Ko e talanoa fekau’aki pea moe mo’ui kakato ‘o e mātu’a Tonga nofo Nu’usila

<p>New Zealand’s older adult population is gradually increasing, in line with global increases in the number of older people. Pacific populations living in New Zealand currently have the least number of people aged 65 years and older in New Zealand (2.4% or 13,944 people), however; this is projected to increase in the next 20 years by 160%. After controlling for multiple health risks, socio-economic and demographic variables, ethnicity has been shown to have an independent role as a predictor of health and wellbeing. Research on the wellbeing of older Pacific peoples in New Zealand is limited, with none having been published that involves or relates to older Tongan people. Therefore, research exploring the perspectives and experiences of the psychosocial factors of wellbeing of older Pacific peoples in New Zealand is required. This thesis describes the perspectives and experiences of nine older Tongan people from the Wellington region, and their consideration of what contributes to their wellbeing. The research aimed to describe wellbeing based on the participants’ own concepts of wellbeing, and also identify factors that either enabled or inhibited their wellbeing. A qualitative research design guided by Pacific models of the Talanoa methodology and the Kakala research framework was utilised. Talanoa were conducted with all participants, with the talanoa transcripts qualitatively analysed using content and thematic analysis. The study found that wellbeing for older Tongan people is centred upon the quality of their mo’ui kakato (life in its entirety). It is multi-dimensional, interrelated and broader than just physical and mental health aspects. God was the overarching component, and their belief in God greatly influenced their views of wellbeing or their life as a whole. These findings will assist family members, churches, communities, health professionals and others to improve their practices and therefore support the improvement of older Pacific peoples’ wellbeing. </p>

Ko e talanoa fekau’aki pea moe mo’ui kakato ‘o e mātu’a Tonga nofo Nu’usila

<p>New Zealand’s older adult population is gradually increasing, in line with global increases in the number of older people. Pacific populations living in New Zealand currently have the least number of people aged 65 years and older in New Zealand (2.4% or 13,944 people), however; this is projected to increase in the next 20 years by 160%. After controlling for multiple health risks, socio-economic and demographic variables, ethnicity has been shown to have an independent role as a predictor of health and wellbeing. Research on the wellbeing of older Pacific peoples in New Zealand is limited, with none having been published that involves or relates to older Tongan people. Therefore, research exploring the perspectives and experiences of the psychosocial factors of wellbeing of older Pacific peoples in New Zealand is required. This thesis describes the perspectives and experiences of nine older Tongan people from the Wellington region, and their consideration of what contributes to their wellbeing. The research aimed to describe wellbeing based on the participants’ own concepts of wellbeing, and also identify factors that either enabled or inhibited their wellbeing. A qualitative research design guided by Pacific models of the Talanoa methodology and the Kakala research framework was utilised. Talanoa were conducted with all participants, with the talanoa transcripts qualitatively analysed using content and thematic analysis. The study found that wellbeing for older Tongan people is centred upon the quality of their mo’ui kakato (life in its entirety). It is multi-dimensional, interrelated and broader than just physical and mental health aspects. God was the overarching component, and their belief in God greatly influenced their views of wellbeing or their life as a whole. These findings will assist family members, churches, communities, health professionals and others to improve their practices and therefore support the improvement of older Pacific peoples’ wellbeing. </p>

Age Equity: A Framework for Addressing Ageism, Stigma, and Bias

In the Covid-19 context, researchers and policy makers have turned their attention to long-standing disparities in health equity, including by race, ethnicity, poverty, sexuality, and gender. Yet, scholarship to date does not conceptualize age as a critical aspect of difference requiring an equity lens. In this presentation, we utilize an Age Equity Framework to investigate ageism based on research findings from the 2018 National Health, Aging and Sexuality/Gender Study (NHAS): Aging with Pride. Investigating ageism, stigma, and bias, we found nearly half of LGBTQ older adults feel invisible and disrespected. After adjusting for background characteristics, experiences of ageism were associated with higher rates of stigma, lifetime victimization, discrimination, lower support and community engagement, and adverse outcomes (lower mental and physical health and quality of life). The rapidly growing older adult population highlights the pressing need to consider age inequities and the importance of achieving age equity across the life course.

Taking Age-Friendly Campus Efforts to New PEAKS

The University of North Georgia’s Personal Enrichment, Action, Knowledge Series (PEAKS) was developed as a monthly series of engaging and seasonally appropriate presentations and activities designed to expressly meet the needs of the region’s large and quickly growing older adult population during the Covid-19 pandemic and resultant isolation. The PEAKS programs are available virtually to allow for broad participation throughout the 30 county UNG service region. While we developed PEAKS to specifically reach-out to older adults in our region, we have found that our audience is actually multi-generational, actively engaging with our speakers and one another. AFU underpinnings for PEAKS include Principle #8 - To enhance access for older adults to the university's range of health and wellness programs and its arts and cultural activities; and #9 - To engage actively with the university's own retired community.

Technology Supporting Cognitively Impaired Older Adults: A Scoping Review for the ENHANCE Center

Cognitive impairments (CIs) result in difficulties with a wide range of daily activities. Older adults are especially at risk for CIs, and as the older adult population increases, so does the importance of understanding and supporting the needs of those with CIs. The Enhancing Neurocognitive Health, Abilities, Networks, and Community Engagement (ENHANCE) Center was established with a focus on developing technology-based support for socialization, transportation, and prospective memory needs of older adults with CIs due to mild cognitive impairment (MCI), traumatic brain injury (TBI), and stroke. The extent to which relevant literature in these domains existed was unknown. We conducted a scoping review to identify existing research meeting the following criteria: participants aged 50+ years classified as having a CI due to MCI, TBI, or stroke; and a focus on technology-based support for socialization, transportation, and/or prospective memory needs. Using PRISMA guidelines, we searched three electronic databases, and reviewers screened citations for inclusion and completed data charting. Following screening, only 11 studies met our inclusion criteria. Qualitative and quantitative data are reported for each study. In addition to few studies available, it was common for studies to include 20 or fewer participants. Most assessed technology interactions at one time and few studies examined longitudinal use and benefits. While each paper examined one aspect of user-centered design, no technologies were reported that underwent all stages of the user-centered design process, from needs assessment to iterative design and usability testing, to efficacy trial. Such gaps highlight the important role ENHANCE can play.

Reflections on Identity in Memoirs of Writers With Aphasia: Lessons Learned on the Path Toward Recovery

Personal stories provide insight into the experience of illness as it intersects with one’s identity. Prior studies by the first author examined identity as manifested in personal accounts of U.S. World War II veterans with and without dementia. The current study examines identity as revealed through written memoirs of middle-aged and older adults who have aphasia, from a cross-section of North American, European, and Australian cultures. The abrupt onset of stroke and associated aphasia, and the subsequent path toward re-engagement in life with an often-chronic communicative impairment, provide a unique window into the nature and evolution of the identity of the writer. The written modality offers an opportunity for reflective formulation that is not afforded to the memoir-writers in their verbal expression. Nineteen memoirs and biographical accounts of individuals with aphasia from a range of primarily individualistic cultures were examined for content reflective of the identity of the author, focused on post-stroke phases of restitution and quest. Primary authors were people with aphasia or rarely their close family member. Some were professional editors, poets or authors. Gender and life backgrounds were varietal. Manifestations of personal identity, its reinforcement, and its evolution were evidenced in: the provision of lessons learned from living with aphasia; content of letters exchanged with friends; engagement with family in life and recovery; fictional and poetic expression; spiritual insight; renewed or altered occupational pursuits; and comments on facing one’s mortality. Findings hold implications for the cross-cultural practice of narrative medicine with the older adult population.

Hospital-induced Delirium among Medical Older Adults: Evaluating the Veracity of Prognostic Models

Several prognostic models have been developed and validated for delirium prediction among older adults. However, model development and validation studies need to be evaluated for risk of bias to establish the veracity of the prognostic models. This is a critical step before they can be implemented in clinical practice. Multiple systematic reviews have evaluated prognostic models of hospital-induced delirium. However, none of the existing systematic reviews evaluated the validity of models for non-surgical, medical hospitalized older adults. We conducted a scoping review to evaluate the validity of existing prognostic models of hospital-induced delirium in medical older adults. CINAHL, PsycINFO, PubMed, and Web of Science were searched for original studies. The database search yielded 4,312 records. Five studies were included in the qualitative synthesis. All the studies claimed to have developed valid prognostic models. However, the risk of bias assessment revealed that existing prognostic models of hospital-induced delirium in medical older adults are at a high risk of bias. Collectively, the statistical analysis was the greatest source of bias. Notably, while we have seen a proliferation of prognostic models for use in the surgical older adult population, efforts at developing prognostic models in the medical older adult population seem to have declined since the early 1990s. Newer methods of data collection, such as data mining of electronic health records, and statistical analysis, such as machine learning, have shown promise in accurate prediction of hospital-induced delirium while overcoming many challenges associated with manual data collection and traditional statistical analyses.

Residential Care in California: Spatial and Temporal Trends in Facility Development and Care Capacity

The U.S. is aging, and the older adult population and number of long-term care services are growing but not at corresponding rates and concentrations depending on location. Insufficient research has analyzed residential care at the neighborhood or city level of analysis, where geographical trends in growth often reveal notable patterns of long-term care unobserved at county and state levels of analyses. We merged the California Department of Social Services Residential Care for the Elderly Dataset with census place and tract data to chart the growth of facilities and beds per older adults in all of California and its three largest cities, including 805 facilities licensed from 1996 to 2015. During the study timeframe, residential care steadily increased in California by the number of facilities and beds relative to older adults. However, due to a consistently increasing older adult population, the Cities of San Diego and San Jose experienced gradual and intermittent decline in capacity per older adults, respectively, even as they added many beds to their inventories from the sporadic development of large assisted living and continuing care retirement communities. Additionally, San Jose and Los Angeles exhibited the most overlap in mapping densities of facility development and oldest old adults, with San Diego showing less intersection in cartographic analysis. Understanding facility development and care capacity trends can help local agencies and jurisdictions in the U.S. and other countries discern whether planning policies and other geographical and development factors appropriately encourage the development of residential care and other long-term care facilities.

Anti-Racism and Health Equity as Missing Values to Productive Aging: Implications for Emerging Professionals

Productive aging scholarship has grown in scope and rigor over the last four decades, yet anti-racism and health equity have not been formally integrated into the conceptual framework. Furthermore, there is a dearth of research that explicates heterogeneity among a growing diverse older adult population. This presentation will integrate anti-racism and health equity as core values to productive aging scholarship in order to explore risk and protective factors to employment, volunteering, and caregiving among a growing diverse older adult population. Part of this presentation will include major findings from longitudinal population-based studies as well as key findings from a Consensus Statement by the National Academies of Sciences, Engineering, and Medicine (NASEM) on work and retirement trajectories. Dr. Gonzales will also share professional strategies (e.g., grant submissions, publishing, teaching) with ESPO members who want to center anti-racism, health equity, and social justice in their scholarship.