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Health Promotion for the Elderly

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (30 October 2020) | Viewed by 43811

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Special Issue Editor

Prof. Dr. Ching-Ju Chiu

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Guest Editor

Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan City 701, Taiwan
Interests: health promotion and health education for the elderly; mHealth/eHealth for active aging; Type 2 diabetes; dementia; depression; frailty and geriatric syndrome; disablement process; longitudinal data analysis; cross-national comparison

Special Issue Information

Dear Colleagues,

The progressive aging of the population is a demographic phenomenon in most countries of the world. Today, nearly 9 percent of people worldwide (617 million) are aged 65 and over. This percentage is projected to jump to nearly 17 percent of the world’s population by 2050 (1.6 billion). Due to the increasing elderly population size, proven effective interventions or population strategies promoting health and wellbeing for older adults are pivotal to public health research and societies as well. Since older adults face challenges to their wellbeing, such as that older adults are more likely to be suffering from chronic conditions and multimorbidities, and their functional capacity is frequently limited, health promotion targeted t older adults differs significantly from that addressing younger generations. However, methods promoting health and wellbeing for older adults with a different health continuum have not yet been fully recognized as an area of health promotion.

This Special Issue in the International Journal of Environmental Research and Public Health is devoted to making a substantial contribution to knowledge gaps in the understanding of preferences, measures, and cost-effective strategies and policies addressed exclusively at elderly populations. Because certain lifestyle issues are more important among this segment of population, such as loneliness, social isolation, limited functional capability, disease management and self-care, and the fact that promoting health across the health continuum of the older adults can be promoted by various means, ranging from education, behavior modification and environmental design to legislative involvement, a wide range of topics will be included in this issue.

We welcome manuscripts related but not limited to issues dealing with low participation in health promotion for homebound older adults, unmet needs of minorities or immigrants, and proven health promotion strategies considering the continuum of health, age, gender, cohort, living arrangement, or family structure of the elderly. We also encourage translational research that tests new approaches incorporating personal health coaching or person-centered design, eHealth, or considering organizational, community, or legislative strategies.

Prof. Dr. Ching-Ju Chiu
Guest Editor

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Keywords

health promotion strategies across the health continuum
education strategy
behavior modification
environmental design
legislative involvement
living arrangement
gender difference
minority or migrant health
technology
recruitment and retention issue

Published Papers (10 papers)

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11 pages, 304 KiB

Open AccessArticle

Can Individual Attitudes toward Aging Predict Subsequent Physical Disabilities in Older Taiwanese Individuals? A Four-Year Retrospective Cohort Study

by Chien-Yao Sun, Chun-Yin Yeh, Yan Zhao and Ching-Ju Chiu

Int. J. Environ. Res. Public Health 2021, 18(1), 98; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18010098 - 25 Dec 2020

Cited by 4 | Viewed by 2610

Abstract

Individual attitudes toward aging have been regarded as a modifiable risk for physical disability. However, longitudinal cohort studies have not been carried out in countries in Asia. In the present study, we aimed to explore the association between individual attitudes toward aging and subsequent physical disabilities using a nationwide representative cohort, the Taiwan Longitudinal Study on Aging (TLSA), over a 4-year follow-up period. In 2003, a baseline survey for 10-item attitudes toward aging scale consisting of widely different domains across financial relationships with children, grandparenting, living arrangements, and remarriage was conducted. Later, physical disabilities, including mobility and activities of daily living (ADL) limitations, were evaluated in 2007. A total of 1635 participants aged 57 and over were analyzed. Older age, self-rated poor health, and those suffering from pain were found to be more likely to have higher risk of physical disabilities. The older adults who expressed a willingness to receive financial support from their adult children were reported to have a lower risk of mobility limitations (adjusted odds ratio (aOR): 0.67, 95% confidence interval (CI): 0.50–0.90), while those who did not want to assist with child care as grandparents had a higher risk of ADL difficulties (aOR: 2.46, 95% CI: 1.31–4.60). Our work shed light on the importance of individual attitudes toward aging in predicting long-term physical disabilities and illuminated the intimate role of grandparents, both financial and participatory, in Chinese families. In the future, culturally adapted attitudes toward aging scale should be developed to identify older Chinese adults at risk of physical disabilities. Full article

(This article belongs to the Special Issue Health Promotion for the Elderly)

18 pages, 395 KiB

Open AccessArticle

Intergenerational Ties in Context: Association between Caring for Grandchildren and Cognitive Function in Middle-Aged and Older Chinese

by Shiming Liao, Ling Qi, Jie Xiong, Jie Yan and Ruoxi Wang

Int. J. Environ. Res. Public Health 2021, 18(1), 21; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18010021 - 22 Dec 2020

Cited by 14 | Viewed by 3753

Abstract

Grandchild caregiving is suggested to improve the elderly’s cognitive function, but the specific relationship remains under-investigated. Considering gender disparity, this study aimed to understand the relationship between grandchild caregiving and cognition. In total, 7236 Chinese residents (≥45 years old) were selected from the 2015 China Health and Retirement Longitudinal Study (CHARLS). The China Health and Retirement Longitudinal Study Harmonized Cognitive Assessment Protocol (CHARLS-HCAP) was used to measure cognition. Grandparenting was measured from three dimensions: caregiving frequency, intensity, and the number of grandchildren cared for. The relationship was examined by multivariate linear regression, with age as a moderator. The results showed that the majority of respondents provided care to their grandchildren, especially grandmothers. Grandchild caregiving was positively associated with cognition (β = 0.686, 95% CI = 0.334–1.038), especially in the older-aged group. Moderate, not regular grandparenting, or caring for one grandchild was more positively associated with cognitive function. However, intensive and regular grandchild care was significantly associated with cognition only in men. No moderating effects of age were found in women. The study confirmed that moderate intensity and frequency of caregiving was related to better cognitive function in middle-aged and older Chinese population, whereas cultural context and gender differences could be considered when designing targeted policies. Full article

(This article belongs to the Special Issue Health Promotion for the Elderly)

11 pages, 456 KiB

Open AccessArticle

Perspectives of the Elderly with Mild Cognitive Impairment Living Alone on Participating in a Dementia Prevention Program: A Q Methodology Study

by Li-Ting Lu, Chiu-Mieh Huang, Su-Fei Huang, Shu-I Wu and Jong-Long Guo

Int. J. Environ. Res. Public Health 2020, 17(21), 7712; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17217712 - 22 Oct 2020

Viewed by 2129

Abstract

This study aimed to identify and describe the various patterns of perspectives among older adults with mild cognitive impairment (MCI) living alone on participating in a dementia prevention program. Q methodology was applied to investigate the perspectives of 30 community-dwelling elderly people with MCI living alone from March to August 2018. As Q methodology applies a forced distribution through the Q-sorting technique, it could capture participants’ perspective patterns. Thirty-two Q-statements were constructed to explore the participants’ attitudes regarding their participation in a dementia prevention program. The participants performed Q-sorting to rank the 32 statements into a Q-sort grid. Principal component analysis was conducted using the PQ Method 2.35 software to identify patterns in participants’ perspectives. Four patterns of shared perspectives, accounting for 54.65% of the total variance, were identified: (a) awareness of health benefits and readiness to take preventive actions; (b) emphasis on cost consideration, and not ready to participate; (c) concern about family’s attitude and needing family support; (d) emphasis on medical care and needing providers’ recommendation. The exploration of clusters of the elderly with MCI could assist health professionals in acknowledging elderly people’s attitudes and responses towards participating in a dementia prevention program. Full article

(This article belongs to the Special Issue Health Promotion for the Elderly)

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15 pages, 366 KiB

Open AccessArticle

Instrumental Activities of Daily Living (iADL) Limitations in Europe: An Assessment of SHARE Data

by Diana Portela, Marta Almada, Luís Midão and Elísio Costa

Int. J. Environ. Res. Public Health 2020, 17(20), 7387; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17207387 - 10 Oct 2020

Cited by 26 | Viewed by 3711

Abstract

This study aims to evaluate the instrumental activities of daily living (iADLs) limitations in Europe and its association with socio-demographic characteristics, economic parameters and physical and mental health status. We used data from the wave 6 of SHARE database. Individuals were classified as having either none or one or more limitations on iADLs. Participants aged 65 or more years who answered all questions for the variables included in this work were selected. A total of 54.8% of participants were female and had a mean age of 74.37 (SD = 7.08) years. A global prevalence of 1 or more iADLs in Europe was shown to be 23.8% and more prevalent in women than in men (27.1% vs. 17.6%) and in people aged 85 years or more (51.5%). Older age, female gender, lower education, physical inactivity, frailty, having two or more chronic diseases, presence of depression, polypharmacy, poor self-perception of health and lower network satisfaction were found to be factors associated with the presence of 1 or more iADLs limitation. This study highlights the burden of iADLs limitations at the European level. These are based on a multidimensional biopsychosocial model and are associated with both health conditions and environmental factors. This intersection between the physical and social world underscores its potential as a health indicator and can, to some extent, explain some of the pronounced differences seen among European countries. Different inter-tasks can also stress different dimensions of health indicators in distinct and specific groups of individuals. Minimizing the impact of iADL limitations can improve the quality and sustainability of public health systems. Full article

(This article belongs to the Special Issue Health Promotion for the Elderly)

23 pages, 2557 KiB

Open AccessArticle

Healthy Ageing in Place: Enablers and Barriers from the Perspective of the Elderly. A Qualitative Study

by Cristina Bosch-Farré, Maria Carmen Malagón-Aguilera, David Ballester-Ferrando, Carme Bertran-Noguer, Anna Bonmatí-Tomàs, Sandra Gelabert-Vilella and Dolors Juvinyà-Canal

Int. J. Environ. Res. Public Health 2020, 17(18), 6451; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17186451 - 4 Sep 2020

Cited by 32 | Viewed by 6638

Abstract

Background: Most elderly people wish to grow old at their own homes. The sociodemographic characteristics; home and neighbourhood conditions; and the social services support and networks are determinants in the possibility of “ageing in place”. The present study aimed to explore the ageing in place phenomenon, as well as the enablers and barriers that interact in a healthy ageing from the perspective of the elderly connected to local entities. Methods: A generic qualitative design was proposed in the Health Region of Girona in Catalonia (Spain). Seventy-one elderly people were purposefully selected. Six focus groups were conducted, and data were thematically analysed. Results: Three key themes were generated: (1) Participants experienced ageing differently. The physical and mental health, the family environment and financial stability were key elements for life quality. (2) The perception of the elderly’s role in the community depended on their age, health status and attitude towards life. (3) The participants identified several enablers and barriers to healthy ageing in place. Conclusions: The promotion of older people’s autonomy and wellbeing, together with the creation of an active network of health and social services, may improve the possibility for elderly to age at home and avoid or delay institutionalisation. Full article

(This article belongs to the Special Issue Health Promotion for the Elderly)

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11 pages, 1865 KiB

Open AccessArticle

Health Promotion and Disease Prevention Interventions for the Elderly: A Scoping Review from 2015–2019

by Ching-Ju Chiu, Jia-Chian Hu, Yi-Hsuan Lo and En-Yu Chang

Int. J. Environ. Res. Public Health 2020, 17(15), 5335; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17155335 - 24 Jul 2020

Cited by 22 | Viewed by 7242

Abstract

In this study, a scoping review method is used to review the distribution and trends in health promotion research and explore the use and contribution of eHealth technologies in health promotion in the elderly. The study includes six search databases: PubMed, CINAHL, the CochraneLibrary, EMBASE, PubPsych, and ERIC (EBSCOhost), and studies published from January 2015 to October 2019, written in English, were included and analyzed. The findings of the study reveal that the amount of literature on promoting health for the elderly has increased, and some specific types of interventions are still favored in current health promotion efforts for older adults. The most commonly used methods were found to be health promotion (n = 322), followed by screening (n = 264), primary prevention (n = 114), and finally social support (n = 72). Beyond the above interventions, eHealth technology is also used in health promotion activities to prevent the elderly from falling and to improve home safety, etc. However, although the application of eHealth technology has been applied in areas such as fall prevention, mental health promotion, and home security monitoring, it is still immature, and thus more rigorous research is needed in different areas, especially in older populations, various professions, women, and people with dementia. Full article

(This article belongs to the Special Issue Health Promotion for the Elderly)

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11 pages, 304 KiB

Open AccessArticle

Sekentei as a Socio-Cultural Determinant of Cognitive Function among Older Japanese People: Findings from the NEIGE Study

by Hiroshi Murayama, Shigeru Inoue, Takeo Fujiwara, Naoki Fukui, Yuichi Yokoyama and Yugo Shobugawa

Int. J. Environ. Res. Public Health 2020, 17(12), 4480; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17124480 - 22 Jun 2020

Cited by 3 | Viewed by 2325

Abstract

Sekentei (social appearance) is a Japanese concept that describes a person’s sense of implicit societal pressure to conform to social norms. However, evidence of a relationship between sekentei and health outcomes is sparse. This study examined the association between sekentei and cognitive function among community-dwelling older Japanese people. Baseline data were obtained from the Neuron to Environmental Impact across Generations (NEIGE) study conducted in 2017; 526 randomly sampled community-dwelling individuals aged 65–84 years living in Tokamachi, Niigata Prefecture, Japan were analyzed. The 12-item Sekentei Scale was used to assess sekentei. Cognitive function levels were evaluated with the Japanese version of Mini-Mental State Examination (MMSE-J; ranging from 0–30). Approximately 10% and 25% had cognitive decline and mild cognitive impairment, respectively (MMSE-J scores of ≤23 and 24–26, respectively). Multinomial logistic regression analysis showed that both high and low levels of sekentei were associated with lower cognitive function, particularly mild cognitive impairment, after adjusting for sociodemographic factors, health behaviors, health conditions, and genetic factors. The current findings suggest that a moderate level of sekentei consciousness is beneficial for cognitive health, and that sekentei could be an important socio-cultural factor affecting cognitive function. Full article

(This article belongs to the Special Issue Health Promotion for the Elderly)

11 pages, 1224 KiB

Open AccessArticle

Three-Year Longitudinal Association Between Built Environmental Factors and Decline in Older Adults’ Step Count: Gaining insights for Age-Friendly Urban Planning and Design

by Kimihiro Hino, Hiroyuki Usui and Masamichi Hanazato

Int. J. Environ. Res. Public Health 2020, 17(12), 4247; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17124247 - 14 Jun 2020

Cited by 20 | Viewed by 3753

Abstract

This study examined the longitudinal association between the change in the step count of older adults and the neighborhood-built environment (BE) in Yokohama, Japan. We analyzed pedometer data in March 2016 and March 2019 that were acquired from 21,557 older adults aged 65–79 years at baseline, who lived in 758 neighborhoods in Yokohama City and participated in the Yokohama Walking Point Program (YWPP). Six BE variables were computed, for each of which neighborhoods were classified into quartiles. Using multilevel regression analysis, we examined the association between the BE variables, baseline step count, and change in step count. Higher population density, lower intersection density, and the second shortest quartile of the average distance to the nearest railway station were associated with a higher baseline step count. A lower intersection density and shorter average distance to the nearest railway station were associated with a smaller decline. The lowest quartile of population density was inversely associated with step-count decline. In conclusion, the neighborhood BEs were not only associated with their step count at baseline, but also widened the disparity of the step count over the three years. These findings would contribute to creating age-friendly cities where older adults can maintain and promote their health. Full article

(This article belongs to the Special Issue Health Promotion for the Elderly)

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12 pages, 326 KiB

Open AccessArticle

Unmet Healthcare Needs and Healthcare Access Gaps Among Uninsured U.S. Adults Aged 50–64

by Namkee G. Choi, Diana M. DiNitto and Bryan Y. Choi

Int. J. Environ. Res. Public Health 2020, 17(8), 2711; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17082711 - 15 Apr 2020

Cited by 11 | Viewed by 6299

Abstract

Lack of health insurance (HI) is a particular problem for near-older Americans aged 50–64 because they tend to have more chronic health conditions than younger age groups and are at increased risk of disability; however, little recent research has focused on HI coverage and healthcare access among this age group. Using the U.S. National Health Interview Survey data for the years 2013 to 2018, we compared HI coverage and healthcare access between the 50–64 and 65+ age groups. Using logistic regression analysis, we then examined the sociodemographic and health characteristics of past-year healthcare access of near-older Americans without HI to those with private HI or public HI (Medicare without Medicaid, Medicaid without Medicare, Medicare and Medicaid, and VA/military HI). We estimated the odds of healthcare access among those without HI compared to those with private or public HI. Near-older Americans without HI were at least seven times more likely to have postponed or foregone needed healthcare due to costs, and only 15% to 23% as likely to have had contact with any healthcare professional in the preceding 12 months. Expanding HI to near-older adults would increase healthcare access and likely result in reduced morbidity and mortality and higher quality of life for them. Full article

(This article belongs to the Special Issue Health Promotion for the Elderly)

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10 pages, 596 KiB

Open AccessBrief Report

A Logic Model for Evaluation and Planning in an Adult Day Care for Disabled Japanese Old People

by Takashi Naruse, Ayaka Kitano, Hiroshige Matsumoto and Satoko Nagata

Int. J. Environ. Res. Public Health 2020, 17(6), 2061; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17062061 - 20 Mar 2020

Cited by 9 | Viewed by 4482

Abstract

Adult day care (ADC) provides various services for meeting clients’ needs. Based on the mini-Delphi method with 46 ADC staff and the discussions with eight ADC administrators, this study developed and finalized a comprehensive logic model to represent the elements of ADC. For the three basic structures of a logic model—inputs/activities, outputs, and outcomes—the model contained seven core categories and 23 sub-categories. The ADC inputs/activities consisted of two core categories: “Place to stay” and “Intervention from staff”. These inputs/activities caused two kinds of outputs: “Clients’ experiences” and “Families’ experiences”. “Accumulating experiences” with repeated ADC visits was established as the link between the ADC outputs and outcomes, which were “Clients’ change” and “Families’ change”. ADC centers provide various experiences for their clients and their caregivers, ranging from the fulfillment of needs for fundamental care to psychiatric care and self-actualization. Improving various model-related inputs/interventions can produce better experiences and outcomes. The model can guide ADC administrators, policymakers, and researchers in the evaluation of a heterogeneous ADC service program that is community-based, thereby ensuring optimal care for clients with an efficient use of resources. Full article

(This article belongs to the Special Issue Health Promotion for the Elderly)

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