). Subsequent multivariate linear regression analysis identified fear of falling, number of medications, use of walking aids, educational level, and living alone as independent predictors of fall risk perception (all p < .05). There were differential effects of these factors on fall risk perception in men and women. CONCLUSION:Community-dwelling older adults from this sample exhibited a moderate level of fall risk perception, indicating that although they recognize potential for falls, there may still be gaps in their awareness or understanding of personal risk factors. This perception is shaped by a combination of factors, underscoring importance of fall prevention. It is imperative that community health workers assist older adults to gain an accurate understanding of their fall risks and facilitate development of tailored fall prevention strategies.
PURPOSE:The current study examined the association between social activity engagement and cognitive frailty among nursing home residents. METHOD:A cross-sectional study was conducted in two hospital-affiliated nursing homes in southern Taiwan. A convenience sample of 159 residents was recruited. Cognitive frailty was defined as the coexistence of physical frailty, assessed using the Study of Osteoporotic Fracture Index, and mild cognitive impairment, measured by the Montreal Cognitive Assessment. Social activity engagement was assessed using the Socially Supportive Activity Inventory, which includes nine activities in long-term care settings. RESULTS:In unadjusted analyses, higher participation in religious activities was associated with lower odds of cognitive frailty. After adjusting for age, sex, comorbidities, hyperpolypharmacy, activities of daily living, and depressive symptoms, participation in activities organized by outside organizations and religious activities remained significantly associated with reduced cognitive frailty. CONCLUSION:Social activities involving meaningful and reciprocal interaction may support cognitive health and help prevent cognitive frailty among nursing home residents.
PURPOSE:Older adults living with Alzheimer's disease and related dementias (ADRD) receiving skilled nursing facility (SNF) care have different clinical trajectories and care needs compared to those without ADRD. Little is known about whether palliative care affects these two populations differently. METHOD:We conducted a secondary comparative cohort analysis of a feasibility pragmatic pilot trial (n = 52) to explore the effect of a primary palliative care intervention among older adults with and without ADRD. SNF nurse practitioners received training in the delivery of a primary palliative care intervention. The Palliative Outcomes Scale version 2 measured quality of life at baseline and 14 to 21 days follow up. RESULTS:No statistically significant intervention effect was found; however, quality of life scores in the ADRD cohort trended toward improvement, whereas the non-ADRD cohort trended toward worsening with a similar effect size. CONCLUSION:Further research is needed to optimize palliative care interventions for SNF residents with different illness trajectories.
Purpose: The current study aimed to examine the association between cognitive function, fear of falling, and physical activity and assess the moderating effect of physical activity on the association between cognitive function and fear of falling. Method: A cross-sectional study was conducted among community-dwelling older adults ( N = 255, mean age = 74.7 years, SD = 7.4 years). Sedentary time (ST), moderate-to-vigorous physical activity (MVPA), and light-intensity physical activity were measured using an accelerometer. Bivariate analyses and a regression model were conducted to determine the moderating effect of physical activity. Results: The regression model found a statistically significant association between ST and fear of falling (β = 0.008; p < .001), and the moderating effect of physical activity was not significant. Conclusion: Findings suggest that older adults should engage in more MVPA rather than ST. The current study did not establish the moderating effect of physical activity.
Purpose: Smart speakers can support aging in place, yet older adults from low-income communities face barriers to adoption due to limited training and instructional materials. The current article outlines a user-centered design approach to developing and evaluating tailored video tutorials and print materials that teach smart speaker functions to low-income older adults in subsidized housing. Method: The four-phase study involved: Phase 1, needs assessment through focus groups with residents ( n = 5) and housing staff ( n = 3); Phase 2, prototype development with resident co-designers ( n = 2); Phase 3, pilot testing through individual interviews with users ( n = 5) and non-users ( n = 5); and Phase 4, evaluation of short-term effects on health and wellness. Results: The protocol integrates design thinking, systems approach to training, and Kirkpatrick Model frameworks to ensure community-responsive development and comprehensive evaluation. Conclusion: This replicable protocol offers a framework for developing equitable digital learning tools for underserved older adults through community partnership and iterative user-centered design.
Purpose: The current study aimed to explore the practical challenges encountered by family caregivers when assisting community-dwelling people with dementia during mealtime. Method: Using a descriptive qualitative design, 18 family caregivers of people with dementia who experienced feeding difficulties were recruited from the Neurology Outpatient Department and Memory Clinic of the First Affiliated Hospital of Wenzhou Medical University between November 2024 and May 2025. Data were collected through face-to-face semi-structured interviews and analyzed using inductive content analysis. Results: Data analysis identified four interrelated categories describing the day-to-day practical challenges encountered by caregivers during mealtime assistance: functional decline, problematic eating behaviors, communication breakdown, and resistance to care. Conclusion: Mealtime assistance in dementia care involves multifaceted, practice-level challenges that extend beyond nutritional management. Findings provide an empirically derived framework to guide clinical assessments and inform targeted, skill-based caregiver support.
Purpose: Many people living with dementia (PLWD) with advancing disease are unable to access office-based care for primary and dementia care. Nurse practitioners (NPs) could fill this gap. The objective of the current review was to determine patient, caregiver, and health care system outcomes of home-based dementia care models that use NPs. Method: A scoping review was completed using the Arksey and O'Malley Framework. Two independent reviewers completed title/abstract and full-text screening. Data were extracted using Microsoft Excel. A thematic synthesis was completed to summarize findings. Results: The search yielded 4,410 citations; 17 articles met inclusion criteria, reporting on 10 models. Outcomes included high-quality care, decreased emergency department use, decreased acute care length of stay, delayed facility-based long-term care placement, and high rates of advanced care planning and transition to palliative care. Conclusion: Home-based dementia care models that use NPs for longitudinal care have the potential to support aging in place.
PURPOSE:To examine psychological well-being, depressive symptoms, and social support among bereaved older adults attending geriatric clinics in Nigeria, with particular attention to geographic, cultural, and clinical diversity, as well as other sociodemographic predictors. METHOD:A multicenter cross-sectional study was conducted across six tertiary hospitals representing Nigeria's geopolitical zones. A total of 378 bereaved older adults (aged ≥60 years) were recruited using purposive sampling. Data were collected via an adapted questionnaire incorporating validated scales. Descriptive and inferential analyses were performed. RESULTS:Only 40.2% of participants reported positive well-being, whereas a higher proportion, 61.1% (n = 231), had at least one depressive symptom. Psychological well-being was significantly higher among participants aged ≥70 years, females compared to males, Christians compared to those with other religious affiliations, and those without chronic disease or alcohol intake (p < .001). Social support was moderate overall across study sites. CONCLUSION:Bereaved Nigerian older adults experience a substantial psychological burden. Age, sex, and health status were significant predictors of mental well-being. These findings underscore the need for targeted and culturally sensitive psychosocial interventions across Nigeria's diverse older adult population.
PURPOSE:The current study examined multidisciplinary staff's perceptions of the impact of staff-patient interactions in short-term nursing home units. METHOD:We conducted five focus groups with 32 nursing home staff with experience in subacute/post-acute care (e.g., nursing, therapy). Two independent coders analyzed qualitative data using thematic analysis. RESULTS:Four themes emerged: High Emotional Expression Among Short-Stay Patients; Clinical Care Team Making Sense of Patients' Emotions; Bidirectional Exchange of Emotions Between Patients and Staff; and Coping With Emotions is a Normal Part of the Job/Workplace. CONCLUSION:Staff-patient interactions led to negative (e.g., emotional exhaustion, imposter syndrome) and positive (e.g., patient gratitude) experiences among staff. Participants described a bidirectional relationship between staff and patient emotions. Findings may help identify opportunities to strengthen interpersonal effectiveness and emotion regulation among staff and patients as well as strategies to improve unit culture and organizational support (e.g., social support, flexible assignments, psychological services).
PURPOSE:To assess financial toxicity and its predictors among South Korean family caregivers of people living with dementia (PLWD). METHOD:In the current cross-sectional survey, 230 family caregivers of PLWD were recruited from a tertiary hospital outpatient clinic and five community-based dementia care centers in South Korea. Data were collected using validated instruments. Multiple linear regression was used to identify predictors of financial toxicity. RESULTS:Among participants, 64.7% experienced moderate to severe financial toxicity (mean score of the Korean version of the Comprehensive Score for Financial Toxicity = 22.65 [SD = 8.27]). Higher caregiver burden (B = -0.35, 95% confidence interval [-0.46, -0.24]), female sex, younger age, and poor self-rated health were statistically significant predictors. CONCLUSION:Most family caregivers of PLWD in South Korea experience considerable financial toxicity, strongly associated with caregiving burden. Findings highlight the need for tailored psychological and financial interventions, and policy support for high-risk family caregivers of PLWD.
PURPOSE:The current study investigated the serial mediating effects of nutritional status and sarcopenia on the relationship between oral frailty and cognitive function among community-dwelling older adults. METHOD:A cross-sectional study was conducted with 126 older adults aged ≥65 years at a public health center in South Korea. Oral frailty, nutritional status, and cognitive function were assessed using structured questionnaires. Sarcopenia was evaluated based on muscle mass, grip strength, and gait speed. RESULTS:Oral frailty was significantly associated with cognitive decline. Nutritional status and sarcopenia sequentially mediated this relationship, suggesting a muscle-brain-nutrition pathway that links oral health to cognitive outcomes. CONCLUSION:Findings highlight the importance of early detection and intervention for oral frailty. Gerontological nursing interventions should integrate oral health assessment, nutritional support, and physical activity promotion to maintain cognitive function in older adults.
PURPOSE:Adverse childhood experiences (ACEs) have been confirmed to be associated with cognitive function, but their influence on the trajectories of cognitive function among middle-aged and older adults in China is not well understood. The current study sought to identify distinct trajectories of cognitive function and examine the influence of ACEs on these trajectories. METHOD:Data from 3,024 participants aged ≥45 years from four waves of the China Health and Retirement Longitudinal Study (CHARLS 2011-2018) were analyzed. Cognitive function was assessed using episodic memory and mental intactness measures, with ACEs retrospectively reported in the 2014 life history survey. Latent growth mixture modeling (LGMM) identified distinct cognitive trajectories, and multinomial logistic regression examined the association between ACEs and cognitive trajectory. RESULTS:LGMM revealed three cognitive trajectories: Class 1 (stable increasing type with low starting point), Class 2 (descending type with high starting point), and Class 3 (descending type at the middle level). Higher ACEs scores were associated with increased likelihood of belonging to the less favorable cognitive function trajectories. CONCLUSION:Findings suggest that ACEs are significantly associated with cognitive function among middle-aged and older adults in China, with higher ACEs scores being more likely to be associated with less favorable cognitive function trajectories.
PURPOSE:To explore trends and associated factors of loneliness among older adult men and women. METHOD:The current study analyzed data from the Taiwan Longitudinal Study on Aging database, including 1,333 individuals aged ≥65 years over an 8-year period (2007-2015). Changes in loneliness were examined separately for men and women. Generalized estimating equation analysis identified the determinants of loneliness. RESULTS:The prevalence of loneliness increased with age in both genders: for men, 9.1% (2007), 12% (2011), and 12.4% (2015); for women, 12.4% (2007), 15.5% (2011), and 18.7% (2015). For men and women, loneliness was associated with lack of spouse, living alone, poor self-reported health, physical function impairment, lower financial satisfaction, and reduced emotional support. Hearing impairment was significant for men, whereas visual impairment, lack of emotional support, and absence of social engagement were significant for women. CONCLUSION:Findings highlight the importance of developing gender-specific interventions to address loneliness among older adults.
Purpose: To examine the relationship between digital competence and chronic disease management self-efficacy in older adults, with a focus on the mediating role of telemonitoring readiness. Method: A cross-sectional study was conducted among 196 older adults with chronic diseases in Saudi Arabia. Participants completed validated measures assessing digital competence, telemonitoring readiness, and chronic disease management self-efficacy. Data were analyzed using Pearson correlation and mediation analysis via the PROCESS macro. Results: Significant positive relationships were found between digital competence and telemonitoring readiness (r = 0.35, p < .01), digital competence and self-efficacy (r = 0.68, p < .01), and telemonitoring readiness and self-efficacy (r = 0.43, p < .01). Telemonitoring readiness significantly mediated the relationship between digital competence and self-efficacy, contributing 14.7% of the total effect. Conclusion: Enhancing digital competence and telemonitoring readiness is crucial for improving chronic disease management self-efficacy among older adults. Health care strategies should focus on digital literacy programs and increasing telemonitoring readiness to foster better health outcomes. Digital literacy programs, nurse-led support, and policy initiatives should prioritize telemonitoring adoption to enhance self-efficacy among older adults.
PURPOSE:The current study estimated the prevalence of sarcopenia and identified sociodemographic, behavioral, and biochemical factors associated with sarcopenia among rural older adults in South Korea. METHOD:Data from the 2022 Korea National Health and Nutrition Examination Survey were analyzed for 332 rural adults aged ≥65 years. Sarcopenia was defined by the 2019 Asian Working Group for Sarcopenia criteria using appendicular skeletal muscle mass index and handgrip strength. Receiver operating characteristic analysis determined the optimal age cutoff, and multivariate logistic regression identified predictors. RESULTS:Sarcopenia prevalence was 11.4%. Significant factors included age ≥74 years (odds ratio [OR] = 2.739), body mass index ≤23 kg/m2 (OR = 4.986), vitamin D deficiency (OR = 0.345), and inadequate aerobic activity (OR = 0.177). CONCLUSION:Sarcopenia is prevalent among rural Korean older adults. Interventions addressing vitamin D deficiency and physical inactivity may support independence and healthy aging in underserved populations.
