Older adults’ growing use of the internet and related technologies, further accelerated by the COVID-19 pandemic, has prompted not only a critical examination of their behaviors and attitudes about online threats but also a greater understanding of the roles of specific characteristics within this population group. Based on survey data and using descriptive and inferential statistics, this empirical study delves into this matter. The behaviors and attitudes of a group of older adults aged 60 years and (...) older (n=275) regarding different dimensions of online safety and cybersecurity are investigated. The results show that older adults report a discernible degree of concern about the security of their personal information. Despite the varied precautions taken, most of them do not know where to report online threats. What is more, regarding key demographics, the study found some significant differences in terms of gender and age group, but not disability status. This implies that older adults do not seem to constitute a homogeneous group when it comes to attitudes and behaviors regarding safety and security online. The study concludes that support systems should include older adults in the development of protective measures and acknowledge their diversity. The implications of the results are discussed and some directions for future research are proposed. (shrink)

In France, continuing professional training is a national obligation within the framework of lifelong education (Law n° 71-575 of July 16, 1971). Although it is considered an essential tool for adapting skills in the second half of one’s career, older workers benefit less than their younger counterparts (Demailly, 2016). Some specialists also consider this population to be specific when it comes to training (Cau-Bareille et al., 2006; Kern, 2016; Tikkanen and Nyhan, 2009). In order to better understand the interest (...) and the educational issues of this public in terms of training engineering, this article proposes to explore this theme using a multidisciplinary approach. (shrink)

In decision making under risk manifold individual differences are involved. To investigate their effect – specifically the effects of executive functions, memory, impulsivity, and consideration for future consequences − 130 healthy older adults were assessed through cognitive tests, self-report tools, and decisional tasks (the Game of Dice Task and the Balloon Analogue Risk-Taking Task). From a Latent Profile Analysis, three profiles characterised by differences in decisional performances emerged. “Impulsive and present-focused” individuals, notable for high levels of impulsivity and (...) consideration for immediate consequences, and “Cautious” individuals, characterised by having impulsivity scores below average, presented decisional performances characterised by lower incomes and a higher number of risky choices compared to “Impulsive and cognitively functional” individuals, signified by the highest levels of impulsivity and cognitive functioning. Findings outlined how different configurations of individual differences can affect older adults’ decisions and implications can follow for deepening the decisional mechanisms in older adults. (shrink)

Financial products and options are frequently complex and difficult for consumers to understand, which, alongside positively oriented sales pitches and predatory practices, may lead to uninformed and hazardous financial decisions. While several legal reforms have been implemented to improve consumers’ understanding of financial products, these modifications have only achieved mixed results. An ongoing challenge is the passive nature of such modifications, giving rise to confirmation bias—noticing the information which confirms one’s belief about a product, while ignoring or not paying enough (...) attention to the potential risks. The aim of this study was to test an implementable form of public policy to help older adults successfully navigate these financial decisions. We tested whether a self-evaluation worksheet, involving an active manipulation of financial content, would significantly impact older adult participants’ responses in an experimental reverse mortgage scenario. Forty community-dwelling, healthy older adults were randomized to one of two conditions: Control Condition and Manipulation Condition. In addition to completing a comprehensive neuropsychological examination, participants were administered the Reverse Mortgage Task. Results indicated that a simple yet active manipulation—imparting accurate and understandable information regarding a complex financial product that must be further manipulated—led to the following among participants in the Manipulation Condition: declines in mood; superior understanding of the financial product; and reduced intention of purchasing the financial product. In order for older adults to be well informed about reverse mortgages, policies must be put in place to ensure that adequate and accurate information has been not only provided but also actively processed by the individual. (shrink)

In higher-level cognitive tasks, older compared to younger adults show a bias towards positive emotion information and away from negative information (a positivity effect). It is unclear whether this effect occurs in early perceptual processing. This issue is important for determining if the positivity effect is due to automatic rather than controlled processing. We tested this with older and younger adults on a positive/negative face emotion valence classification task using masked priming. Positive (happy) and negative (angry) (...) face targets were preceded by masked repetition or valence primes with neutral face baselines. In Experiment 1, 30 younger and 30 older adults were tested with 50 ms primes. Younger adults showed repetition priming for both positive and negative targets. Older adults showed repetition priming for positive but not negative targets. Neither group showed valence priming. In Experiment 2, 30 older and 29 younger adults were tested with longer duration primes. Younger adults showed repetition priming for both positive and negative emotions, and no valence priming. Older adults only showed repetition and valence priming for positive targets. We proposed older adults’ lack of angry face priming was due to an early attention orienting strategy favouring happy expressions at the expense of angry ones. (shrink)

The study was conducted to unveil social connectedness of the older adults in non-urban societies in Ghana, and the ecological and social inclusion theories underpinned the study. The descriptive cross-sectional survey was undertaken based on the positivist school of thought. Older adults who were 60 years or more, participated in the study. Older Adults’ Social Connectedness Questionnaire was designed to gather data to answer the research questions and test the hypothesis. Frequency counts and percentages, (...) mean and standard deviation and independent samples t-test were the analytical tools employed for the data analysis. The study unveiled, inter alia, that the older adults tend to enjoy moderate level of social connectedness and the major groups of people they frequently socially interact with are relatives, religious group members, neighbours and friends. The study also unveiled that religious activities, phone calls, cultural and social activities are the principal conduits for the older adults’ social interaction with significant others. Finally, the study establ ished a difference in the level of social connectedness of the male and female older adults. It is reckoned that the older adults in the rural settings need more and intensive social interactions to serve as impetus for longevity. (shrink)

Although there is a growing recognition that older adults and those with extensive comorbid conditions undergo cancer screening too frequently, there is little information about patients’ perceptions regarding cessation of cancer screening. Information on older adults’ views of screening cessation would be helpful both for clinicians and for those designing interventions to reduce overscreening.

Numerous studies have documented the detrimental impact of age-based stereotype threat on older adults' cognitive performance and especially on veridical memory. However, far fewer studies have investigated the impact of ABST on older adults' memory distortion. Here, we review the subset of research examining memory distortion and provide evidence for the role of stereotype threat as a powerful socio-emotional factor that impacts age-related susceptibility to memory distortion. In this review we define memory distortion as errors in (...) memory that are associated with gist-based errors or source misattributions. Whereas, some of the reviewed experiments support the conclusion that ABST should be considered in the context of age-related differences in memory distortion, others reported little or no impact of stereotype threat. These discrepancies suggest that the role of ABST, and socio-emotional processes generally, in age-related changes in memory distortion are less clear. In this review, we argue that ABST does play an important role in age-related changes in memory distortion. We present evidence suggesting that discrepancies in the reviewed literature may be reconciled when evaluated in the context of the leading theories about stereotype threat: the Executive Resource Depletion hypothesis and the Regulatory Focus theory. We also discuss how differences in methodology and participant characteristics can account for a priori contradictory results in the literature. Finally, we propose some recommendations for researchers and practitioners when assessing memory in older adults. (shrink)

Background Health ministries in Europe are investing increasingly in innovative digital technologies. Older adults, who have not grown up with digital innovation, are expected to keep up with technological shifts as much as other age groups. This is ethically challenging, as it may threaten a sense of dignity and well-being in older adults. Research objective To clarify the phenomenon of sense of dignity experienced in older adults, concerning how their expectations and needs are met (...) within the context of digitally led healthcare in Norway. Research design A Reflective Lifeworld Research design was chosen, and purposive, in-depth interviews were conducted. Participants and research context The participants were 13 adults 75 years and older from Northern Norway, living at home and not receiving consistent assistance. Ethical considerations Followed the principles of the Helsinki Declaration. This study was approved by the Social Science Data Services in Norway (project number 916119). Interviews were conducted carefully within a safe environment chosen by the participants. Findings Older adults experience that using new digital systems in healthcare makes them become dependent with experiences of helplessness. They feel an increased sense of dependency on other people, and that recognition can assail their experience of personal dignity. Older adults not only expect digitally led healthcare to give them a feeling of safety but also experience feeling insecure concerning privacy and loss of possibilities for dialogue with healthcare providers. They are met by demands from society, which they often struggle to achieve. Conclusion The phenomenon of sense of dignity experienced in older adults, concerning how their expectations and needs are met within digitally led healthcare, indicates a sense of feeling lost in the digital world. Further, innovative healthcare lacks focus on ethical performance. This impacts their perception of dignity, as loss of dignity is noticed especially in its rupture. (shrink)

Inadequate pain control, especially in older adults, remains a significant issue when caring for this population. Older adults, many of whom experience multiple acute and chronic conditions, are especially vulnerable to having their pain seriously underassessed and inadequately treated. Nurses have an ethical obligation to appropriately treat patients’ pain. To fulfill their ethical obligation to relieve pain in older patients, nurses often need to advocate on their behalf. This article provides an overview of the persistent (...) problem of undertreated pain in older adults and explores how nurses can meet this ethical duty through the application of Beauchamp and Childress’ three principles of beneficence. (shrink)

Eliciting negative stereotypes about ageing commonly results in worse performance on many physical, memory, and cognitive tasks in adults aged over 65. The current studies explored the potential effect of this “stereotype threat” phenomenon on older adults’ emotion recognition, a cognitive ability that has been demonstrated to decline with age. In Study 1, stereotypes about emotion recognition ability across the lifespan were established. In Study 2, these stereotypes were utilised in a stereotype threat manipulation that framed an (...) emotion recognition task as assessing either cognitive ability, social ability, or general abilities. Participants then completed an emotion recognition task in which they labelled dynamic expressions of negative and positive emotions. Self-reported threat concerns were also measured. Framing an emotion recognition task as assessing cognitive ability significantly heightened older adults’ reports of stereotype threat concerns. Despite this, older adults’ emotion recognition performance was unaffected. Unlike other cognitive abilities, recognising facially expressed emotions may be unaffected by stereotype threat, possibly because emotion recognition is automatic, making it less susceptible to the cognitive load that stereotype threat produces. (shrink)

A large share of the available literature on television and ageing depicts old age as a life stage characterized by losses in which people use television as a substitute for decreased activities. The aim of the present study is to investigate how television viewing is part of both selection and compensation strategies. Based on a qualitative interview study among a diverse sample of older adults, we found three ways in which television viewing is part of selection strategies and (...) three ways in which it is part of compensation strategies. In contrast to the focus on compensation in previous research, we found that selection strategies appear to provide a better characterization of older people’s television viewing than compensation strategies. Moreover, particular television viewing behavior does not automatically signal whether television viewing is part of selection or compensation strategies. (shrink)

Older adults in the United States have been the age group hardest hit by the Covid pandemic. They have suffered a disproportionate number of deaths; Covid patients eighty years or older on ventilators had fatality rates higher than 90 percent. How could we have better protected older adults? Both the popular press and government entities blamed nursing homes, labeling them “snake pits” and imposing harsh fines and arduous new regulations. We argue that this approach is (...) unlikely to improve protections for older adults. Rather than focusing exclusively on acute and critical resources, including ventilators, a plan that respected the best interests of older adults would have also supported nursing homes, a critical part of the health care system. Better access to protective equipment for staff members, early testing of staff members and patients, and enhanced means of communication with families were what was needed. These preventive measures would have offered greater benefit to the oldest members of our population than the exclusive focus on acute care. (shrink)

The COVID-19 pandemic has exacerbated many social problems and put the already vulnerable, such as racial minorities, low-income communities, and older individuals, at an even greater risk than before. In this paper we focus on older adults’ well-being during the COVID-19 pandemic and show that the risk-mitigation measures presumed to protect them, alongside the generalization of an ageist public discourse, exacerbated the pre-existing marginalization of older adults, disproportionately affecting their well-being. This paper shows that states (...) have duties to adopt and put into practice redress measures to compensate for the negative consequences of COVID-19 public health policies on older adults’ overall well-being. These duties flow from the minimal ethical requirement of respect for persons. We show that respect is a morally basic attitude that presupposes taking the others’ interests into account, with the aim of advancing their well-being. This duty is not limited to kinship, relatives, and friends but it extends to states and the rest of the civil society. In the conclusion, we draw lessons from the COVID-19 pandemic and sketch some redress measures that could compensate for the decrease in older adults’ well-being as a result of the adoption of measures to contain the spread of the virus. (shrink)

Older people are an increasingly important consumer group and hence advertising target, yet relatively little research in the UK and in Europe has examined how older adults are portrayed in advertising. In this study, a sample of 221 magazine advertisements depicting older adults were coded for features such as the advertised products, setting, role prominence, rhetorical scheme, tone and type of portrayal. In a departure from previous studies, we devised a set of six descriptive ‘types’ (...) which encapsulate the way older people are portrayed in these advertisements. Also, and as the main focus of this paper, we compared a magazine designed for people over 50 to ten general readership magazines in order to investigate any differences in the portrayal of older adults in age-targeted vs. general readership advertising. Previous research on old age stereotyping, social identity theory and inter-group theory form the basis of our analysis. (shrink)

BackgroundHospitalized older adults frequently have impaired cognition and must rely on surrogates to make major medical decisions. Ethical standards for surrogate decision making are well delineated, but little is known about what factors surrogates actually consider when making decisions.ObjectivesTo determine factors surrogate decision makers consider when making major medical decisions for hospitalized older adults, and whether or not they adhere to established ethical standards.DesignSemi-structured interview study of the experience and process of decision making.SettingA public safety-net hospital (...) and a tertiary referral hospital in a large city in the Midwest United States.ParticipantsThe study included 35 surrogates with a recent decision-making experience for an inpatient aged 65 or older.MeasurementsThe key factors that surrogates considered when making decisions. Interview transcripts were coded and analyzed using the grounded theory method of qualitative analysis.ResultsSurrogates considered patient-centered factors and surrogate-centered factors. Patient-centered factors included: respecting the patient’s input, using past knowledge of the patient to infer the patient’s wishes, and consider ing what is in the patient’s best interests. Some surrogates expressed a desire for more information about the patient’s prior wishes. Surrogate-centered factors included: surrogate’s wishes as a guide, surrogate’s religious beliefs and/or spirituality, surrogate’s interests, and family consensus.ConclusionOur study indicates that surrogate decision making is more complex than the standard ethical models, which are limited to considerations of the patient’s autonomy and beneficence. Because surrogates also imagine what they would want under the circumstances and consider their own needs and preferences, models of surrogate decision making must account for these additional considerations. Surrogates’ desire for more information about patients’ preferences suggests a need for greater advance care planning. (shrink)

This study analyzes the most important predictors of acceptance of social network sites in a sample of Chilean elder people. We employ a novelty procedure to explore this phenomenon. This procedure performs apriori segmentation based on gender and generation. It then applies the deep learning technique to identify the predictors by segments. The predictor variables were taken from the literature on the use of social network sites, and an empirical study was carried out by quota sampling with a sample size (...) of 395 older people. The results show different predictors of social network sites considering all the samples, baby boomer males and females, silent males and females. The high heterogeneity among older people is confirmed; this means that dealing with older adults as a uniform set of users of social network sites is a mistake. This study demonstrates that the four segments behave differently, and many diverse variables influence the acceptance of social network sites. (shrink)

Policy makers and health professionals are grappling with the high costs of and demand for health care, questions of sustainability and value, and changing population demographics—in particular, ageing populations. Digital solutions, including the adoption of patient‐reported measures, are considered critical in achieving person‐centred and value‐based health care. However, the utility of patient‐reported measures and the data they produce may be subject to ageist beliefs, prejudices and attitudes, rendering these data ineffective at promoting improved patient experiences and outcomes for older (...) adults. This article explores the ethical considerations raised in relation to patient‐reported measures and the digital agency of older patients. (shrink)

El presente trabajo tiene como objetivo determinar los tipos de actividades de reformulación conversacional que aparecen en conversaciones en adultos mayores con diferentes niveles de desempeño cognitivo: normales y trastorno cognitivo leve, a partir de una tarea de construcción de un discurso narrativo-argumentativo. Desde una perspectiva de investigación cualitativa, se obtuvo un corpus de 4 entrevistas, que fue codificado con la ayuda del software ATLAS.ti lo que permitió la generación de conceptos y el desarrollo de explicaciones a partir de los (...) datos, los que fueron contrastados con el marco teórico disponible. Los resultados indicaron que los hablantes realizaron actividades de auto-reformulación auto-iniciada, auto-reformulación iniciada por otro y hetero-reformulación derivada del auto-inicio. Las dos primeras se redujeron en los hablantes identificados con trastorno cognitivo leve, mientras que el último tipo de actividad fue el más frecuente y dominante en la conversación. Los hablantes con trastorno cognitivo leve realizaron reformulaciones que no corregían o adecuaban el discurso, por lo que no cumplieron con la finalidad de la reparación. This study aimed to determine the types of activities of conversational reformulation that occur during oral dialogues with older adults who have varying levels of cognitive performance. Study participants, who ranged between normal cognitive function and mild cognitive impairment, were given the task of constructing a narrative-argumentative dialogue. For qualitative investigation purposes, a corpus of four interviews was obtained. Each series of interviews were encoded using ATLAS.ti software which generated linked concepts and explanations from the data. Findings were then compared with the available theoretical framework. The results indicated that participants exhibited three modes of reformulation technique: self-initiated self-reformulation activities; self-reformulation started by another person; and hetero-reformulation derived from self-start. The first two were reduced in speakers exhibiting mild cognitive impairment, while the latter was the most frequent and dominant mode in the conversation. Speakers with mild cognitive impairment executed reformulations that did not correct or enhance the speech, and as such did not meet the purpose of reformulation. (shrink)

BackgroundInformation and communication technology solutions have the potential to support active and healthy aging and improve monitoring and treatment outcomes. To make such solutions acceptable, all stakeholders must be involved in the requirements elicitation process. Due to the COVID-19 situation, alternative approaches to commonly used face-to-face methods must often be used. One aim of the current article is to share a unique experience from the Pharaon project where due to the COVID-19 outbreak alternative elicitation methods were used. In addition, an (...) overview of common functional, quality, and emotional goals identified by six pilot sites is presented to complement the knowledge about the needs of older adults.MethodsOriginally planned face-to-face co-creation seminars were impossible to carry out, and all pilot sites chose alternative requirements elicitation methods that were most suitable in their situation. The elicited requirements were presented in the form of goal models. In one summary goal model, we provide an overview of common functional, quality, and emotional goals.ResultsDifferent elicitation methods were combined based on the digital literacy of the target group and their access to digital tools. Methods applied without digital technologies were phone interviews, reviews of literature and previous projects, while by means of digital technologies online interviews, online questionnaires, and virtual co-creation seminars were conducted. The combination of the methods allowed to involve all planned stakeholders. Virtual and semi-virtual co-creation seminars created collaborative environment comparable to face-to-face situations, while online participation helped to save the time of the participants. The most prevalent functional goals elicited were “Monitor health,” “Receive advice,” “Receive information.” “Easy to use/comfortable,” “personalized/tailored,” “automatic/smart” were identified as most prevalent quality goals. Most frequently occurring emotional goals were “involved,” “empowered,” and “informed.”ConclusionThere are alternative methods to face-to-face co-creation seminars, which effectively involve older adults and other stakeholders in the requirements elicitation process. Despite the used elicitation method, the requirements can be easily transformed into goal models to present the results in a uniform way. The common requirements across different pilots provided a strong foundation for representing detailed requirements and input for further software development processes. (shrink)

The Test of Basic Auditory Capabilities is a battery of auditory-discrimination tasks and speech-identification tasks that has been normed on several hundred young normal-hearing adults. Previous research with the TBAC suggested that cognitive function may impact the performance of older adults. Here, we examined differences in performance on several TBAC tasks between a group of 34 young adults with a mean age of 22.5 years and a group of 115 older adults with a mean (...) age of 69.2 years recruited from the local community. Performance of the young adults was consistent with prior norms for this age group. Not surprisingly, the two groups differed significantly in hearing loss and working memory with the older adults having more hearing loss and poorer working memory than the young adults. The two age groups also differed significantly in performance on six of the nine measures extracted from the TBAC with the older adults consistently performing worse than the young adults. However, when these age-group comparisons were repeated with working memory and hearing loss as covariates, the groups differed in performance on only one of the nine auditory measures from the TBAC. For eight of the nine TBAC measures, working memory was a significant covariate and hearing loss never emerged as a significant factor. Thus, the age-group deficits observed initially on the TBAC most often appeared to be mediated by age-related differences in working memory rather than deficits in auditory processing. The results of these analyses of age-group differences were supported further by linear-regression analyses with each of the 9 TBAC scores serving as the dependent measure and age, hearing loss, and working memory as the predictors. Regression analyses were conducted for the full set of 149 adults and for just the 115 older adults. Working memory again emerged as the predominant factor impacting TBAC performance. It is concluded that working memory should be considered when comparing the performance of young and older adults on auditory tasks, including the TBAC. (shrink)

In ‘Nothing to Be Ashamed of: Sex Robots for Older Adults with Disabilities,’1 I make the case that the unwanted absence of sex from a person’s life represents not just a loss of physical pleasure, but a loss of dignity. Since people aged 65 and over suffer disproportionately from disabilities that impair sexual functioning, I focus on this population. Drawing on an analysis of dignity developed at greater length elsewhere,2 I argue that sex robots can help older (...) adults with disabilities and that societies ought to take reasonable steps to make them available to this population. Unlike other assistive technologies, robots invite human-robot relationships and can form close connections with older adults.3 In response to the proposal, four commentators have introduced objections that I address below. Sorell4 argues that people who are young and able-bodied may wish for sex in their lives too and its absence may be a bigger concern for them than for older people. In reply, while my focus is older adults with disabilities that impair sexual function, I also acknowledge that loss of sexual function can occur at any age as can the absence of a …. (shrink)

The number of older adults incarcerated in prisons is growing significantly, and there is a great need for legal authority, processes, and resources to mitigate individual and social burdens of elder neglect and abuse within these settings. Older adults in prison may be particularly vulnerable to abuse, neglect, or exploitation. They are dependent on the carceral system for basic resources, are at risk for retaliatory actions for reporting mistreatment, and bear disproportionately high health burdens. This essay (...) first considers standards and resources for mitigating elder mistreatment in the community and residential‐care settings in contrast to the available resources in prisons. Arguing that a conceptual model of elder abuse tailored to the prison population is needed, the essay proposes a research agenda through which such a model could be developed. The model could then be used in the creation of policy for detecting and mitigating elder mistreatment of incarcerated people. The essay concludes with a call to action to address the rift in legal protections and processes that leave older adults in prison at increased risk of abuse and neglect without a clear pathway for recourse. (shrink)

Moral distress among nurses is well researched and well documented, but there is limited research on the moral distress experienced by care leaders, who serve as intermediaries between patient care nurses and higher levels of administration. Healthcare professionals experience moral distress daily in the context of older adult care. The aim of this scoping review was to evaluate recent literature on moral distress in older adult care with the goal of revealing how care leaders’ experiences of moral distress (...) in older adult care have been conceptualized in earlier studies. The research questions were: How is the concept of moral distress as experienced by care leaders in older adult care defined in the existing literature? How is the concept of moral distress conceptualized in the literature? The research has been conducted in accordance with the guidelines set forth by the Finnish National Advisory Board on Research Ethics TENK. We saw that consensus on how moral distress is defined is lacking. Care leaders in older adult care experience substantial moral distress, which could be linked to the duality of their leadership role. Moral distress can be caused by a complex interplay of individual and structural factors and the challenging complex moral issues inherent to older adult care. Moral distress could impact care leaders’ emotional health, job performance, overall job satisfaction and result in higher turnover rates, absenteeism, decreased quality of patient care, and increased organizational costs. Addressing moral distress on the individual, team, and organizational levels is crucial for enhancing care leaders’ well-being and improving the overall quality of care for older adults. A focus on the identification of strategies whereby care leaders can be supported, exploration of the long-term effects of moral distress on healthcare professionals in general, and the organizational outcomes associated with moral distress should be included in future research. (shrink)

Background: The present study compared the effects of a traditional resistance training and resistance training combined with cognitive task on body composition, physical performance, cognitive function, and plasma brain-derived neurotrophic factor levels in older adults. Methods: Thirty community-dwelling older adults were randomized into TRT and RT+CT. Exercise groups performed a similar resistance training program, twice a week over 16 weeks. Cognitive Training involved performing verbal fluency simultaneously with RT. Exercise sessions were performed 2-3 sets, 8-15 repetitions (...) at 60-70% of 1-repetition maximum. Body composition, physical function, cognitive performance, and BDNF levels were assessed before and after intervention period. Results: The physical performance was similarly improved in response to both TRT and RT+CT. However, exclusive improvements on cognitive function and BDNF levels were observed only after RT+CT. Conclusion: The RT program associated with a cognitive task, improved physical and cognitive performance in healthy older adults. (shrink)

This article reveals a 91-year-old cognitively intact man’s lived experiences of being cared for in a geriatric context in which the majority of the patients were cognitively impaired. A narrative patient story was analysed phenomenologically. The findings indicate that this patient’s basic needs for ethical care were not met. The staff did not see him as a unique individual with his own preferences, resources and abilities to master his life. In order to survive this lack of ethical care, he played (...) the role of an ‘old cognitively impaired man’, which provided him with at least the understanding and attention the cognitively impaired patients received from the staff. The findings also indicate that ethical care is independent of whether or not older cognitively intact and impaired patients stay or live in the same unit, but it is more dependent on a caregiver’s ability to respect and confirm each and every patient for who he or she is and would like to be. (shrink)

For us, narrative care is grounded in pragmatist philosophy and focused on experience. Narrative care is not merely about acknowledging or listening to people's experiences, but draws attention to practical consequences. We conceptualize care itself as an intrinsically narrative endeavour. In this article, we build on Lugones' understanding of playfulness, particularly to her call to remain attentive to a sense of uncertainty, and an openness to surprise. Playfulness cultivates a generative sense of curiosity that relies on a close attentiveness not (...) only to the other, but to who we each are within relational spaces. Generative curiosity is only possible if we remain playful as we engage and think with experiences and if we remain responsive to the other. Through playfulness, we resist dominant narratives and hold open relational spaces that create opportunities of retelling and reliving our experiences. Drawing on our work alongside older adults, as well as people who work in long‐term care, we show the possibilities of playfulness in the co‐composition of stories across time. By intentionally integrating playfulness, narrative care can be seen as an intervention, as well as a human activity, across diverse social contexts, places and times. (shrink)

Prior research indicates that time perspective (TP; views of past, present and future) is related to decision making style. By contrast, no prior study considered relations between time perspective and decision-making competence. We therefore investigated associations between dimensions of the Swedish Zimbardo Time Perspective Inventory (S-ZTPI) and performance on the Adult Decision-Making Competence (A-DMC) battery in a sample of older adults (60-90 years, N = 346). A structural equation model involving four A-DMC components as indicators of a general (...) DMC factor and the six TP dimensions as the predictors revealed a significant negative association between the Present Fatalistic dimension and DMC. Given that age-related differences were apparent in DMC and that Present Fatalistic orientation increased with age, we tested a model by which the age-related differences in DMC were mediated by age-related differences in Present Fatalistic attitudes and in working memory. The results were consistent with full mediation of the age effects, with Present Fatalistic and working memory jointly accounting for a substantial amount of the variance in DMC (51%). The finding that DMC among older adults, in particular more cognitively demanding aspects such as applying decision rules, can be undermined by increased present fatalistic attitudes and declines in working memory is discussed in terms of theoretical frameworks highlighting the contribution of both motivational and cognitive factors to effective decision making. (shrink)

Determining whether and/or how to enable older persons with disabilities to engage in sex raises several ethical considerations. With the goal of enabling the sexual functioning of older adults with disabilities, Jecker argues that sex robots could be used as a helpful tool. In her article, ‘Nothing to be Ashamed of: Sex Robots for Older Adults with Disabilities’, Jecker acknowledges the importance of sexual functioning and the fact that ageist assumptions incorrectly classify older persons (...) as asexual. Additionally, older adults may experience disabilities that negatively influence their sexual functioning, which is problematic since sex may be linked to the following capabilities: developing a meaningful life narrative; being healthy; experiencing bodily integrity; feeling and communicating emotions; affiliating with others and reflecting on and choosing a life plan.1 In accordance with Nussbaum’s capabilities approach,2 Jecker says that society has a duty to support these capabilities at a minimal threshold. And insofar as sexual functioning may be relevant to the capabilities for older adults with disabilities, then we need to respond accordingly. One way of achieving this aim is by providing access to sex robots. I agree that sex robots ought to be made available for older adults with disabilities. Nevertheless, the article inspires several areas for further exploration. As Jecker rightfully mentions, older adults are often incorrectly labelled as non-sexual. For instance, in their analysis of older individuals’ views on sex and quality of life, Gott …. (shrink)

Older adults were considered a vulnerable group for the COVID-19 infection and its consequences, including problems with sleep.AimTo evaluate the prevalence of sleep disorders in older adults, to describe their sleep patterns, as well as to analyse if there were any changes in comparison with the period pre-pandemic.Materials and MethodsOnline survey used for data collection received answers from 914 elderly age range 65–90 years, from April to August 2020. Results: 71% of the sample reported a pre-existent (...) sleep disorder, and some of them worsened during the pandemic, especially Insomnia in women and Obstructive Sleep Apnea in men. No difference in sleep duration before and during the pandemic was found, although there was a worsening of some aspects related to sleep, such as sleep quality, sleep efficiency, awakening quality, sleep latency and nocturnal awakenings, especially in the female gender. Educational level influenced sleep latency, indicating higher sleep latency among those with primary education when compared with the ones with Ph.D.ConclusionThe pandemic had influenced sleep patterns among the elderly, as well as worsening of pre-existent sleep disorders. Female gender and low educational level were considered risk factors for sleep alterations, and high educational level, on its turn, appeared to be a protective factor. (shrink)

Population aging has brought great challenges to many regions throughout the world. Enhancing the sense of participation, access, and well-being of older adults is the goal of China’s aging development. This study, taking urban–rural difference as the entry point, examined the difference in subjective well-being between urban and rural older learners. A total of 2,007 older adults learners aged over 50 years were recruited in Zhejiang, Anhui, and Shandong Provinces in China, including 773 rural (...) class='Hi'>older adults and 1,234 urban older adults. This study found that there was a significant positive correlation between senior learning and the subjective well-being of urban and rural older adult learners. Furthermore, there was a significant difference between the subjective well-being of urban and rural older adult learners’ and there was also an urban–rural difference between the effects of older adult learning on the subjective well-being. Based on the above findings, this study reveals the mechanism of the impact of older adult learning on subjective well-being of urban and rural older adults and gives relevant suggestions for improving the subjective well-being of urban and rural older learners. (shrink)

In aging humans, aerobic exercise interventions have been found to be associated with more positive or less negative changes in frontal and temporal brain areas, such as the anterior cingulate cortex (ACC) and hippocampus, relative to no-exercise control conditions. However, individual measures such as gray-matter (GM) probability may afford less reliable and valid conclusions about maintenance or losses in structural brain integrity than a latent construct based on multiple indicators. Here, we established a latent factor of GM structural integrity based (...) on GM probability assessed by voxel-based morphometry, magnetization transfer saturation, and mean diffusivity. Based on this latent factor, we investigated changes in structural brain integrity during a six-month exercise intervention in brain regions previously reported in studies using volumetric approaches. Seventy-five healthy, previously sedentary older adults aged 63–76 years completed an at-home intervention study in either an exercise group (EG;n= 40) or in an active control group (ACG;n= 35). Measures of peak oxygen uptake (VO2peak) taken before and after the intervention revealed a time-by-group interaction, with positive average change in the EG and no reliable mean change in the ACG. Significant group differences in structural brain integrity changes were observed in the right and left ACC, right posterior cingulate cortex (PCC), and left juxtapositional lobule cortex (JLC). In all instances, average changes in the EG did not differ reliably from zero, whereas average changes in the ACG were negative, pointing to maintenance of structural brain integrity in the EG, and to losses in the ACG. Significant individual differences in change were observed for right ACC and left JLC. Following up on these differences, we found that exercising participants with greater fitness gains also showed more positive changes in structural integrity. We discuss the benefits and limitations of a latent-factor approach to changes in structural brain integrity, and conclude that aerobic fitness interventions are likely to contribute to brain maintenance in old age. (shrink)

This book exploits the power of phenomenological methods to access and describe lived moral experiences of pain and suffering for patients, their families and the wider community. Creating new fields of communication for patients, their family members and health professionals in shared decision making processes, this book builds on knowledge about suffering to help and guide correct action in preventing and relieving chronic pain and improving systems of care. It offers a new phenomenology for understanding moral experience in serious illness (...) and suffering, and its implication for policy, practice and research. A series of applied chapters, looking at individual experiences of suffering and care experiences, present some areas of ethical inquiry, including: pain and suffering maternal care ethics evaluation and moral deliberation about treatment options decision-making and moral agency end-of-life experiences of care. Exploring how moral phenomenology could provide fruitful alternatives to traditional frameworks in bioethics, this is an important addition to the literature. It will be of interest to scholars and students of bioethics and phenomenological methods in the health and human services. (shrink)

Reasoning requires making inferences based on information gleaned from a set of relations. The relational complexity of a problem increases with the number of relations that must be considered simultaneously to make a correct inference. Previous work (Viskontas, Morrison, Holyoak, Hummel, & Knowlton, 2004) has shown that older adults have difficulty integrating multiple relations during analogical reasoning, especially when required to inhibit irrelevant information. We report two experiments that examined the ability to integrate multiple relations in younger, middle-aged, (...) and older adults performing two other reasoning tasks. These tasks systematically varied relational complexity, and required either inductive reasoning (a version of the Raven's Matrices Task) or transitive inference. Our results show that as people age they have increasing difficulty in solving problems that require them to integrate multiple relations. This difficulty may stem from a decrease in working memory capacity. (shrink)

When managing their emotions, individuals often recruit the help of others; however, most emotion regulation research has focused on self-regulation. Theories of emotion and aging suggest younger and older adults differ in the emotion regulation strategies they use when regulating their own emotions. If how individuals regulate their own emotions and the emotions of others are related, these theorised age differences may also emerge for interpersonal emotion regulation. In two studies, younger and older adults’ intrapersonal and (...) interpersonal emotion regulation strategy choices were examined via self-report and behavioural assessments of regulating the emotions of another participant (Study 1; N = 80) and of a virtual human (Study 2; N = 100). Across both studies, younger adults reported greater intrapersonal suppression but not greater reappraisal. Younger and older adults were generally similar (supported by Bayesian analyses) for both self-reported and behavioural interpersonal emotion regulation strategies. Behavioural interpersonal emotion regulation was not related to self-reported intra- and interpersonal preferences. These results suggest interpersonal emotion regulation in ageing may show distinct patterns from theorised age differences in intrapersonal emotion regulation. (shrink)

Depression experienced by older adults is proving an increasing global health burden, with rates generally 7% and as high as 27% in the USA. This is likely to significantly increase in coming years as the number and proportion of older adults in the population rises all around the world. Therefore, it is imperative that the effectiveness of approaches to the prevention and treatment of depression are understood. Creative arts interventions, including art, dance movement, drama and music (...) modalities, are utilised internationally to target depression and depressive symptoms in older adults. This includes interventions led by trained arts therapists as well as other health and arts professionals. However, to date there has not been a systematic review that reports effects and examines the processes (why) and mechanisms (how) of creative arts interventions are used to address depression in this older age group. This systematic review of studies on creative arts interventions for older adults experiencing depression examined: outcomes of four creative arts modalities (art, dance movement, drama, and music); with particular attention paid to processes documented as contributing to change in each modality; and mechanisms considered to result from these processes. Our analysis of 75 articles (17 art, 13 dance, 4 drama and 41 music) indicates mostly significant quantitative or positive qualitative findings, particularly for interventions led by creative arts therapists. Mechanisms of change gleaned from the studies that were common across modalities include physical (e.g. increased muscle strength; neurochemical effects, such as endorphin release), intra-personal (e.g. enhanced self-concept, strengthened agency and mastery; processing and communication of emotions), cultural (e.g. creative expression, aesthetic pleasure), cognitive (e.g. stimulation of memory) and social (e.g. increased social skills and connection), that were all considered to contribute to reduced depression and symptoms. Recommendations for future research include a stronger focus on testing of processes and mechanisms. (shrink)

Emergency departments in many nations worldwide have been struggling for many years with crowding and the subsequent provision of care in hallways and other unconventional spaces. While this issue has been investigated and analyzed from multiple perspectives, the ethical dimensions of the place of emergency department care have been underexamined. Specifically, the impacts of the place of care on patients and their caregivers have not been robustly explored in the literature. In this article, a feminist ethics and human geography framing (...) is utilized to argue that care provision in open and unconventional spaces in the emergency department can be unethical, as vulnerability can be amplified by the place of care for patients and their caregivers. The situational and pathogenic vulnerability of patients can be heightened by the place of the emergency department and by the constraints to healthcare providers’ capacity to promote patient comfort, privacy, communication, and autonomy in this setting. The arrangements of care in the emergency department are of particular concern for older adults given the potential increased risks for vulnerability in this population. As such, hallway healthcare can reflect the normalized inequities of structural ageism. Recommendations are provided to address this complicated ethical issue, including making visible the moral experiences of patients and their caregivers, as well as those of healthcare providers in the emergency department, advocating for a systems-level accounting for the needs of older adults in the emergency department and more broadly in healthcare, as well as highlighting the need for further research to examine how to foster autonomy and care in the emergency department to reduce the risk for vulnerabilities. (shrink)

This paper describes the significance of key empirical findings from the recent and landmark study Caring and Aging with Pride: The National Health, Aging and Sexuality Study (with Karen I. Fredriksen‐Goldsen as the principal investigator), on lesbian, gay, bisexual, and transgender aging and health disparities. We will illustrate these findings with select quotations from study participants and show how nonconscious bias (i.e., activation of negative stereotypes outside conscious awareness) in the clinical encounter and health care setting can threaten shared decision‐making (...) and perpetuate health disparities among LGBT older adults. We recognize that clinical ethicists are not immune from nonconscious bias but maintain that they are well situated to recognize bias and resulting injustice by virtue of their training. Further, we discuss how clinical ethicists can influence the organization's ethical culture and environment to improve the quality and acceptability of health care for LGBT older adults. (shrink)

Background: In China, the conventional family-based ageing care model is under pressure from social transitions, raising the question of whether and to what extent families are still capable of dealing with the care of the aged. Objective: This article examines the vulnerability and inadequacy of families to bear responsibility for the care of the aged against a backdrop of socioeconomic transformation and diminishing institutional support in rural China. Research design: This article adopts an empirical ethical approach that integrates empirical investigation (...) with ethical inquiry. Participants and research context: The empirical component of this article focuses on the lived experiences of caring for a wife and mother with dementia in one rural Chinese family, collected from a 6-month fieldwork study conducted at one primary hospital. Ethical considerations: Approval was obtained from the university ethics committee. Findings: The empirical study highlights a conflicted family process of managing and negotiating care that indicates the inadequacies and limited ability of families to deal with aged care tasks. In addition, inadequate structures and institutional deficiencies exacerbate the vulnerability of rural families and their inability to offer adequate care. Conclusion: Acknowledging the vulnerability of families as ageing care providers, this article calls for a socially supported family care model for rural older people in China and also proposes policy recommendations. (shrink)