Gerontology Commons^™

Sustainable Small House Project, Mollie Jo George

UNO Student Research and Creative Activity Fair

The Sustainable Small House Project was developed in cooperation with UNO/UNL Engineering, UNO Gerontology, and Metro Community College. This project merges both sustainable living with the small house movement to promote aging-in-place for older adults. This presentation describes the journey of Dr. Bing Chen as he envisioned the Sustainable Small House Project to its development and finally to implementation at its current location--west of Baxter Arena or adjacent to the UNO ballfield.

From a gerontological lens, the project focuses on principles of universal design which allows for aging-in-place, fall-detection and prevention using smart technologies such as Nobi, and voice-activated technologies …

Occupational Therapists' Experience Of Using Home Adaptation And Assistive Products As Interventions For Older Individuals And Persons With Disabilities In Thailand, Peeradech Thichanpiang, Veerawat Sansri, Surachart Thongchoomsin, Sutinun Juntorn, Thitiya Wangkawan, Supatida Sorasak, Phichaya Baramee, Kannika Permpoonputtana, Chirathip Thawisuk, Chutikorn Nopparat, Anuchart Kaunnil Corresponding Author

The Qualitative Report

As Thailand becomes an aged society it is important to promote advancements in geriatric medicine to provide the best care for older individuals. The right assistive facilities and household mobility equipment are essential for everyday activities. The use of home adaptations and assistive products can maximize the quality of life for older individuals and make life more convenient for those with disabilities. This study aimed to investigate the experience of occupational therapists, using home adaptations and assistive products. An individual interview was conducted with eight occupational therapists who worked at regional hospitals and centers of excellence throughout Thailand using a …

Living Below The Line: Economic Insecurity And Older Americans, Insecurity In The States, 2022, Jan Mutchler, Yan-Jhu Su, Nidya Velasco Roldan

Center for Social and Demographic Research on Aging Publications

New estimates from the 2022 Elder Index^TM suggest that nearly half of older adults living alone, and one out of five older couples, lack the financial resources required to pay for basic needs. We compared household incomes for adults age 65 and above living in one- and two-person households to the 2022 Elder Index for each state to calculate Economic Insecurity Rates (EIRs), the percentage of independent adults age 65 or older with annual incomes that do not support economic security. The EIRs allow a better understanding of how many and which older adults are experiencing economic insecurity. National …

Wage And Cost Study Of Oregon Assisted Living And Residential Care Providers, 2022, Ozcan Tunalilar, Sarah Dys, Paula Carder, Diana Jacoby

Institute on Aging Publications

Senate Bill 703 directed Oregon Department of Human Services (ODHS) to conduct a study of licensed residential care (RCF) and assisted living (ALF) facilities, including those with a memory care (MC) endorsement, to evaluate: a) Total cost to provide care to residents, b) the sufficiency of the Medicaid reimbursement paid to facilities to meet the total cost of care, and c) the average compensation paid to direct care workers by the facilities by geographic region. ODHS contracted with the Institute on Aging (IOA) at Portland State University (PSU) to conduct a study to achieve these three objectives. In the fall …

Elder Abuse In Canada: Dimensions And Policy Responses, Taylor Marekovic

Major Papers

Elder abuse and neglect continues to be a gray area when it comes to convicting perpetrators such as family, friends, strangers, and caregivers who commit any form of physical, psychological, financial, neglect, or sexual abuse towards an elder. This is due to the legal definition being vague and non-transparent. The legal and health systems rely on two different definitions of what is deemed to be elder abuse and neglect in Canada when reviewing or assessing allegations of such abuse. Elder abuse and neglect increased throughout the COVID-19 pandemic, during which Ontario and the rest of Canada experienced staffing shortages in …

Enhancing The Quality Of Life For Senior Citizens: A Facilitator’S Guidebook For Mindful Music And Movement, Shannon Sexton

Mindfulness Studies Theses

Music appreciation and enjoyment enhance well-being throughout the lifespan. The challenges and constraints that people experience as they age can lead to lack of access to music, decreased physical activity, and fewer avenues for creative expression. Group music and movement interventions created for older populations offer opportunities for social connection and improved quality of life. Mindful practices add further benefit when combined with these interventions. Current available programs are scarce and most often do not encompass mixed modalities. In addition, the benefits of these programs do not show long-term sustainability. The purpose of this thesis is to explore the effects …

Direct Care Staff Experiences In Oregon Assisted Living, Residential Care And Memory Care Communities, 2022, Paula Carder, Sarah Dys, Lindsay Schwartz, Diana Jacoby, Jacklyn N. Kohon, Dani Himes, Madeleine Fox, Sheryl Elliott, Lauren Bouchard, Portland State University Institute On Aging

Institute on Aging Publications

Resident care assistants (e.g., direct care workers, caregivers, personal care aides) provide the majority of services to assisted living, residential care and memory care-endorsed (ALF/RCF) residents. They faced significant burdens during the COVID-19 pandemic, which amplified existing challenges in some ALF/RCF communities, yet little is known about their work experiences. This qualitative study collected data through focus group and individual interviews with 21 resident care assistants and 12 external colleagues who have experience hiring, training or managing resident care assistants and other ALF/RCF staff, including registered nurse consultants, staffing agency operators, state policy staff, ALF/RCF community operations managers, and advocates. …

Educating Dietetics Students About The Nutritional Concerns Of Older Adults, Lily Brickman

Electronic Theses and Dissertations

The percentage of individuals in the United States who fall within the 65 years and older cohort is anticipated to increase substantially over the next decade due to the large baby boomer generation aging into this category by 2030. Consequently, the healthcare demands of older adults are expected to increase, and medical and healthcare providers must be educated and prepared to meet the unique needs of this population. The purpose of this study is to help learn why interest in FSN 406 Nutritional Care of Older Adults has been so low since its inception in 2020, and whether other institutions …

An Online Vignette Study To Examine The Outcomes Of A Preclinical Alzheimer Disease Diagnosis, Matthew John Wynn

Arts & Sciences Electronic Theses and Dissertations

As Alzheimer disease research forges ahead, and new potential treatments are developed, a conceptualization is emerging of a presymptomatic disease stage. This stage, known as preclinical Alzheimer disease, is characterized by the buildup of amyloid beta and tau proteins in the brain to abnormal levels in a cognitively normal person. There are unknown potential risks and benefits of communicating biological marker risk information for Alzheimer disease using the preclinical Alzheimer disease diagnostic label. The current study uses a vignette methodology to measure older adults’ understanding of risk information when presented with information regarding their risk for developing Alzheimer dementia. Participants …

Fear And Frustration: A Qualitative Analysis Of The Social And Political Impacts Of Covid-19 On U.S. Older Adults, Kacie Ryden, Sarah Schultz

PURE Insights

The COVID-19 pandemic had dramatic impacts on the physical, social, and emotional health of individuals. Older adults, in particular, have experienced the highest mortality rates and the greatest concerns ranging from physical safety to economic stress to social isolation. This paper presents findings drawn from the COVID-19 Coping Study, a national longitudinal study of the social, behavioral, health, and economic pandemic impacts on older adults (aged 55+) in the U.S. The authors qualitatively analyzed attitudes, behaviors, fears, and frustrations expressed by the study participants in an open-ended survey question during the monthly follow-up survey in Fall 2020. The results revealed …

An Exploratory Qualitative Study Of Elder Abuse And Neglect In Long-Term Settings, Noelle A. Haury

PURE Insights

Older adults living in long-term care settings seek support as they age. Due to health concerns, they may be vulnerable to elder abuse and neglect. As older adults continue to reach older adulthood at later ages, elder abuse will continue to increase and adversely affect older adults living in both long-term care and home settings. Those who experience elder abuse have many negative health- related outcomes.

Understanding elder abuse and neglect is critical in both addressing it and creating innovative prevention strategies. This exploratory qualitative research study included interviews with five professionals working in settings that have equipped them with …

Genealogy Tells: Informing Health And Aging Policies Using East Tennessean Older Women's Family Histories, Perceptions, And Experiences Of Health Inequity, Heather Davis

Doctoral Dissertations

Older women face unique health inequities challenges. This study aims to provide an understanding of older women’s perceptions and situated experiences regarding the gendered health inequities they face and the social determinants (SDH) thereof. It examines how these health inequities are situated in older women’s genealogical (familial) and geographical health and mortality outcomes histories and how their perceptions and experiences of health inequities and their familial mortality outcomes histories are characterized by the geopolitical and social norms in which they live. The purpose of this project is to present policy and decision-makers with insights about and recommendations from older women …

Empowering Older Adults With Their Information Privacy Management, Reza Ghaiumy Anaraky

All Dissertations

Literature depicts a deficit-based narrative around older adults and their technology use, suggesting that older adults are not able to keep up with their younger counterparts in adopting new technologies. In this dissertation, I argue that this view is not necessarily accurate or productive. Instead, I argue that the deficit is in the technology design, which is not inclusive and often caters to the needs of younger adults.

I study older and younger adults' privacy decision-making as a showcase. To study the privacy decision-making process with more granularity, I used a dual-route approach (decision heuristics and privacy calculus) to disentangle …

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Associations Of The Covid-19 Pandemic With Older Individuals' Healthcare Utilization And Self-Reported Health Status: A Longitudinal Analysis From Singapore, Sangnam Ahn, Seonghoon Kim, Kanghyock Koh

Research Collection School Of Economics

Background: The COVID–19 pandemic has challenged the capacity of healthcare systems around the world and can potentially compromise healthcare utilization and health outcomes among non-COVID–19 patients. Objectives: To examine the associations of the COVID-19 pandemic with healthcare utilization, out-of-pocket medical costs, and perceived health among middle-aged and older individuals in Singapore. Method: Utilizing data collected from a monthly panel survey, a difference-in-differences approach was used to characterize monthly changes of healthcare use and spending and estimate the probability of being diagnosed with a chronic condition and self-reported health status before and during the COVID-19 outbreak in 2020. Subjects: Data were …

The Impact Of Having Foreign Domestic Workers On Informal Caregivers Of Persons With Dementia: Findings From A Multi-Method Research In Singapore, Qi Yuan, Yunjue Zhang, Ellaisha Samari, Anitha Jeyagurunathan, Tee Hng Tan, Fiona Devi, Peizhi Wang, Harish Magadi, Richard Goveas, Li Ling Ng, Mythily Subramaniam

Research Collection School of Social Sciences

Background: Informal caregivers of persons with dementia (PWDs) sometimes engage foreign domestic workers (FDWs) to support their caregiving journey. However, there has not been much research to establish if this is really beneficial. The current study aims to investigate whether engaging FDWs specifically for caregiving of PWDs truly moderates caregiver stress and to explore caregivers’ experiences of engaging FDWs. Methods: A multi-method study design with a quantitative and qualitative sub-study was adopted. For the quantitative sub-study, 282 informal caregivers of PWDs were recruited. Propensity score matching analysis was used. For the qualitative sub-study, 15 informal caregivers with FDWs were interviewed. …

How Has Grandparenthood Changed In Rural China?, Merril D. Silverstein

Population Health Research Brief Series

China’s rapid modernization and development have led to changes across Chinese society, including within the family. China is experiencing declining birth rates, meaning that fewer older adults are becoming grandparents. At the same time, there has been growing demand for grandparents to serve as caregivers for their grandchildren. This data slice examines the changes in grandparenting in rural China and calls for policies that decrease caregiver burnout, stress, and associated poor health outcomes.

Older Adults On Snap Experience Gaps In Benefits, Colleen Heflin, Leslie Hodges, Irma A. Arteaga, Chinedum O. Ojinnaka, Gabriella Alphonso

Population Health Research Brief Series

The Supplemental Nutrition Assistance Program (SNAP) is the largest food and nutrition assistance program in the United States. Burdens associated with SNAP recertification often lead to administrative churn, when a household experiences a gap in SNAP benefit receipt. Older adults are at risk of experiencing benefit gaps, which may negatively impact their health and nutrition. This brief summarizes results of a recent study that examined administrative churn among Missouri SNAP participants aged 60 years and older. The authors call for program changes that reduce the frequency and duration of churn among older adults.

「回首．動情．傳承」長者生命故事計劃, 嶺南大學亞太老年學研究中心 Asia-Pacific Institute Of Ageing Studies, Lingnan University, Lai Ieng Lau, Pui Yiu Ho, Kwong Lam Wu, Hiu Tung Chan, Ying Laam Tang, Shuk Ling Wong, Wai Ching Lai, Kam Yin Lai, Chun Wai Lo, Yiu Long Tai, Ka Chung Kwong, Hon Wun So

Manual & Guide 手冊及指引

嶺南大學亞太老年學研究中心獲華人永遠墳場管理委員會（「華永會」）資助為期一年的「回首．動情．傳承」長者生命故事計劃(「計劃」)。此計劃旨在讓青年人認識長者生命經驗，學習克服困難與挫折以提升抗逆力，建立正向人生觀。

近年，主流媒體經常批評年輕人的負面人生觀，例如：「躺平主義」、「享樂主義」、「犬儒心態」等，亦不時看到青年人輕生的新聞。我們曾在大學內處理過不少受情緒困擾及企圖自殺的個案，與學生深入交流後，發現他們面對着沉重的學業壓力、財政困難或複雜的家庭關係，內心充滿掙扎不安。

此計劃讓嶺大學生與長者導師進行深度的對談，透過了解長者走過的路、他們經歷過的挫折和教訓，給予年輕人生命的啟示。如果我們以旅遊比喻人生，長者就像環遊世界的資深背包客，即使大家遊覽不同的地點、觀賞過不同的風景，他們總能夠分享一些旅遊的心得，讓新手遊客走少一點冤枉路，或領悟到旅遊的樂趣和意義。長者亦可以藉由敍述人生片段回顧他們生命中的故事，學習接納過去，增加自我認同感。青年人創作生命教育書冊，將長者積極的人生觀傳給年輕一代，並藉此鼓勵其他長者豁達地度過餘年。

我們於2022年初招募嶺南大學學生接受「生命故事敍述」培訓，內容包括：本港的人口老化現象、敍述治療理論、與長者溝通的技巧及模擬實踐練習等，以裝備同學的知識和技巧。本中心再向屯門、元朗區的長者機構發邀請信，誠邀長者擔任生命導師接受訪問。

嶺大安排同學以兩人一組的小隊形式，於2022年6至7月期間前往長者中心、日間護理中心、嶺南大學或長者家中，與十二位長者進行深入訪談。訪談結束後，同學根據訪談的內容，為長者書寫他們獨特的生命故事。例如在人離鄉賤的異國環境下，努力打拼事業的Alfred；堅持不懈持續進修的淑芹和馮春林；即使沒機會求學，仍憑一雙巧手闖出一片天的譚惠；在文化大革命的漩渦中，憑着熱忱而改變命運的蘭英；還有為家人無私奉獻的鳳群、歐婆婆、雅芳及細女；離鄉別井勇闖異地的阿美和阿水；即使被家人賣去做「妹仔」，仍能以「阿Q精神」面對的諒餘。

為保障長者的私隱權益，本書內所有刊登之故事皆經過受訪者或社工審閱，部份受訪者選擇以化名的形式來分享自己的故事，我們亦移除了部份敏感的個人資料。

Adult Day Services In Maine: Benefits, Challenges, And Opportunities, Elizabeth Gattine Jd, Eileen Griffin Jd, Kimberly I. Snow Mhsa, Ba

Disability & Aging

In Maine and nationally, adult day services tend to be underfunded and underutilized compared to other types of long term services and supports (LTSS). In part, investment in adult day services is hampered by a lack of standardized data collection and limited research on issues of accessibility, cost-effectiveness, and the impact of adult day services on the broader health system. Lack of uniformity in state regulatory frameworks for licensing, program design, service delivery, and other administrative requirements further complicates cross-state comparisons. Considering these limitations, a key goal of this report is to provide a more detailed and comprehensive understanding of …

Health Related Challenges Of Rural Elderly Living In Co-Residential Family Care Arrangements, Kidus Yenealem Mefteh

The Qualitative Report

Family plays an indispensable role in the care and support of the rising number of older people particularly in developing countries like Ethiopia where the system of public transfer is minimal. Previous studies in Ethiopia focus on institutionalized and urban-dwelling elderly with little attention to the elderly in the informal care paradigm and rural areas. This study aims to explore the health-related experiences of dependent rural elderly who get care and support within a family setting. A phenomenology method was used, and in-depth interviews were employed to collect data from purposively sampled elders. Data were inductively coded and developed into …

The Role Of Leisure In Older Adults Moving Homes, Kristin Prentice

Electronic Thesis and Dissertation Repository

Moving homes is a common experience for older adults in later life. Concomitant with moving is the transition process of adapting to the new home and developing a sense of place. When older adults change residences they experience disruption in place and risk losing identities. Leisure engagement has been known to help older adults adapt to new transitions in their life, such as death of a spouse, health decline and retirement. Leisure engagement has been linked to the development of sense of home and maintaining identity when moving to residential care settings and congregate living, however, these processes are not …

Mentorship In The Field Of Aging: Purposes, Pivots, And Priorities, Patricia W. Slattum, Tiffany R. Washington, Sarah Dys, Patricia M. D’Antonio, Tonya J. Roberts, Matthew Lee Smith

Health Behavior Research

The Gerontological Society of America (GSA) is a multi-disciplinary organization dedicated to advancing the field of aging and improving the lives of older adults. With a long-standing commitment to mentorship and career development, this article focuses on GSA’s Mentoring Consultancies and Career Conversations events and their pivot to meet the needs and demands of current and future gerontologists amid the COVID-19 pandemic. This article provides a description of these events in the context of planning, content, and member engagement. Recommendations are provided to other organizations seeking to enrich their membership through mentorship and career development activities.

Weight Perceptions And Health Education On Obesity Among Older Adults, Seonghoon Kim, Vicky Mengqi Qin, Xuan Zhang, Kanghyock Koh, Mindy Eiko Tadai, Micah Tan

ROSA Research Briefs

The current brief presents preliminary findings from a special module that measures perceptions of weight and receptivity to health education among older adults. Singapore Life Panel® (SLP) data collected in January 2022 (n=2814) were utilized. Two policy recommendations were made: The main findings highlight that weight misperception is prevalent among older adults. More than a third of respondents (39%) incorrectly perceive their weight status, particularly among overweight and obese older adults, as well as Malay and lower educated respondents. This suggests the importance of public health education for older adults to reduce misperceptions about their own over- and under-weight status, …

Life In An Endemic Covid-19: Older Adults' Well-Being, Activity, And Perceptions, Rachel Ngu, Micah Tan, Jia Ying Low

ROSA Research Briefs

The current research brief provides a preliminary examination of whether older adults have been able to ‘return’ to the pre-pandemic way of life in an endemic COVID-19. To do this, we look at several key indicators, including (1) tracking older adults’ overall life satisfaction, activity levels, and trust in government over the past 3 years, (2) older adults’ confidence to resume activities, as well as subjective perceptions about their safety when leaving the home in an endemic COVID-19, and (3) older adults’ ability to adhere to the Home Recovery Program (HRP), where individuals with COVID-19 are able to recover from …

Resilience, Accelerated Aging And Persistently Poor Health: Diverse Trajectories Of Health Among The Global Poor, Iliana V. Kohler, Cung Truong Hoang, Vikesh Amin, Jere R. Behrman, Hans-Peter Kohler

Population Center Working Papers (PSC/PARC)

Objectives: This study is among the first to document lifecourse trajectories of physical and mental health across adult and older ages (20-70 years) for a poor sub-Saharan African population having faced frequent and sustained adversities.

Methods: The 2006-19 waves of the Malawi Longitudinal Study of Families and Health (MLSFH) were analyzed using group-based trajectory models (GBTM) to identify trajectories of heath (SF12 mental/physical health and BMI) across the lifecourse. Predictors of trajectory membership were estimated using fractional multinomial logits.

Results: Analyses identified three distinct trajectories: (1) good initial mental/physical health that persisted throughout the lifecourse ("resilient aging"); (2) good initial …

Dyadic Positive And Negative Religious Coping Among Older Singaporean Couples And Marital Satisfaction, Gloria J. Lai, Kenneth Tan, Micah Tan, Grace Cheong, Cheng Cheng, Mathews Mathew

Research Collection School of Social Sciences

Difficulties faced in life can affect marital relationships and such troubles may be dealt with in a multitude of ways, including coping religiously. The present study examined how religious coping, either in a positive or negative manner, may have an impact on marital satisfaction. Importantly, this association was studied dyadically in a sample of religiously diverse (Buddhists, 32.3%; Taoists, 17.6%; protestant Christians, 14.1%; and others who did not identify with a specific religion, 19.1%), married older Singaporean adults (N = 1928; 964 couples). Using actor-partner interdependence modeling, we found significant actor, partner, and combined actor-partner effects for positive and negative …

江門市居家養老研究報告 = A Research Report On Ageing In Place In Jiangmen City, 嶺南大學-五邑大學居家養老聯合研究創新中心

APIAS Research Report 研究報告

本研究旨在瞭解江門市”社區居家養老”的狀況及需求，以便當局制定服務，讓長者能在自己最熟悉的地方養老。

硏究採用「量性研究」(Quantitative research method) 的方法，以問卷收集了482位居住在江門市城市、鄉鎮和農村60歲或以上長者的個人狀況和對居家養老的意見。

硏究發現8成以上長者偏好在家養老及覺得其現在居所環境適合養老，但超過一半長者居所的安全性成疑，這包括居所存在鼠患蟲患、住屋光線不足和缺乏維修等。另外，有大約3成認爲社區設施便利性有待提升。

在社交支持方面，超過8成老年人擁有良好的社交支持網絡，出入醫療場所和在生活上遇到難題時能獲得幫忙；少部分無法尋求任何幫助。值得注意的是，尋求正式機構協助的長者不多。

在財務狀況方面，約6成長者主要收入來源為退休金，另外少於半數老年人依靠兒女資助。有部分受訪者依賴存款，政府補貼和勞動收入。受訪者月收入偏低，以1000~4000元爲主，部分沒有任何收人。被訪者的醫療保險覆蓋率接近9成，約有2成人對承擔醫療費用感到吃力。

參與是次研究的受訪者普遍身體狀況和自理能力良好，7成以上滿意當前生活狀態 (包括居所狀況、社會支持、居家安老安排、社區設施及其生活條件)，認爲目前條件能支持他們居家養老。

本研究提出五大建議。第一，雖然目前大部分受訪者滿意當前生活狀態，居家養老服務供給水平仍有改進空間。為應付老年人口急增，政府應加速發展養老業。第二，社區和居家環境需配合長者的身體機能和需要，進行適老化改造，以支持他們在家養老。第三，爲減輕長者醫療費用的負擔，建議政府篩查符合救助標準的長者，提高老年人醫療補貼。第四，為了讓更多老年人能在社區組織中獲得適切的正式服務支持，政府應加大服務購買力度，增加服務名額同時提升服務質素。第五，子女對年長父母的陪伴和依靠是不能缺乏的，但部分子女沒有很好地履行贍養義務。爲增加子女對年老父母的照顧力度，政府應從教育、媒體方面營造社會尊老敬老氛圍。

Reflecting On Resilience: Insight Into Resiliency Development And Utilization In Oregon's Older Adults From 2020 To 2022, Riley A. Wilton

University Honors Theses

Introduction

The events of the last 2 years have complicated the lives of older adults throughout the world. For many, their survival can be traced back to one key trait: resilience.

Background

In the state of Oregon, the years 2020-2022 came with a host of issues that expanded past the COVID-19 pandemic. These events provide context for the world our storytellers discuss.

Methods

Using a snowball recruitment strategy through the efforts of community organizations and senior centers, 4 storytellers sat down to describe their resilience in different ways. They were asked to reflect on their own life experiences, how it …

Aging In Lynn: A Community Needs Assessment, Caitlin Coyle, Mary Krebs, Setarreh Massihzadegan

Center for Social and Demographic Research on Aging Publications

This report describes research undertaken by the Center for Social & Demographic Research on Aging within the Gerontology Institute at the University of Massachusetts Boston, on behalf of the City of Lynn and the Lynn Department of Elder Services. The goals of this project were to investigate the needs, interests, preferences, and opinions of residents of the City of Lynn age 60 or older. The contents of this report are meant to inform the planning and operation of the Lynn Senior Center, and organizations that work with and on behalf of older residents of the City of Lynn. The report …

The Role Of Physical Activity And Gender As Moderators For The Relationship Between Insomnia And Depression, Claire E. Wickersham

Graduate Doctoral Dissertations

Objective: The aim of this study was to examine the association between insomnia and depressive symptoms among middle-aged and older adults and to investigate whether gender or physical activity moderates this relationship. Method: This study used nationally representative data from the 2016 and 2018 waves of the Health and Retirement Study (HRS) and binomial logistic regression was used to estimate models. Regression models for risk of depressive symptoms (2018) were based on a longitudinal model with time-lagged indicators of insomnia, levels of physical activity, and covariates (2016). Results: Analyses showed that participants who reported having insomnia in 2016 were more …