Development of Universal Design Mobile Interface Guidelines (UDMIG) for Aging Population

Taiwan has a fast-aging population, and it is expected to see an associated increase in the number of older adults with disabilities. We aimed to understand whether Taiwanese older adults’ disability trajectories mediated the association between disablement process factors and later long-term care (LTC) service use. Data were from the nationally representative Taiwan Longitudinal Study on Aging Survey, 1996–2007 (N = 3,429). Trajectories of disability in activities of daily living and instrumental activities of daily living were identified by using growth mixture modeling. Structural equation modeling was applied to examine the effect of disability trajectory as mediator on disablement process factors, such as demographics, number of comorbidities, depression, and leisure activities (LAs), and on later LTC service use. Three distinct disability trajectories were identified among the group of surveyed older adults: healthy (N = 2,998, 87.43 %), progressive disability (N = 363, 10.59 %), and maintained disability (N = 68, 1.98 %). These disability trajectories, either progressive disability or maintained disability trajectory, were found to have a positive mediating effect on the association between disablement process factors (older, lower educational attainment, larger number of comorbidities, and depressive symptoms) and greater use of LTC services. However, encouraging older adults to engage in LAs reduced later use of LTC services through both total and significant mediating effect of postponing development of disability trajectory in older Taiwanese adults. These findings suggest that an active lifestyle is important for older adults’ physical health and to decrease the societal burden of LTC service use.

There is extraordinary growth in the number and proportion of older adults in almost every country around the world. Low birthrates and low death rates are transforming the age structure of societies. Certainly, societies face challenges in ensuring economic security and health care to burgeoning older populations. It is true that growing numbers of older adults are physically and cognitively frail from the chronic conditions prevalent in late life. However, a larger number of older adults are fit and functioning, with as many as twenty years of life after formal retirement. And it is likely that the average age for the onset of dependency and death will continue to rise. By and large, the discussion of population aging has focused on “age drain”—the burden of older adults on the economy and the health-care system. We do not deny that chronic conditions and resulting disabilities eventually curtail human capacity for certain activities and that many older adults need supportive services. However, the productive aging perspective suggests that health and social services do not sufficiently address the issues of an aging society. The “age drain” perspective ignores the growing human capital of the older population, especially as education levels increase. This capacity can be engaged in activities that make economic and social contributions to society, including working, volunteering, caregiving, and grandparenting. This engagement can lead to multiple positive ends: offsetting the financial strains of an aging population, contributing to the betterment of society, and maintaining the health of older adults (Morrow-Howell, et al. 2001, cited under Introductory Works). This bibliography defines productive engagement in later life as the participation of older adults in activities that produce goods and services, whether paid for or not. This includes working, volunteering, and caregiving. Other scholars include educational and training activities. Indeed, there is not a set definition, but the term “productive engagement” represents the shift from the perspective that sees older adults as burdens to one that views them as contributors. As seen in the literature presented here, scholars have sought to understand current levels of productive engagement, factors associated with this engagement, programs and policies that promote engagement, and the outcomes of engagement to the individual, families, communities, and society. This article reflects a broad scope of critical issues associated with productive engagement in later life. Its author gratefully acknowledges the assistance of Morgan Van Vleck and Sophie Mauk, graduate students at the George Warren Brown School of Social Work at Washington University in St. Louis in creating this bibliography.

The prevalence of car dependence and sedentary lifestyles has created concern in the transportation and health sectors. Walking is the most popular and practical kind of exercise that can significantly enhance health. In Chile, more than half of older adults have health issues and almost 72% of the elderly population never engages in physical activity. This study aims to investigate the relationship between older adults’ walking behavior and the built environment along the streets and parks in Santiago’s middle-income neighborhoods. Six medium-income central and pericentral neighborhoods of Santiago were selected. The average number of older persons who walk along the paths and two modified audit forms were used to measure walking behavior and built environment features, respectively. Both correlation analysis and backward regression were used to examine the associations. While elements like the existence of bus stops, pedestrian streets, and general cleanliness contribute to the enhanced number of older adults who walk along street segments, the presence of insecurity signs was found to be negatively associated with the number of older adults who walk in the neighborhood parks. Furthermore, complexity and mystery showed a negative association with the number of older adults in the neighborhood parks. Urban policymakers might use these findings to encourage older adults to walk more in Santiago’s medium-income neighborhoods.

The number of older adults in the USA is growing rapidly and by 2030 Americans aged 65 years or older will account for roughly 20% of the total population. We estimate multidimensional deprivation among the elderly in the US Deprivation is measured in four distinct dimensions of well-being: health condition, standard of living, education and economic security measured by housing costs. Three different indices are estimated to analyze the joint impact of deprivation in these dimensions on older adults’ overall welfare. The study uses the American Community Survey which is the largest nationally representative household survey in the USA. Results show that, around 38% of the elderly were deprived in at least one dimension, 12% in at least two dimensions. Deprivation prevalence was higher among Asians and Blacks and especially among the Hispanic. Older Hispanic adults were predominantly deprived in education and income. The study argues that measuring disparity in overlapping dimensions will be useful to design effective policies in the future.

In 2016, Statistics Canada released the results of the most recent census. For the first time ever, the proportion of Canadians aged 65-plus years surpassed the proportion aged 15 and under. The increase in the proportion of older adults was viewed as further evidence of the faster rate of aging of Canada’s population. Such demographic shifts are not unique to Canada; many industrialized nations around the world are experiencing similar changes in their populations. Increases in the older adult population in many countries might produce beneficial outcomes by increasing the potential for intergenerational contact and exposure to exemplars of successful aging. Such positive intergenerational contact could counter prevailing age stereotypes and improve intergenerational relations. On the other hand, such increases in the number of older adults could be viewed as a strain and potential threat to resources shared with younger age groups. The possibility of increased intergenerational conflict makes it more important than ever before to understand how older adults are stereotyped, how those stereotypes can produce different kinds of biased behavior toward them, and what the impact of those stereotypes are on older adults themselves. Social-cognitive age representations are complex and multifaceted. A common stereotype applied to older people is one of warmth but incompetence, often resulting in paternalistic prejudice toward them. However, such benevolent prejudice, characterized by warm overtones, can change to hostile bias if older adults are perceived to violate prescriptive norms about age-appropriate behavior. In addition to coping with age prejudice, older adults also have to deal with the deleterious effects of negative age stereotypes on their day-to-day function. Exposure to negative aging stereotypes can worsen older adults’ cognitive performance in a number of contexts. As well, age stereotypes can be incorporated into older adults’ own views of aging, also leading to poorer outcomes for them in a variety of domains. A number of interventions to counteract the effects of negative aging stereotypes appear promising, but more work remains to be done to reduce the impact of negative aging stereotypes on daily function in later life.

BackgroundSince 2008, the number of older adults has increased by 34% and is expected to nearly double by 2060. Among US older adults over 70 years of age, 22‐30% report difficulty performing at least one activity of daily living (ADL). ADL performance is associated with functional fitness parameters. Negative longitudinal changes in functional performance among older adults are associated with cognitive decline and may be able to predict future cognitive impairment. Thus, it is imperative to understand the influence of cognition on functional fitness among older adults.Method84 older adults (80.9+5.4 years) consented to have their functional fitness and cognition assessed. Functional fitness parameters included the following assessments: Short Physical Performance Battery (SPPB), 10‐meter walk (habitual and fast), dual‐task (habitual and fast), power chair stand assessment (average and peak power and velocity). Cognition was assessed using the Montreal Cognitive Assessment (MoCA) and a digital Visual Paired Comparison (VPC) task. Categories of low and high cognitive function were determined using the VPC results. A one‐way ANOVA was conducted to determine differences between cognitive groups.ResultParticipants with high cognitive performance scored significantly better on the SPPB, 10‐meter fast walk, dual‐task fast condition, and average velocity during the power chair stand assessment. SPPB scores were 10.2% lower among older adults with low cognitive performance (p = .04). The high cognition group walked 16.5% (0.16 m/s) faster when compared to the low cognitive group (p = .04). Dual‐task (fast) performance was 13.2% slower among the low cognition group (p = .03). Additionally, low cognitive older adults moved 16.7% slower when rising from a seated position during the power chair stand task (p = .01). MoCA was 2.76 points lower among the low cognition group (p < .001).ConclusionBased on the current results, a relationship exists between functional fitness and cognitive performance in older adults. However, it remains unknown whether functional fitness can influence cognition or vice versa and how these impact ADL performance. Future research is warranted to determine if and how the relationship between cognitive function and functional fitness changes over time in older adults.

Modeling the effect of social media on older adults’ usage intention of public transport

BackgroundWith a rapidly ageing population and a decline in the availability of family caregivers, the number of older adults with disabilities who have unmet long-term care needs is gradually increasing worldwide. However, whether there are gender differences in the association between primary caregivers or their attitudes and unmet needs for activities of daily living (ADL) assistance remains largely unknown.MethodsThis study used the latest 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), containing the data of 1187 older adults with disabilities aged 65 and older, to identify gender differences in the attitudes of primary caregivers toward the unmet needs for ADL assistance among with disabilities adults in China. Binary logistic regression analysis was conducted to determine the effects of primary caregivers and their caregiving attitudes on the unmet care experiences of older adults with ADLs. In addition, a gender-stratified analysis was conducted to compare the differences based on older adults’ gender.ResultsThe results revealed that the lack of positive attitudes from primary caregivers might create a situation of unmet needs for ADL assistance among older adults. When family members carry the main burden of care, older adults with disabilities, especially older women, have a lower level of unmet needs for ADL assistance. Therefore, it is important to consider gender-specific interventions to improve ADL assistance among older adults.ConclusionsThe findings suggest that the presence of a family member as a caregiver has a significant effect on unmet needs for ADL assistance in women, highlighting the importance of developing an emotional bond with the caregiver. Given that the availability of informal caregivers, such as family members, is declining, it is crucial to provide financial assistance and formal services, such as paid home services and community-based care services, and reduce the burden on family caregivers to address the unmet needs for ADL assistance among older adults with disabilities in China.

Background: As the number of older adults in Thailand continues to increase, along with increased incidence of surgical intervention that causes pain, the quality of pain care in older adults is needed. Nurses are primarily responsible for assessing and managing pain in older adults (Jose Closs, 2008; Prowse, 2007). The use of evidencebased practices (EBPs) improves quality of care and saves healthcare cost. However, in Thailand where empirical study of using EBP related to pain in older adults is limited, research to understand how Thai nurses use EBP acute pain in older adults is needed. Purpose: The purpose of this study is to describe current practices, perceived barriers and perceived facilitators of Thai nurses on using EBP for assessing and managing acute pain in postoperative older adults. Method: A descriptive exploratory survey was conducted in 8 mid and large-size hospitals in Thailand. The Acute Pain EBP Questionnaire (APEBPQ) (Suwanraj, 2009) was distributed to 240 Thai nurses. 236 questionnaires were returned with the response rate of 98.3 percent. Open-ended questions related to barriers and facilitators of using EBPs were coded to identify major themes. MANOVA was performed to explore the differences between years of nursing experience on perceived barriers and facilitators. Results: The majority of participants are female (96.8%) with mean age 35.5 years (range=23-54). Thai nurses reported using 51/53 recommendations from EBPG Acute Pain most of the time/always (95%). Using an equianalgesic table (1.80±1.16) and assessing MMSE in older adults with postoperative pain (1.74±1.15) were occasionally used. Research reports published in English was the greatest barriers. Nurses perceived greatest support from a Head ward than other colleagues. Nurses with 11-20 years of nursing experience had higher reported barriers than those with 1-10 years of nursing experience.

BackgroundGhana is currently undergoing a profound demographic transition, with large increases in the number of older adults in the population. Older adults require greater levels of healthcare as illness and disability increase with age. Ghana therefore provides an important and timely case study of policy implementation aimed at improving equal access to healthcare in the context of population ageing.This paper examines the determinants of National Health Insurance (NHIS) enrolment in Ghana, using two different surveys and distinguishing between younger and older adults. Two surveys are used in order to investigate consistency in insurance enrolment. The comparison between age groups is aimed at understanding whether determinants differ for older adults. Previous studies have mainly focused on the enrolment of young and middle aged adults; thus by widening the focus to include older adults and taking into account differences in their demographic and socio-economic characteristics this paper provides a unique contribution to the literature.MethodsUsing data from the 2007-2008 Study on Global Ageing and Adult Health (SAGE) and the 2012-2013 Ghanaian Living Standards Survey (GLSS) the determinants of NHIS enrolment among younger adults (aged 18-49) and older adults (aged 50 and over) are compared. Logistic regression explores the socio-economic and demographic determinants of NHIS enrolment and multinomial logistic regression investigates the correlates of insurance drop out.ResultsSimilar results for people aged 18-49 and people aged 50 plus were revealed, with older adults having a slightly lower probability of dropping out of insurance coverage compared to younger adults. Both surveys confirm that education and wealth increase the likelihood of NHIS affiliation. Further, residential differences in insurance coverage are found, with greater NHIS coverage in urban areas. The findings give assurance that both datasets (SAGE and GLSS) are suitable for research on insurance affiliation in Ghana.ConclusionThe paper indicates that although the gap in coverage among rich and poor and urban and rural residents appears to have decreased, these factors still determine NHIS coverage of younger and older adults. The same holds for education. Increasing efforts are needed to ensure equal access to healthcare.

Context: India at present is experiencing a phenomenal increase in the number of older adults. Old age is marked by challenges across multiple domains of life. To overcome the challenges of old age, the focus should be on improving the quality of life (QOL) and meaning in life (MIL) of older adults. Aim: This study aimed to determine the effect of leisure activity on QOL and MIL of male and female older adults in old-age homes. Methodology: A cross-sectional study was conducted among 120 male and female retired older adults (65–80 years), living in old-age homes of Hooghly district, West Bengal, using the Older People's Quality of Life Questionnaire (OPQOL-35) by Bowling and Meaning in Life Questionnaire (MLQ) by Steger, Frazier, Oishi, & Kaler. Results: Older adults who engaged in active leisure activities had higher QOL and MIL than those engaged in passive leisure activities. Male older adults had higher QOL and MIL than female older adults. Conclusion: Opportunities to pursue active leisure activities should be promoted among older adults in old-age homes.

Breast cancer is a disease associated with aging. In the US, the median age of breast cancer diagnosis and death is 61 years and 68 years, respectively. The number of older adults in the US is rising, and the number of individuals age 65 and older is expected to double by the year 2030. This demographic shift will lead to an increase in the number of individuals diagnosed with breast cancer. It is estimated that from 2010 to 2030 there will be a 57% growth in the number of new cases of breast cancer in patients age 65 and older.1 A challenge in caring for older adults with breast cancer is that they have been historically underrepresented in clinical trials that set the standard for breast cancer care.2 However, a growing body of evidence-based literature can be utilized to inform and optimize the care of the older adults with breast cancer. This presentation will focus on the treatment of early stage breast cancer in older adults, including the risks and benefits of local and systemic therapies, as well as survivorship issues. Recently reported phase III studies have led to advances in the treatment of older adults with breast cancer. A phase III randomized study evaluated the role of radiation therapy following lumpectomy in patients age 70 and older with stage I hormone receptor (HR) positive breast cancer who received treatment with tamoxifen. Receipt of radiation therapy was associated with a decrease in the risk of locoregional recurrence; however, there was no difference in overall survival. The study results underscore the importance of competing comorbidity as a cause of death in older adults with early stage breast cancer.3 The role of axillary lymph node dissection was evaluated in a randomized study of women over age 60 with node-negative, HR positive breast cancer who received treatment with tamoxifen. Patients were randomized to breast surgery and axillary dissection, or breast surgery alone. There was no difference between disease-free and overall survival in the 2 study arms.4 A phase III randomized study evaluated the efficacy of standard adjuvant IV chemotherapy (doxorubicin and cyclophosphamide [AC] or cyclophosphamide, methotrexate, and 5-fluorouracil [CMF]) versus oral chemotherapy (capecitabine) in patients age 65 and older with stage I-III breast cancer. Those patients who received standard chemotherapy showed improvement in progression-free and overall survival compared with patients who received capecitabine. This study demonstrates that IV polychemotherapy regimens remain the standard of care for older adults who are prescribed adjuvant chemotherapy.5 These phase III studies advance our understanding in the care of older adults with breast cancer. Furthermore, they demonstrate the feasibility and importance of accruing older adults to phase III trials, which will improve our evidence-based care of this growing population.

Background: The global population aged 60 years and above is projected to increase from 1.1 billion in 2023 to 1.4 billion by 2030. Regular physical activity is a crucial health-promoting behavior for older adults, playing a significant role in preventing and delaying various chronic diseases and premature mortality. This study investigated the relationship between socioeconomic status and physical activity among older adults residing in Selseleh County, Lorestan Province. Iran. Materials and Methods: This descriptive-analytical cross-sectional study was conducted on a sample of 500 older adults from Selseleh County, Lorestan Province, Iran, selected through multi-stage random sampling. In the first stage, proportional quota sampling based on health centers was used to allocate a sample size commensurate with the older adult population of each center. In the second stage, all health houses and health sites under the coverage of each center were alphabetically ordered, the number of older adults in each house or health sites was specified, and then sample numbers were randomly selected. Finally, the participants in the study were identified through the SIB system and enrolled in the study. Resulte: Overall, the mean physical activity score was 124.11±30.28 minutes per week (males: 155.12±51.93 minutes; females: 88.71±24.42 minutes). Moreover, 43.0% of the participants reported low physical activity, 22.0% reported moderate activity, and 35.0% reported high activity. Data showed a significant inverse relationship between education level, socioeconomic status, age, and physical activity (P<0.001). A significant relationship was found between marital status and physical activity (P<0.001), with married individuals exhibiting higher mean physical activity compared to other groups (single, divorced, and widowed individuals). Furthermore, a significant relationship was observed between gender, place of residence, and mean physical activity (P<0.001), with higher means noted in rural areas and among males. Conclusion: The findings from this study indicated that the majority of older adults surveyed engaged in low to moderate physical activity. Given that the World Health Organization identifies the level of physical activity and mobility as the primary health indicator for a community, implementing effective programs and creating the necessary infrastructure for promoting physical activity among older adults appears essential.

Older adults often struggle to locate a function quickly in feature-rich user interfaces (UIs). Mobile UIs not only pack a ton of features in a small screen but also get frequent updates to their visual layouts—thereby exacerbating the problem. This paper explores a design solution where users could search for a UI feature using spoken-word queries. We investigated: 1) what type of questions older users ask when facing interaction challenges in unfamiliar scenarios, 2) how those query types compare with younger users’ inquiries, and 3) how older adults use a voice assistant design probe in a Wizard-of-Oz (WoZ) study. Results reveal five query types when verbally articulating interaction issues: validation, directed and undirected informational, navigational, and conceptual. In the WoZ study, older users typically asked for help following a series of non-unique or off-task feature selections (n = 13/15), and in 77% of those instances, they completed the task in the next interaction.

ABSTRACTEncouraging wellness at home is a necessary step in alleviating the burden of an increasing number of older adults on the health care system and can also provide a vehicle for promoting independence and quality of life among older adults. However, aging at home comes with its own challenges, one of which is depression caused by isolation, a serious condition related to healthy aging and outcomes affecting a large number of older adults. Addressing communication needs across housing options might bring us closer to understanding and preventing social isolation and loneliness among older adults. This article presents an iterative process of applied within-subjects survey and action research studies for designing communication technologies—sympathetic devices for older adults living independently. Emphasis and discussion is given to describing the design process of the sympathetic devices. Several concepts and products were designed and tested with older adults with consideration for aesthetic preferences as well as usefulness, ease of use, and accessibility of the technological devices. The results provide strong evidence of the importance of both form and function, when designing such technological devices for acceptance and adoption by older adults. More importantly, the research highlights a need for a multidisciplinary and intergenerational approach to address the real needs of older adults in the design of such technologies.