As older adults are interested in using VR, especially if poor health prevents the continuation of desirable activities or new experiences, it is important to respond to older adults' preferences and remove barriers that limit use and enjoyment.

Meaningful family involvement is a modifiable factor that can potentially enhance resident QOL. Facilities can become more family-oriented through encouraging communication between staff and families, helping spouses and other family members fulfill their desired caregiving role, and discussing the family's motivations for providing personal care during visits.

Health care providers face fixed reimbursement rates from government sources and need to carefully adjust staffing to achieve the highest quality within a given cost structure. With data from the Certification and Survey Provider Enhanced Reports (1999-2015), this study holistically examined how staffing levels affect two publicly reported measures of quality in the nursing home industry, the number of deficiency citations and the deficiency score. While higher staffing consistently yielded better quality, the largest quality improvements resulted from increasing administrative registered nurses and social service staffing. After adjusting for wages, the most cost-effective investment for improving overall deficiency outcomes was increasing social services. Deficiencies related to quality of care were improved most by increasing administrative nursing and social service staff. Quality of life deficiencies were improved most by increasing social service and activities staff. Approaches to improve quality through staffing adjustments should target specific types of staff to maximize return on investment.

Chronic illness with its accompanying physical stressors poses a risk factor for loneliness and depression in later life. Testing a model of stress and coping, we examined the effects of three types of coping resources (religious coping; Selection, Optimization, and Compensation [SOC] adaptive strategies; and perceived social support) on the deleterious effects of chronic illness among older women. Community-dwelling older women ( N = 138) with at least one chronic illness ( M = 3.9, SD = 2.1) completed mailed questionnaires. Respondents reported multiple morbidities and 90% reported interference with daily life. Social support was associated with less loneliness and depression and mediated the relationship between physical health and loneliness. Our study demonstrates two distinct pathways to depressive symptoms: one through physical symptoms, pain, and disability, and another through the experience of loneliness. Findings support intervention approaches that address disability-related issues and loneliness, and assist older women with chronic illness in identifying and marshaling social support.

Exposure to secondhand smoke (SHS) is known to be harmful to health. However, the association between household SHS and cognitive function among middle-aged and older women in China is understudied. Lagged dependent variable regression was used to examine the association between household SHS exposure and the cognitive function of married women who had been exposed to SHS, using data from 2 waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011-2013). Controlling for age, educational attainment, geographic residence, household expenditures, and chronic conditions (i.e., hypertension, diabetes, and depressive symptoms), the results indicated that longer SHS exposure was associated with a greater decline in memory over 2 years. After comparing differences across age groups, this pattern was significant for women aged 55-64 years. Furthermore, those who were illiterate, lived in rural areas, and reported depressive symptoms had a greater decline in memory. With evidence linking household SHS exposure with a higher risk of cognitive decline, effective education and public health intervention programs are urgently needed. Stronger tobacco control regulations and education about the dangers of household SHS are viable strategies to reduce the impending dementia epidemic in China.

Background and Objectives Quantitative and qualitative data from a statewide survey of family members of nursing home residents were analyzed to determine the predictors of, and motivations for, family involvement. Research Design and Methods We examined 3 types of involvement: visiting, providing personal care, and family–staff communication. Our mixed methods approach used (a) multilevel regression models to examine predictors of family involvement, including family member perceptions and resident, family member, and facility characteristics, and (b) a thematic analysis of qualitative data regarding the experiences of family members and their motivations for involvement. Results Families were more involved when a short-term stay (<3 months) was expected, and when residents were in poorer physical condition. Spouses and female family members were more involved than others, yet the effect of gender varied by relationship type. At the facility level, families of residents in rural facilities reported less family involvement. Aside from these commonalities, predictors of each type of involvement varied. Themes from the qualitative data identify unique motivations for each type of involvement—to enhance residents’ identity, care, or quality of life. Discussion Families visit more and provide more hands-on assistance when they are not confident in the care being provided or the well-being and stability of their resident loved one. Receiving adequate information, perceiving staff as friendly, and residents as looking well cared for promote greater family–staff communication. Implications Findings can inform strategies to increase meaningful family involvement in nursing homes.

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This study examines the changes in activity investment among older adults and the role of these changes in the relationship between health limitations and depression. Residents of six senior living facilities (N = 178) completed questionnaires including the Geriatric Depression Scale, health and functioning measures and the Revised Change in Activity and Interest Index (CAII-R) which measures self-perceived changes in the level of investment in social and leisure activities among older adults. Respondents indicated more disengagement from CAII-R subscales Active Instrumental (AI) and Active Social (AS) and increased engagement in Passive Social Spiritual. Fourth Age adults (age 80+) reported greater reductions in AI than Third Age adults (age 64-79). Reduced AS investment had the strongest association with depression and mediated the relationship between poor health or functioning and depression. These categories of activity may guide occupational therapy practitioners and other health providers in selecting the focus of intervention for older clients according to their identified life stage. The study provides evidence of distinct differences in interests within the parameters of normal aging and a baseline from which to assess the impact of illness and disability on the activity choices for clients in different life stages.