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Social Determinants, Behavioral and Lifestyle Choices, and Health Disparities of Older Adults

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 August 2023) | Viewed by 15431

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Special Issue Editors

Dr. Ronica N. Rooks

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Guest Editor

Department of Health and Behavioral Sciences, University of Colorado Denver, P.O. Box 173364, CB 188, Denver, CO 80217, USA
Interests: aging; chronic conditions; health disparities; neighborhood environment; and social determinants of health
Special Issues, Collections and Topics in MDPI journals

Dr. Joyce Weil

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Guest Editor

Gerontology Program, Department of Health Sciences, Towson University, Towson, MD 21252, USA
Interests: meaning of place; social demography of aging; social inequalities across the lifecourse; social support and aging; older women’s health and well-being; health disparities and aging

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue on “Social Determinants, Behavioral and Lifestyle Choices, and Health Disparities of Older Adults” in the International Journal of Environmental Research and Public Health. The venue is a peer-reviewed scientific journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. For detailed information on the journal, we refer you to https://www.mdpi.com/journal/ijerph.

Many factors contribute to health disparities for older adults, ranging from individual health behaviors and lifestyle choices to social determinants of health, such as neighborhood characteristics, community environment, gentrification, etc. It is important to explore how older adults’ health is impacted by these various levels. For example, what is the role of individual health behaviors (e.g., physical activity, nutrition, body mass index/weight, smoking, alcohol drinking, other substance use, and sleep) and other lifestyle choices (e.g., social and intellectual engagement and mental well-being) in contributing to health equity or inequity?

The role of community environment, i.e. an individual’s residence and surrounding geographic area, including social, physical, and built environments, is important to older adults’ health. Older adults aged 65+ can: 1) encounter increased limitations in mobility and housing options; 2) spend more time throughout the day in their communities using resources than younger adults who are employed full-time; 3) have longer exposure to potentially unhealthy communities vs. younger adults; and 4) experience stronger place attachment as they grow older, providing a sense of continuity through life course changes. These issues can vary by environment or place and social vulnerabilities, such as socioeconomic status (SES), race and ethnicity, gender, sexuality, immigrant, and other statuses differentially influencing health outcomes.

As an example of community environment research, older adults may be vulnerable to gentrification, i.e. the transformation of neighborhoods from low to high value. Gentrification affects a community’s history and culture, often reducing trust and reciprocal relationships that facilitate neighbors helping neighbors. With changing social relationships and infrastructure, gentrification may lead to older adults’ social isolation and an inability to age-in-place. Thus, gentrification can also be a place-based stressor associated with older adults’ poorer health.

Manuscript Submisson Information

We encourage empirical research addressing multiple levels, from individual behaviors to structural factors related to various health outcomes and health disparities among older adults in the USA or internationally, using quantitative, qualitative, or mixed methods. This research may speak to the following topics (but not limited to these):

Multiple levels of factors related to health, including individual health behaviors to social, economic, and physical conditions
Relationships among social determinants, neighborhoods, and health
The role of neighborhoods or community environment in health equity or health disparities
Life course factors, such as the role of cumulative advantage/disadvantage to living in the same neighborhood over time as we age
Gentrification related to social vulnerabilities and health disparities

The special issue will be edited by researchers working on multiple levels of health determinants, intersecting the social sciences, public health, and social gerontology fields. Associate Professor Ronica N. Rooks (University of Colorado Denver; [email protected]) and Associate Professor Joyce Weil (The University of Northern Colorado; [email protected]). Please email Drs. Rooks or Weil to indicate your interest in submitting a manuscript or for more information.

Authors are invited to submit abstracts related to the topic areas described above. The guest editors will review all abstracts to assess for topic appropriateness and scientific rigor. Authors of high-scoring abstracts will be invited to submit a complete manuscript for anonymous peer review by the guest editors and additional peer reviewers. Please submit a 400 word structured abstract for initial review.

Dr. Ronica N. Rooks
Dr. Joyce Weil
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

lifestyle factors
social determinants of health
neighborhoods or community environment
socially vulnerable populations
health disparities or health equity
aging in place, sense of community, and social engagement
gentrification
residential segregation
home and community-based services/health and social services
life course theory or cumulative advantage/disadvantage
intersectionality theory
resilience
age-friendly communities
solutions – prevention, interventions, or policy

Published Papers (8 papers)

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Research

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13 pages, 915 KiB

Open AccessArticle

Enhancing Driving Ability in Older Adults through Health Exercises and Physical Activity: A Randomized Controlled Trial

by Akihiko Katayama, Ayako Hase and Nobuyuki Miyatake

Int. J. Environ. Res. Public Health 2023, 20(19), 6802; https://doi.org/10.3390/ijerph20196802 - 22 Sep 2023

Viewed by 1004

Abstract

The global rise in the aging driving population has heightened concerns about traffic incidents involving this demographic. Beyond transportation, automobiles represent a vital lifeline for older adults, fostering social activities and influencing their health-related quality of life. This study explores improving and sustaining driving ability among older adults with anticipated declines through health-conscious exercises. Sixty-eight participants were randomly allocated into two groups. The exercise-oriented group (E-group) engaged in twelve 90 min health and exercise sessions over twelve weeks, while the control group (C-group) maintained their regular daily routines and did not receive any specific interventions during this period. The focal point of assessment was driving ability, as evaluated by a person using a real car on public roads without using a simulator. Driving ability and physical fitness were assessed before the intervention in both groups. Post-intervention measurements occurred twelve weeks after the initial gauging, encompassing both cohorts. Comparative analysis of pre- and post-intervention changes was executed between the two groups. The E-group demonstrated improved overall driving ability compared to the C-group. The results suggest that healthy exercise and physical activity may maintain and enhance driving ability for older adults. Full article

(This article belongs to the Special Issue Social Determinants, Behavioral and Lifestyle Choices, and Health Disparities of Older Adults)

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13 pages, 341 KiB

Open AccessArticle

Self-Reported Cognitive Aging and Well-Being among Older Middle Eastern/Arab American Immigrants during the COVID-19 Pandemic

by Linda Sayed, Mohammed Alanazi and Kristine J. Ajrouch

Int. J. Environ. Res. Public Health 2023, 20(11), 5918; https://doi.org/10.3390/ijerph20115918 - 23 May 2023

Viewed by 1326

Abstract

Background: The COVID-19 pandemic posed new challenges for cognitive aging since it brought interruptions in family relations for older adults in immigrant communities. This study examines the consequences of COVID-19 for the familial and social support systems of aging Middle Eastern/Arab immigrants in Michigan, the largest concentration in the United States. We conducted six focus groups with 45 participants aged 60 and older to explore participant descriptions of changes and difficulties faced during the pandemic relating to their cognitive health, familial and social support systems, and medical care. The findings indicate challenges around social distancing for older Middle Eastern/Arab American immigrants, which generated three overarching themes: fear, mental health, and social relationships. These themes provide unique insights into the lived experiences of older Middle Eastern/Arab American adults during the pandemic and bring to light culturally embedded risks to cognitive health and well-being. A focus on the well-being of older Middle Eastern/Arab American immigrants during COVID-19 advances understanding of how environmental contexts inform immigrant health disparities and the sociocultural factors that shape minority aging. Full article

(This article belongs to the Special Issue Social Determinants, Behavioral and Lifestyle Choices, and Health Disparities of Older Adults)

17 pages, 718 KiB

Open AccessArticle

Transport, Mobility and the Wellbeing of Older Adults: An Exploration of Private Chauffeuring and Companionship Services in Malaysia

by Abdul Rais Abdul Latiff and Saidatulakmal Mohd

Int. J. Environ. Res. Public Health 2023, 20(3), 2720; https://doi.org/10.3390/ijerph20032720 - 03 Feb 2023

Cited by 2 | Viewed by 1700

Abstract

As physical abilities and health decline with age, older adults tend to lose their driving abilities, which affects their mobility. As mobility is important to older adults’ wellbeing, there is a need to explore alternative modes of transportation to increase their ability to actively participate in society. Hence, this paper aims to understand the characteristics of private chauffeuring and companionship services for older adults, and to assess their possible effects on older adults’ wellbeing. We gathered the views of transport operators, government agencies, and city councils that offer private chauffeuring and companionship services for older adults. We frame the model of private chauffeuring and companionship services as alternative mobility for older adults and outline a conceptual framework for its possible effects on their wellbeing. The underlying mobility characteristics were availability, accessibility, safety, and affordability—all of which influence wellbeing. The study found that the private chauffeuring and companionship model for older adults includes an additional model of government-to-consumer services in addition to the existing peer-to-peer and business-to-consumer services. While the services are available, the services provided are not standardized, with different operators offering different services and prices, and limiting certain geographical areas. Transport operators perceived that the services they offer promote older adults’ physical and mental health, improve their social participation in the community, and empower them in making their travel decisions. The findings of the paper provide insights for policy makers for future planning of alternative transportation for older adults to enhance their mobility. Full article

(This article belongs to the Special Issue Social Determinants, Behavioral and Lifestyle Choices, and Health Disparities of Older Adults)

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14 pages, 671 KiB

Open AccessArticle

Increasing Access to Care for the Underserved: Voices of Riders, Drivers, & Staff of a Rural Transportation Program

by Abby J. Schwartz, Alice R. Richman, Mallary Scott, Haiyong Liu, Weyling White and Caroline Doherty

Int. J. Environ. Res. Public Health 2022, 19(20), 13539; https://doi.org/10.3390/ijerph192013539 - 19 Oct 2022

Cited by 1 | Viewed by 2040

Abstract

The qualitative data presented in this paper was part of a larger concurrent mixed methods study evaluating the effectiveness of a transportation program (Project TRIP) for low-income residents in rural eastern North Carolina. Twenty stakeholders involved in TRIP were interviewed, including riders (n = 12) of which 83% were over 50 years old, program staff including the program coordinator and 5 case managers (n = 6), and transportation providers (n = 2). Due to the COVID-19 pandemic, interviews were completed by phone with each participant. Themes from the qualitative data included the: (1) Emotional, health, & financial impacts of TRIP, (2) Changes that should be implemented into TRIP when replicating the program, and (3) Unique aspects of how TRIP operates that could inform other rural transportation programs. Thematic analysis was used to analyze the transcript data. The findings are couched in the context of how TRIP potentially defrays the impacts of cumulative disadvantage that residents experience over the life course by increasing access to healthcare. Full article

(This article belongs to the Special Issue Social Determinants, Behavioral and Lifestyle Choices, and Health Disparities of Older Adults)

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19 pages, 825 KiB

Open AccessArticle

How Social Determinants of Health of Individuals Living or Working in U.S. Department of Veterans Affairs Home-Based Long-Term Care Programs in Puerto Rico Influenced Recovery after Hurricane Maria

by Leah M. Haverhals

Int. J. Environ. Res. Public Health 2022, 19(20), 13243; https://doi.org/10.3390/ijerph192013243 - 14 Oct 2022

Cited by 1 | Viewed by 2324

Abstract

In September 2017, Hurricane Maria devastated Puerto Rico, causing extensive infrastructure damage and a significant number of deaths. In the months and years since, recovery from Maria has been slow, hampered by delayed delivery of fiscal aid, corruption, economic hardships, and Puerto Rico’s colonial status. Simultaneously, Puerto Rico’s population is rapidly aging and hundreds of thousands of mostly younger Puerto Ricans are migrating out of Puerto Rico for more opportunities. Many Puerto Ricans who are older or disabled and need long-term care receive this care in home-based environments, as Puerto Rico has minimal institutionalized long-term care infrastructure and limited funding to expand it. The Department of Veterans Affairs (VA) offers several home-based long-term care options for Veterans in Puerto Rico. In this qualitative case study, veterans, VA staff, veterans’ caregivers, caregivers’ family members, and veterans’ family members receiving or involved with providing this care were interviewed regarding their experiences during and after Hurricane Maria. Specifically, this study highlights how social determinants of health of those residing in or involved with VA home-based long-term care programs influenced recovery from Hurricane Maria, and how findings can inform disaster recovery and provision of home-based long-term care going forward. Full article

(This article belongs to the Special Issue Social Determinants, Behavioral and Lifestyle Choices, and Health Disparities of Older Adults)

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Review

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14 pages, 352 KiB

Open AccessReview

Characterizing Multimorbidity Prevalence and Adverse Outcomes in Ethnically and Culturally Diverse Sub-Populations in India: Gaps, Opportunities, and Future Directions

by Preeti Pushpalata Zanwar, Robyn Taylor, Tanisha G. Hill-Jarrett, Elena Tsoy, Jason D. Flatt, Zunera Mirza, Carl V. Hill and Arokiasamy Perianayagam

Int. J. Environ. Res. Public Health 2024, 21(3), 327; https://doi.org/10.3390/ijerph21030327 - 11 Mar 2024

Viewed by 1450

Abstract

India is a large middle-income country and has surpassed China in overall population, comprising 20% of the global population (over 1.43 billion people). India is experiencing a major demographic shift in its aging population. Chronic diseases are common among older adults and can be persistent over the life course, lead to the onset of disability, and be costly. Among older adults in India, the existence of multiple comorbid chronic conditions (i.e., multimorbidity) is rapidly growing and represents a burgeoning public health burden. Prior research identified greater rates of multimorbidity (e.g., overweight/obesity diabetes, hypertension, cardiovascular disease, stroke, and malignancies) in minority populations in the United States (U.S.); however, limited studies have attempted to characterize multimorbidity among older adult sub-populations residing in India. To address this gap, we conducted a narrative review of studies on multimorbidity using the data from the Longitudinal Aging Study of India (LASI), the largest nationally representative longitudinal survey study of adults in India. Our definition of multimorbidity was the presence of more than two conditions in the same person. Our findings, based on 15 reviewed studies, aim to (1) characterize the definition and measurement of multimorbidity and to ascertain its prevalence in ethnically and culturally diverse sub-populations in India; (2) identify adverse outcomes associated with multimorbidity in the Indian adult population; and (3) identify gaps, opportunities, and future directions. Full article

(This article belongs to the Special Issue Social Determinants, Behavioral and Lifestyle Choices, and Health Disparities of Older Adults)

9 pages, 787 KiB

Open AccessReview

Policy Development on Upskilling/Reskilling Older Population Care Staff in China

by Jason Hung

Int. J. Environ. Res. Public Health 2022, 19(15), 9440; https://doi.org/10.3390/ijerph19159440 - 01 Aug 2022

Cited by 2 | Viewed by 2027

Abstract

Mainland China has been concerned about the national growth rate of older adults aged 60 or above. The rapid growth of the cohort of older adults will significantly burden the Chinese healthcare system as they are at higher risk of suffering from chronic illnesses and functional disabilities. In geriatrics, aged populations often endure a wide range of diseases, dysfunctions, and cognitive impairment, so the corresponding healthcare services needed for them are substantial. The rise in the older adults’ life expectancy has compounded the burden of the healthcare system in mainland China in the long term. In this narrative essay, it is important to discuss how the state should assume a higher share of relevant responsibilities, by assessing how Chinese policymaking has been transformed to better satisfy the older population’s care and healthcare needs in mainland China. It is also pivotal to focus on analysing relevant Chinese policy development within the most recent dozen years to address how China’s state and local governments have been progressing in promptly providing health and older population care services to older Chinese adults. Because of the supply shortage and low quality of older population caregivers and alternative professionals, it is necessary to discuss and highlight the need to reskill or upskill relevant caregivers. As the trend of rural-to-urban labour migration continues, working adults of rural origins increasingly cannot provide domestic older population care, and human investment in training caregivers is an urgent task of Chinese policymaking. Therefore, how Chinese policymaking encourages upskilling or reskilling relevant caregivers is examined in this narrative essay. Full article

(This article belongs to the Special Issue Social Determinants, Behavioral and Lifestyle Choices, and Health Disparities of Older Adults)

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Other

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10 pages, 321 KiB

Open AccessCommentary

Essentials to Improve the Effectiveness of Healthy Aging Programming: Consideration of Social Determinants and Utilization of a Theoretical Model

by Katarina Friberg-Felsted and Michael Caserta

Int. J. Environ. Res. Public Health 2023, 20(15), 6491; https://doi.org/10.3390/ijerph20156491 - 01 Aug 2023

Cited by 1 | Viewed by 1138

Abstract

Older adult health, while partially determined by genetics, is mostly determined by behavioral and lifestyle choices. Researchers and interventionists develop and administer behavioral health interventions with older adults, and interventions are advertised in any number of settings, for example, by providers in healthcare settings and by activity directors in senior centers or assisted living facilities. However, previous studies and metanalyses indicate that many interventions targeting older adults are unsuccessful in recruitment or in retention. While providers and activity directors may assume older adults are unwilling to participate in behavioral change, in reality, low participation may be caused by erroneous design and administration. The objective of this manuscript is to recommend to creators and implementers of behavioral interventions for older adults that they focus on two critical considerations: the contextual perspective pertaining to healthy aging as well as an appropriately employed theoretical model that most effectively informs program design and implementation. In this commentary, we discuss how Prochaska and DiClemente’s Transtheoretical Model of Health Behavior Change may lead to more desirable outcomes as it considers that a person may be at any one of six stages of change, from pre-contemplation to maintenance. Currently, many behavioral interventions are targeted at individuals who are poised for action or in maintenance phases, ignoring those in earlier phases, resulting in limited overall success. Regarding viewing healthy aging in a contextual manner, determinants external to the individual may remain unnoted and unconsidered when designing or recruiting for a behavioral intervention. In conclusion, the integration of an intrapersonal health behavior model such as the Transtheoretical Model of Health Behavior Change, coupled with clearer considerations of the interplay of contextual factors operating in the lives of older adults, may allow for more effective design and implementation, as well as resulting in higher participation in behavioral interventions targeted toward older adults. Full article

(This article belongs to the Special Issue Social Determinants, Behavioral and Lifestyle Choices, and Health Disparities of Older Adults)

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