Adult foster care may represent a viable alternative to nursing homes for dependent older adults. This study aimed to estimate the annual and daily cost of adult foster care for older adults. The Karukera Study of Aging in Foster Families is a prospective, one-year observational study including adults aged 60+ living in adult foster care in the French Caribbean Islands. We measured healthcare resource utilization using the RUD (Resource Utilization in Dementia)-Lite instrument. Costs related to healthcare consumption, foster caregiver remuneration, and training were estimated and expressed per patient-year. A total of 106 older adults (mean age: 82.2±11.2 years; 61.3% women) were followed for one year (mean follow-up duration: 306.1±90.8 days). The daily cost of outpatient care was estimated at €33.3, of which €29.9 corresponded to community nursing visits. Caregiver remuneration and training represented a daily expenditure of €62.8 per older adult. The total annual cost of adult foster care was estimated at €35,076, or €96.1 per resident per day. Hospitalization costs were estimated at €224.0 per patient-year, while emergency department visits accounted for €42.0 per patient-year. Compared with a daily cost of €121 per resident in metropolitan nursing homes and €150 per resident in nursing homes in the French Caribbean Islands, adult foster care reduced costs by 20.6% and 35.9%, respectively. In the context of constrained healthcare budgets and increasing demand for long-term care related to dependency, adult foster care may represent a scalable and economically sustainable alternative. NCT04545775
Close relationships that are characterized by both positive and negative qualities (i.e., ambivalent ties) are common in later life and often give rise to interpersonal tensions with deleterious consequences for well-being. However, little is known about their effect on cognitive health. These effects may depend on seldom-studied interpersonal coping strategies that may either stimulate or deplete cognitive resources. This study tested whether ambivalent ties relate to lower cognitive functioning among older adults, and whether interpersonal coping strategies moderate these associations. As part of the Daily Experiences and Well-being Study (DEWS), participants (N = 271, ages 65-89) completed an in-person baseline interview assessing positive and negative qualities of their close social relationships and overall cognitive functioning (composite of four tests), followed by a self-administered questionnaire assessing three interpersonal coping strategies (engaged, avoidant, destructive). Linear regression models revealed that a greater proportion of ambivalent ties was associated with worse overall cognitive functioning, but this association was not moderated by any interpersonal coping strategy. Sensitivity analyses of the separate cognitive tests revealed, unexpectedly, that greater use of engaged coping strengthened the association between ambivalent ties and worse executive functioning performance. A greater proportion of ambivalent ties in one’s social network is associated with lower cognitive functioning among older adults, a link that may not easily be buffered through coping. Results suggest that ambivalent ties are an understudied important potential risk factor for adverse cognitive outcomes in later life.
Abstract Background and Objectives Physical inactivity accelerates functional decline in rural older adults with limited exercise resources. Although bodyweight training is scalable, whether benefits depend on professional supervision remains unclear. We compared professional- and trained volunteer-led bodyweight training programs (BWTP) on functional fitness and body composition in rural community-dwelling older adults. Research Design and Methods In this quasi-experimental, community-based, three-group pretest-posttest study with community-level allocation (April 2021-January 2022), adults aged ≥65 years who were independent in activities of daily living and not engaged in other regular exercise programs were assigned to a professional trainer, trained volunteer, or comparison group. The intervention groups received a 12-week BWTP. Functional fitness and body composition were assessed pre- and postintervention, and Group × Time effects were examined using two-way mixed ANOVA. Results Among 72 participants (Professional Trainer Group, PTG, n = 25; Volunteer Trainer Group, VTG, n = 22; Comparison Group, CG, n = 25), several functional fitness outcomes showed significant Group × Time interactions (p ≤ .003; partial η² = .155-.248). Both intervention groups improved mobility and postural stability more than the CG. PTG improved handgrip strength versus CG (Hedges’ g = 0.85), whereas VTG showed the largest lower-limb muscular endurance gain (g = 1.26). CG declined in several functional measures. No body-composition outcome remained significant after adjustment. Discussion and Implications Trained volunteer-led BWTP may extend exercise delivery and support functional fitness in resource-limited rural communities. Hybrid models with professional oversight warrant evaluation because body-composition effects did not persist after multiplicity adjustment.
