An Education in the Scope and Depth of Gerontological Scholarship

Abstract

When I served as Editor for the Journal of Applied Gerontology from 2011 to 2017, one of the activities I particularly enjoyed was writing brief introductions to the articles in each issue. I attempted to group each issue by theme or themes and wanted to try a similar approach with The Gerontologist. What is evident in this early stage of my editorial tenure is the incredible scope of content that is submitted and eventually accepted for publication; in addition to the range of methodological approaches and methods utilized (thus necessitating our current Associate Editor structure), the broad and deep content of submissions make it nearly impossible to group any given issue into one or even two themes. To this end, I am extremely grateful to Karen Jung, Managing Editor of The Gerontologist, who does an incredible job managing the submission and publication process for each issue. Below I summarize some of the exciting findings and revelations from this month’s articles. One of the distinguishing features of The Gerontologist is its commitment to advancing and refining theories of aging. In this regard, the article by Lu et al. (2023) is particularly exciting. An increasingly important framework to guide public health and related policy is social determinants of health (or, how the conditions of where we are born, age, and live influence health outcomes). A key domain of this framework is social and community support. Specifying a theoretical basis to promote social capital for healthy aging is thus essential. Lu and colleagues do precisely this in their article, whereby they propose a framework comprised of three elements: “(a) facilitating emotional meaningfulness via social participation for older adults, (b) incorporating older adults as coproducers in community development, and (c) nurturing an inclusive and equitable society.” An always crucial step for theories to gain traction in a discipline is their use and dissemination/uptake in the broader field. In this regard, I could very well see many initiatives relying on Lu et al.’s theory to guide their design, implementation, and ultimately, their evaluation of effectiveness (e.g., age-friendly communities). Moving from theoretical to methodological innovation in intervention science, Yang and colleagues (2023) demonstrate an excellent application of Intervention Mapping (IM), which is generally viewed as an effective preliminary step when designing health promotion interventions. Yang et al. utilized a four-step IM process (“identify the health problem that needs to be changed and its associated behavioral and environmental determinants through an in-depth needs assessment; select important and changeable determinants that influence the problem and determine intervention outcomes and objectives; design theory- and evidence-based methods and strategies to be used in the intervention; and develop and refine intervention materials, protocols, and messages”). Yang and colleagues also incorporated robust stakeholder engagement to result in a theory-driven medication self-management intervention that specifies viable targets and mechanisms. A major emphasis of intervention science is the need to identify mechanisms and offer clearer descriptions of intervention components and theory earlier in the design cycle. In doing so, more efficacious and effective interventions are more readily achievable. A topic that strongly emerged across several of the articles in this month’s issue is the study of key transitions, or “turning points,” as we age due to the various biopsychosocial changes that may occur. For example, two very interesting reviews, both using insightful methodological approaches, examine key issues in quality of care during and following transitions to residential long-term care. In the issue’s Editor’s Choice article, Davies and colleagues (2023) utilize meta-ethnography (“which synthesizes qualitative information to explore a phenomenon within a real-life context, in this case, long-term residential care”) to generate several second- and third-order constructs from the available qualitative literature that help to advance the science and practice of long-term care. In doing so, Davies et al. do not only contribute to our conceptualizations of person-centered care but offer a framework of competencies that can further inform how we educate, train, and ideally incentivize those who provide vital, day-to-day care to people living with dementia in residential long-term care settings. Song and colleagues (2023) utilize a mixed methods review approach to determine how responsive behaviors (“verbal or physical actions that can be disruptive, distressing, or challenging to people in the environment”) influence quality of care and adverse outcomes for staff. The conclusions of Song et al. are relevant to those of us who advocate for the use of mixed methods in dementia care science: there is a need to effectively integrate qualitative and quantitative data to understand mechanisms that could inform and perhaps drive effective interventions/programs to enhance dementia care (e.g., Gaugler et al., 2019). The use of the term responsive behaviors is noteworthy. I have heard from people living with dementia, their families, and advocates about their dismay at the predominant use of the terms “behavioral and psychiatric disturbances/BPSD” or “behavioral problems” when attempting to measure and describe the behaviors that may occur with greater frequency and intensity during dementia. I am as responsible as anyone else in dementia care science in my use of the terms “behavioral problem” or “behavioral challenge” as a default. Perhaps the use of the term “responsive” behaviors may help to align our scientific/clinical nomenclature more appropriately with the terms and labels people living with dementia and their care partners actually want. Another key transition of focus, albeit a very different kind, is explored by Kimberly (2023). In this phenomenological analysis of the lived experiences of 10 older persons who have undergone kidney transplantation, Kimberly offers a welcome addition to a literature that likely does not consider the role of aging (and its potentially protective effects) in the study of policies, practices, and procedures related to kidney or other rapidly emerging forms of organ transplantation. In a fascinating comparison of perceptions of older adults when navigating the relinquishment of firearms and driving cessation, Betz et al. (2023) found several convergent and divergent findings. What resonated to me were the similarities, as these findings can serve as a potential basis for future intervention or program design. Among the similarities noted included how driving cessation and the relinquishing of firearms may significantly threaten identity (e.g., independence) in certain cultures thus resulting in emotional challenges. Furthermore, shifts in impairment complicate these transitions, and balancing relationships and variable perspectives when attempting to achieve a satisfactory resolution to driving cessation or relinquishing firearms in older adulthood is critical. Approaching transportation issues from a different vantage point, Gleason and Silverstein (2023) conducted a series of semistructured interviews with managers of paratransit services to examine what is a neglected perspective on the current and future market of transportation for older persons. In what seems to be a chronic concern across the geriatric workforce, among the most prominent themes included a shortage of drivers as well as resource challenges. Modernizing paratransit via more flexible regulations and innovation to offer on-demand transportation services were among Gleason and Silverstein’s recommendations. The authors offer the caveat that any innovations in paratransit for older adults likely cannot take place without resource investment to truly modernize options, particularly in communities where transportation consistently arises as a quality-of-life issue (e.g., rural areas). An intriguing topic that is addressed by two articles in this month’s issue of The Gerontologist is subjective cognitive decline (SCD). SCD refers to “a state of self-experienced decline in cognitive capacity reported by many older adults despite normal performance on cognitive tests” (Robertson and Jacova, 2023). In other words, SCD is often self-reported and may or may not reflect objective cognitive performance. Nonetheless, SCD can certainly contribute to distress on the part of those who experience it. Although interest in SCD as a construct has grown along with the increasing focus on screening earlier in the dementia trajectory, the sheer prevalence of SCD seems to suggest that this phenomenon represents more than an early stage of dementia alone. Robertson and Jacova’s comprehensive review of the literature suggests that: (a) SCD should continue to be included and measured in epidemiological studies across the life span; and (b) although useful for predicting transitions to mild cognitive impairment or dementia, SCD and its treatment require a more expansive, holistic approach than a sole focus on cognition. The excellent longitudinal study by Ferraro and colleagues (2023) complements Robertson and Jacova’s review by examining the empirical associations of subjective memory decline (SMD, similar in definition to SCD above) and incident cognitive impairment in the Health and Retirement Study. Findings indicated that although SMD was linked to incident cognitive impairment among White respondents, this empirical association was not apparent among Black respondents nor among Hispanic respondents (U.S.- or foreign-born). The findings hold important clinical and scientific implications: Black individuals as well as Hispanic individuals are less likely to receive a formal diagnosis of dementia but are at greater risk for the disease. Do we, clinically and scientifically, have at our disposal culturally tailored tools to: (a) identify SCD appropriately in diverse racial, ethnic, and/or cultural contexts; and (b) when such tools do become available, will we deploy them effectively in partnership with communities so that the complex nuances of social determinants of health and stigma are addressed to encourage brain health equity for all? A highlight of this month’s issue is its two articles focusing on key issues facing lesbian, gay, bisexual, and transgender (LGBT) older adults. The first, by Kittle et al. (2023), relies on data from the pioneering and nationwide Caring and Aging with Pride: National Health, Aging, and Sexuality/Gender Study to examine key predictors of health care service use among LGBT older adults. When considering routine health checkups, Kittle and colleagues found that internalized stigma was associated with less frequent routine checkups. However, LGBT identity disclosure was positively linked to checkups and social support moderated the association between these two variables. The focus on both stigma and identity disclosure (the Caring and Aging with Pride study includes validated measures of these constructs) as well as moderating effects of social support suggest important intervention targets for future gerontological research. Fredriksen-Goldsen et al. (2023), who again rely on the Caring and Aging with Pride: National Health, Aging, and Sexuality/Gender Study, examine modifiable factors linked to health-related quality of life. Relying on 3 years of data from this powerful resource, the authors identified a range of potential intervention/support/programmatic targets, some of which are consistent with findings across other older adult samples (e.g., psychosocial resources such as feelings of mastery and socialization; physical activity) but others that strongly indicate the need for adapted, tailored, and/or entirely new strategies that address day-to-day discrimination and identity stigma among LGBTQ older adults. As noted earlier, of great interest to both The Gerontologist and the discipline in general are social determinants of health and how they influence aging. With that in mind, I was excited to see the paper by Qin et al. (2023) which examined the empirical associations between visual difficulty, functional limitations, and whether/how neighborhood characteristics (specifically, neighborhood social cohesion, or the “subjective perception of social exchange and interaction with neighbors”) moderate such relationships. Using data from the National Health and Aging Trends Study, Qin et al. found that visual difficulty was indeed associated with functional limitations among those older persons living in neighborhoods where greater physical disorder was perceived. As with many of the articles in this month’s issue, what intrigued me about this article was that it highlights “targets” for either intervention development or policy/service innovation. In reflecting on the findings of Qin and colleagues, I am particularly interested in how these associations appear over time and their associations with key transitions during older adulthood. Samuel et al. (2023) conducted a two-stage qualitative study (semistructured interviews followed by focus groups) with low-income older adults living in the city of Baltimore to explore how social norms influence decisions when managing financial challenges. Two key themes emerged: social norms related to personal responsibility were often assumed and mentioned by respondents but were also inconsistent with the various structural barriers and respondents’ lack of control over the prevention, causes, and potential support resources that could address financial challenges. These important findings indicate that to prevent older adults from restricting their necessary expenses to the point of risking their own health and well-being, strengthening policies and programs to enhance the social safety net and address the stigma associated with seeking financial support/help are two important strategies to consider. Fong and Youn (2023) apply Rasch measurement (an item response theory approach) to determine if activity of daily living (ADL) items and scales are stable over time in the Health and Retirement Survey (HRS) and two international data sets that are harmonized with the HRS (the Korean Longitudinal Study of Aging and the Japanese Study of Aging and Retirement/JSTAR). The findings indicate not only scale stability over time but also a hierarchy of functional decline (e.g., difficulty with dressing was found to be the first ADL that respondents had difficulty with in both the HRS and JSTAR). The findings continue to raise the ongoing question in gerontology and across many other disciplines: when will we embrace more dynamic item response theory approaches that better capture what is often a hierarchical ordering in our measures? Fong and Youn provide strong evidence that the hierarchical ordering of ADL items is evident and stable across international data sources. As I have told many since I assumed the Editor-in-Chief position in January: serving in this role is perhaps the best education in gerontology that one could hope for. In some ways, editing The Gerontologist brings me back to the days inside and outside the classroom when I first encountered gerontology as an undergraduate student and the enthusiasm I felt when I realized that gerontology held great possibilities as a profession. As you can see from its impressive scope and depth of articles, this month’s issue of The Gerontologist advances innovation in theory, intervention science measurement, and public health implications of aging in ways that can inspire similar excitement. None declared. None declared.

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