Objective: Hypertension represents a gateway diagnosis to more serious health problems that occur as people age. We examine educational differences in three health behavior changes people often make after receiving this diagnosis in middle or older age, and test whether these educational differences depend on (a) the complexity of the health behavior change and (b) gender. Method: We use data from the Health and Retirement Study and conduct logistic regression analysis to examine the likelihood of modifying health behaviors post diagnosis. Results: We find educational differences in three behavior changes—antihypertensive medication use, smoking cessation, and physical activity initiation—after a hypertension diagnosis. These educational differences in health behaviors were stronger among women compared with men. Discussion: Upon receiving a hypertension diagnosis, education is a more important predictor of behavior changes for women compared with men, which may help explain gender differences in the socioeconomic gradient in health in the United States.
Objective: The objective of this study is to examine racial/ethnic differences in prevalence of chronic conditions and multimorbidities in the geriatric population of a state with diverse races/ethnicities. Method: Fifteen chronic conditions and their dyads and triads were investigated using Hawaii Medicare 2012 data. For each condition, a multivariable logistic regression model was used to investigate differences in race/ethnicity, adjusting for subject characteristics. Results: Of the 84,212 beneficiaries, 27.8% were Whites, 54.6% Asians, and 5.2% Hispanics. Racial/ethnic disparities were prevalent for most conditions. Compared with Whites, Asians, Hispanics, and Others showed significantly higher prevalence rates in hypertension, hyperlipidemia, diabetes, and most dyads or triads of the chronic conditions. However, Whites had higher prevalence rates in arthritis and dementia. Discussion: Race/ethnicity may need to be considered when making clinical decisions and developing health care programs to reduce health disparities and improve quality of life for older individuals with chronic conditions.
Objectives: To examine the association between perceived benefit from hearing aid (HA) use and life-space mobility among older adults. Method: Cross-sectional analysis of 76- to 91-year-old community-dwelling adults (n = 702). Data on perceived hearing with and without a HA were obtained via postal questionnaire and data on life-space mobility (Life-Space Assessment, range = 0-120) via phone interview. Results: Participants who perceived more benefit from HA use, had a better life-space mobility score (M = 65, SD = 2.6) than participants who had less benefit from using a HA (M = 55, SD = 3.2). Participants who benefitted more from HA use did not differ from those who did not have a HA (M = 63, SD = 0.9) in their life-space mobility score. Discussion: Perceived benefit from HA use is associated with higher life-space mobility among community-dwelling older adults. Future studies are needed to examine whether use of an appropriate HA promotes life-space mobility among those with difficulties in hearing.
Objective: This study measures the prevalence of falls and fear of falling among a population sample aged ≥65 years from different ethnic minorities living in the Netherlands, and examines whether ethnicity contributed to the differences in fall risk. Method: We analyzed data from 8,892 Dutch, Moroccan, Turkish, and Surinamese participants. Descriptive statistics and multiple regression analyses were conducted with falls and fear of falling as the dependent variable and ethnicity as the independent variable. Results: Moroccan, Turkish, and Surinamese older adults had a significantly higher odds ratio (OR) for fear of falling than their Dutch counterparts (OR = 2.13, 95% confidence interval [CI] = [1.05, 4.31]; OR = 2.09, 95% CI = [1.07, 4.09]; and OR = 2.49, 95% CI = [1.53, 4.03], respectively). The association between ethnicity and falling disappeared after controlling for socio-demographic and health characteristics. Discussion: Dutch minority older adults were at higher risk for fear of falling than their Dutch counterparts. The study underlines the need for targeting culture-sensitive interventions.
Objective: Disability declined in lower levels of impairment during the late 20th century. However, it is unclear whether ADL disability also declined, or whether it did so across race. In this study, we examine cohorts entering later life between 1984 and 1999, by race, to understand changing ADL disability. Method: We used latent class methods to model trajectories of ADL disability and subsequent mortality in the National Long-Term Care Survey among cohorts entering older adulthood (ages 65-69) between 1984 and 1999. We examined patterns by race, focusing on chronic condition profiles. Results: White cohorts experienced consistent declines in ADL disability but Blacks saw little improvement with some evidence for increased disability. Stroke, diabetes, and heart attack were predominant in predicting disability among Blacks. Discussion: Declining disability trends were only observed consistently among Whites, suggesting previous and future disability trends and their underlying causes should be examined by race.
Objective: To determine the prevalence of mild visual impairment (MVI) among urban older adults in primary care settings, and ascertain whether MVI was a risk factor for inadequate performance on self-care health tasks. Method: We used data from a cohort of 900 older adults recruited from primary care clinics. Self-management skills were assessed using the Comprehensive Health Activities Scale, and vision with corrective lenses was assessed with the Snellen. We modeled visual acuity predicting health task performance with linear regression. Results: Normal vision was associated with better overall health task performance (p = .004). Individuals with normal vision were more likely to recall health information conveyed via multimedia (p = .02) and during a spoken encounter (p = .04), and were more accurate in dosing multi-drug regimens (p = .05). Discussion: MVI may challenge the performance of self-care behaviors. Health care systems and clinicians should consider even subtle detriments in visual acuity when designing health information, materials, and devices.
Objectives: We explored the links between chronic diseases and cognitive ability using datasets of community-dwelling older adults from Brazil, Chile, Mexico, and Uruguay from the SABE (Health, Well-Being, and Aging) survey. Methods: Ordinary least squares (OLS), Tobit and linear probability models, adjusting for extensive health and socio-demographic factors, were implemented separately for men and women and complemented by a series of robustness checks. Results: We find a negative association between the number of chronic conditions and cognitive decline that has the following characteristics: (a) differs across gender, (b) increases with the number of chronic conditions, (c) is larger among those individuals in the bottom of the cognitive distribution, (d) and is different across types of chronic conditions. Discussion: These results suggest that returns from preventive policies to reduce cognitive decline would increase if they were targeted to seniors with chronic conditions and implemented before the impact from multiple comorbidities makes the cognitive decline too steep to be reversed.
Objective: Social activity is associated with healthy aging and preserved cognition. Such activity includes a confluence of social support and verbal interaction, each influencing cognition through rarely parsed, mechanistically distinct pathways. We created a novel verbal interaction measure for the Wisconsin Registry for Alzheimer’s Prevention (WRAP) and assessed reliability of resultant data, a first step toward mechanism-driven examination of social activity as a modifiable predictor of cognitive health. Method: Two WRAP subsamples completed a test–retest study to determine 8-week stability (n = 107) and 2-year stability (n = 136) of verbal interaction, and 2-year stability of perceived social support. Reliability was determined using quadratic-weighted kappa, percent agreement, or correlation coefficients. Results: Reliability was fair to almost perfect. The association between social support and interaction quantity decreased with age. Discussion: Social activity data demonstrate moderate to excellent temporal stability. Moreover, in older individuals, social support and verbal interaction represent two distinct dimensions of social activity.
Objective: The objective of this study is to determine if cognitive worries affect psychological well-being, if these effects are long-term, and if such concerns affect well-being more so among persons with a parent having Alzheimer’s disease (AD). Method: We used structural equation models with three waves of data collected from persons ages 40 to 60 at T1. We created summative scores on five indicators of concerns about cognitive functioning and worries about dementia. Well-being measures included depression, life satisfaction, stress, and mastery. Results: We found (a) cognitive worries at Waves 1, 2, and 3 were generally associated with lower levels of psychological well-being at each of these waves; (b) there was no evidence of long-term, lagged effects, and (c) these relationships were statistically similar across groups of adult children and controls. Discussion: Because concerns about cognitive functioning and developing AD are pervasive among middle-aged and older persons, practitioners should be aware of their potentially deleterious effect on psychological well-being.
Objective: To describe quality of life trajectories of older men over a 10-year time frame in mental and physical health domains, and to determine if these trajectories predict death over a subsequent 9-year period. Method: A cohort study of Royal Canadian Air Force aircrew veterans. We used Short Form–36 (SF-36) measures of mental and physical functioning collected prospectively at six time points between 1996 to 2006 (734 men with a mean age of 85.5 [SD 3.0] years in 2006) to determine trajectories. Continued contact with the cohort from 2006 to 2015 determined subsequent mortality. Results: Men were more likely to maintain high levels of mental functioning than physical functioning. Thirty-seven percent of participants maintained a high level of both mental and physical functioning. Declining function in either mental or physical function was associated with lower survival. Conclusion: Men who maintain physical and mental functioning have a lower mortality rate.
Objective: To investigate the impact of objective and subjective social isolation from extended family members and friends on depressive symptoms and psychological distress among a national sample of older adults. Method: Data for older adults (55 years and above) from the National Survey of American Life (N = 1,439) were used to assess level of objective social isolation and subjective social isolation and to test regression models examining their impact on depressive symptoms (Center for Epidemiologic Studies Depression [CES-D] Scale) and psychological distress (Kessler 6 [K6] Scale). Results: The majority of respondents were not socially isolated from family or friends; 5% were objectively isolated from family and friends, and less than 1% were subjectively isolated from family and friends. Regression analyses using both social isolation measures indicated that objective social isolation was unrelated to depressive symptoms and psychological distress. However, subjective social isolation from both family and friends and from friends only was associated with more depressive symptoms, and subjective social isolation from friends only was associated with higher levels of psychological distress. Discussion: Assessments of social isolation among older populations should account for both subjective and objective dimensions, as well as both family and friend social networks. Social isolation from friends is an important, but understudied, issue that has significant consequences for older adult mental health.
Objective: This study examined the association between excessive daytime sleepiness (EDS) and gait characteristics (e.g., speed, variability) in community-dwelling older adults. Method: This cross-sectional study included 3,901 individuals aged ≥65 years. Participants answered questions about EDS, sleep duration, and other sleep-related symptoms. Gait speed, stride length, and the variability in stride length were assessed by using a stopwatch and a WalkWay device. Results: EDS was significantly associated with slower gait speed among younger subjects (<75 years, p = .021) and with both slower gait speed (p = .045) and greater variability in stride length among older subjects (≥75 years, p = .048) in a multivariate analysis adjusted for age, sex, body mass index, medication, number of comorbidities, and education. Discussion: EDS associates with gait ability, particularly in older old adults. Further prospective studies are needed to determine the causal association between gait ability and sleep disturbances, including EDS.
Objective: To analyze gender differences in incidence and determinants of the components of the frailty phenotype. Method: A total of 1,413 older adults were selected in 2006. To estimate the incidence of each frailty component, only individuals who did not exhibit a given component at baseline (independently of the presence of other components) were included in the study. The variables of interest were socioeconomic, behavioral, clinical, anthropometric factors and physical performance. The incidence of each component in 2010 was the outcome. Results: Unintentional weight loss and slowness were more incident in men up to 74 years of age. The other frailty components were more incident in women at all age groups, except weakness. Besides age, the determinants of incidence of the components of frailty were different between genders. Discussion: Strategies for preventing or delaying the installation of frailty need to address gender differences, considering the greater complexity in the network determinants among women.
Objective: To examine the effect of five childhood misfortune domains—parental behavior, socioeconomic status, infectious diseases, chronic diseases, and impairments—on all-site and selected site-specific cancer prevalence and all-site cancer incidence. Method: Panel data from the Health and Retirement Study (2004-2012) were used to investigate cancer risk among adults above the age of 50. Results: Risky parental behavior and impairment in childhood were associated with higher odds of all-site cancer prevalence, and childhood chronic disease was associated with prostate cancer, even after adjusting for adult health and socioeconomic factors. Moreover, having one infectious disease in childhood lowered the odds of colon cancer. Cancer trends varied by race and ethnicity, most notably, higher prostate cancer prevalence among Black men and lower all-site cancer among Hispanic adults. Discussion: These findings underscore the importance of examining multiple domains of misfortune because the type and amount of misfortune influence cancer risk in different ways.
Objective: To identify socioeconomic and contextual factors associated with functional mobility and falls in elderly residents of São Paulo, Brazil. Method: We used data from the Health, Well-Being, and Aging (Saúde, Bem-estare Envelhecimento [SABE]) Study. The dependent variables were falling in the last year and functional mobility impairment. Individual (marital status, race, education, and perception of income sufficiency) and contextual (green area and violence) factors were analyzed by multilevel logistic models. Results: Having 8 or more years of schooling was a protective factor for mobility impairment. Neighborhoods with moderate homicide rate were associated with higher odds of falling. Moderate green spaces were associated with higher odds of falling and lower odds to have mobility impairment for individuals 80 years and older. Discussion: Our findings support the concern that neighborhood characteristics are associated with falls and mobility impairment. Strategies to prevent these outcomes should consider contextual aspects.
Objective: The aim of this study is to examine the effects of a 12-week, behavioral nutrition intervention on dietary behaviors. Method: Inactive older adults (N = 50) were randomized to a 12-week, behavioral nutrition or physical activity intervention, delivered in a group-based format. Questionnaires assessed fruit and vegetable (FV) consumption, and fat- and fiber-related behaviors at baseline and postintervention. Height and weight were measured. Repeated-measures ANOVAs examined changes in dietary behaviors over time between groups, controlling for age, gender, and education. Results: Participants averaged 64.1 ± 8.4 years of age and had a body mass index (BMI) of 33.3 ± 7.5 kg/m2. Group x Time interactions were significant for FV consumption (p = .003), and fat- (p = .02) and fiber-related (p = .008) behaviors at 12 weeks. At 12 weeks, dietary behaviors improved significantly in the nutrition but not in the physical activity group. Effect sizes were medium to large. Discussion: A 12-week, behavioral nutrition intervention improved dietary behaviors. Behavioral interventions may be a low-cost way to improve dietary behaviors among older adults, potentially affecting population health significantly.
Objective: The aim of this study is to investigate how socioeconomic position (SEP) is associated with multidimensional measures of successful aging (SA), and how this varies and accumulates across the life-course. Method: Using data from 1,733 Scottish men and women from two cohorts aged around 57 and 76, respectively, we explored associations of SA, based on the Rowe–Kahn model, with 10 measures of SEP measured in childhood and, distally and proximally, in adulthood. Results: Individual SEP associations with SA score were generally consistent across different indicators and life stages: Respondents with the most versus least favorable SEP had two additional positive SA dimensions. There was also a strong association between SA and cumulative SEP based on all 10 measures combined; respondents with the most versus least favorable lifelong SEP had four additional positive SA dimensions. Conclusion: SEP advantages/disadvantages act and accumulate across the life-course, resulting in widening socioeconomic inequalities in SA in later life.
Objectives: We test a comprehensive model of disability in older stroke survivors and determine the relative contribution of neighborhood, economic, psychological, and medical factors to disability. Method: The sample consisted of 728 stroke survivors from the National Health and Aging Trends Study (NHATS), who were 65 years and older living in community settings or residential care. Confirmatory factor analysis and structural equation modeling were used to test relationships between neighborhood, socioeconomic, psychological, and medical factors, and disability. Results: Economic and medical context were associated with disability directly and indirectly through physical impairment. Neighborhood context was associated with disability, but was only marginally statistically significant (p = .05). The effect of economic and neighborhood factors was small compared with that of medical factors. Discussion: Neighborhood and economic factors account for a portion of the variance in disability among older stroke survivors beyond that of medical factors.
Objective: This research explores whether physical neighborhood disorder or perceived social cohesion is associated with participation in social activities among older Americans (age 65+). Method: Using the first wave of the National Health & Aging Trends Study (NHATS; N = 6,383), a series of logistic regression models were created to assess the odds of participation. Results: Low social cohesion was associated with decreased odds of visiting friends and family (odds ratio [OR] = 0.65; 95% confidence interval [CI] = [0.52, 0.82]) and participating in organizations (OR = 0.68; 95% CI = [0.53, 0.88]). Presence of neighborhood disorder was associated with decreased odds of visiting friends and family (OR = 0.62; 95% CI = [0.47, 0.82]), participating in organizations (OR = 0.66; 95% CI = [0.48, 0.89]), and going out for enjoyment (OR = 0.68; 95% CI = [0.53, 0.86]). Physical capacity and activity value moderated the relationship between neighborhood disorder/cohesion and attending religious services. Discussion: Improving neighborhood disorder and social cohesion may increase social participation among older adults.
Objective: Guided by theoretical and empirical work attesting to the health benefits of social connections, we tested whether Internet connectivity, and training in its use for social purposes, can support the well-being of older adults receiving care. Method: Participants (N = 76) were randomly assigned to receive 3 months training versus care-as-usual. Cognitive and mental health were assessed before and after the intervention. Results: Results show significant cognitive improvements across time in the training, but not control, group. This effect was mediated through a combination of increased social activity, improved self-competence, and maintained personal identity strength. Indirect effects on mental health outcomes via these processes were also observed. Discussion: These findings suggest that Internet access and training can support the self and social connectedness of vulnerable older adults and contribute positively to well-being.
Objective: This study examined factors associated with the self-reported change in health status as a result of caregiving. Method: Multinomial logistic regression were performed to examine the sociodemographic characteristics, care recipients’ characteristics, and caregiving experiences that affect caregivers’ perceptions of health affected by caregiving using data from 1,087 caregiver respondents in the Caregiving in the U.S. 2015 data set. Data were collected through an online or telephone survey of randomly selected adults in 50 states. Results: Worsened self-reported health with caregiving occurred for caregivers aged 50 to 64, racial/ethnic minorities, those who lived within 20 min of the care recipient’s home, the presence of cognitive deficits, prolonged caregiving, and limited availability of accessible and affordable care services. Importantly, the feeling of choice in taking on care responsibilities was associated with an over fourfold increase in the odds ratio (OR) of better health in response to caregiving (OR = 4.21; confidence interval [CI] = [1.95, 9.08]; p < .001). Discussion: Results suggest that improving accessibility of social service resources to assist caregivers in being better supported and having more choice in caregiving responsibilities may foster a positive change in health status with caregiving.
Objective: To investigate the feasibility, effectiveness, and short-term effects of an exercise intervention using a novel exercise park in improving seniors’ balance, physical function, and quality of life. Method: Randomized controlled trial with pre- and post-intervention design (baseline and 18-week intervention) was used. Outcome measures included measures of balance, strength, and function, as well as quality of life and fear of falling. MANCOVA was used to assess differences between groups (control and exercise intervention) over time. Results: Intervention group showed significant improvement on single leg stance (p = .02, 95% confidence interval [CI] = [–8.35, –0.549]), knee strength (p < .01, 95% CI = [–29.14, –5.86]), 2-min walk (p = 0.02, 95% CI = [–19.13, –0.859]), and timed sit to stand (p = .03, 95% CI = [–2.26, –0.143]) tests. Discussion: The exercise park program improved physical function and had high adherence and participation rate. Such intervention has been shown to be safe and therefore might enhance participation in exercise programs for older adults.
Objective: The purpose of this study was to identify the associations between health and health care utilization with driving patterns in a cohort of older adults. Method: In 2012, a total of 1,826 surviving participants in the Rancho Bernardo cohort were sent a health and driving pattern survey; 1,277 were returned. Results: The majority of the respondents (1,151, 91%) were still driving. Older age, female sex, hospitalizations, emergency department (ED) visits and physical therapy visits, neurological disease, depression, limited vision, and limited hearing were associated with non-driving status. A total of 809 (71%) of drivers reported no citations or crashes in the last 5 years. Discussion: The vast majority of older drivers in this cohort continued to drive, and did so safely. Health care utilization, medications, medical conditions, and self-assessment of health were associated with non-driving status. Prospective studies are needed to clarify the temporal relationships between these factors.
Objective: This study examined the associations of neighborhood characteristics and living arrangements with physical and mental health among older Chinese Americans. Method: A sample of 3,159 community-dwelling Chinese older adults in the Greater Chicago area provided reports of health, socio-demographic characteristics, living arrangements, social cohesion, and neighborhood disorder. We used multinomial logistic, Poisson, and negative binominal regression analyses. Results: Neighborhood disorder was consistently associated with negative health indicators, including poor self-reported health, more chronic conditions, depressive symptoms, and anxiety symptoms. Findings about the relationships between social cohesion and health indicators were mixed. Social cohesion was more salient to mental health for those living with spouse, children, and/or grandchildren relative to those living with spouse only. Discussion: Policies and interventions are needed to improve the physical and social environments of neighborhoods and to promote healthy aging among Chinese older adults and in the general population as well.
Objective: The association between patterns of change in self-rated health (SRH) and memory trajectories in older adults was examined using a systematic approach. Method: Data from the Health and Retirement Study (n = 6,016) and the English Longitudinal Study of Ageing (n = 734) were analyzed. Individuals were grouped into five categories according to their pattern of change in SRH over 8 years: stable excellent/very good/good, stable fair/poor, improvement, decline, and fluctuating pattern without a trend. Memory was measured using immediate and delayed recall tests. Kruskal–Wallis, chi-squares tests, and linear mixed models were used to examine the association. Results: Different rates of decline in memory can be identified in the different patterns of change in SRH. Those who had a stable excellent/very good/good pattern had the slowest rate of decline. Discussion: Our findings suggest that SRH status and patterns of change could be used as a marker of cognitive decline in prevention screening programs.
Objective: We examine race/ethnic, gender, and age differences in telomere length (TL) within a diverse, nationally representative sample of older adults. Method: Data come from 5,228 White, Black, and Hispanic respondents aged 54+ in the 2008 Health and Retirement Study. TL was assayed from saliva using quantitative polymerase chain reaction (qPCR) by comparing telomere sequence copy number with a single gene copy number (T/S ratio). Linear regression was used to examine TL by race/ethnicity, gender, and age adjusting for social, economic, and health characteristics. Results: Women had longer TL than men (p < .05). Blacks (p < .05) and Hispanics (p < .10) had longer TL than Whites. Black women and men had the longest TL relative to other groups (p < .05), while White men had the shortest TL (p < .05). Black women and Hispanic men showed greater differences in TL with age. Discussion: Findings indicate social patterns in TL by race/ethnicity, gender, and age among older adults do not reflect differences observed in most population health outcomes.
Objective: The aim of this study is to evaluate fall rates across body mass index (BMI) categories by age group, considering physical performance and comorbidities. Method: In the Osteoporotic Fractures in Men (MrOS) study, 5,834 men aged ≥65 reported falls every 4 months over 4.8 (±0.8) years. Adjusted associations between BMI and an incident fall were tested using mixed-effects models. Results: The fall rate (0.66/man-year overall, 95% confidence interval [CI] = [0.65, 0.67]) was lowest in the youngest, normal weight men (0.44/man-year, 95% CI = [0.41, 0.47]) and greatest in the oldest, highest BMI men (1.47 falls/man-year, 95% CI = [1.22, 1.76]). Obesity was associated with a 24% to 92% increased fall risk in men below 80 (ptrend ≤ .0001, p for interaction by age = .03). Only adjustment for dynamic balance test altered the BMI–falls association substantially. Discussion: Obesity was independently associated with higher fall rates in men 65 to 80 years old. Narrow walk time, a measure of gait stability, may mediate the association.
Objective: The aim of this study was to compare the efficacy of two approaches: multicomponent interventions that focus on working with the carer and dyadic interventions that work with both the carer and the person with dementia. Method: A systematic review involving a search of Medline, EMBASE, and PsycINFO in October 2015 was performed. Randomized controlled trials involving carers of people with dementia and comparing multicomponent interventions with usual care were included. Results: Pooling of all studies demonstrated that multicomponent interventions can reduce depressive symptoms, improve quality of life, reduce carer impact, and reduce behavioral and psychological symptoms of dementia as well as caregiver upset with these symptoms. We were unable to find a significant difference in the effects of dyadic interventions in comparison with carer focused interventions for these outcomes. Discussion: Although effect sizes associated with intervention are small, multicomponent interventions are relatively inexpensive to deliver, acceptable, and widely applicable.
Objective: The objective of this study is to examine the correlates of healthy aging in the context of educational disadvantage and the extent to which identified correlates are shared with the wider, more educationally advantaged population. Method: Data are from the 2012 Health and Retirement Study. The analytic sample included 17,484 self-respondents ≥50 years of age. Educational disadvantage was defined as having less than a high school diploma. Using logistic regression, healthy aging was regressed on demographic, early-life, and health-related factors by educational status. Results: Among educationally disadvantaged adults, demographic characteristics (e.g., age), health practices (e.g., physical activity), and the presence of health conditions were independently correlated with healthy aging. With few exceptions, correlates of healthy aging were similar among educationally advantaged and disadvantaged adults. Discussion: Ordinary factors are associated with healthy aging among adults without a high school diploma, suggesting that healthy aging is possible for larger numbers of adults aging in the context of educational disadvantage.
Objective: The present study aimed to clarify the circumstances under which activity restriction (AR) is associated with depressive symptoms among patients with osteoarthritis (OA) and their spouses. Method: A total of 220 older adults with OA and their caregiving spouses participated in the study. The actor–partner interdependence model (APIM) was used to examine the associations between AR stemming from patients’ OA and the depressive symptoms of patients and spouses. The potential moderating role of marital satisfaction also was examined. Results: After accounting for pain severity, health, and life stress of both patients with OA and spouses, higher AR was associated with more depressive symptoms for both patients and spouses. In regard to partner effects, patients whose spouse had higher AR reported more depressive symptoms. In addition, the association of spouses’ and patients’ AR and their own depressive symptoms was moderated by their marital satisfaction. For both patients and spouses, the associations between their own AR and depressive symptoms were weaker for those with higher levels of marital satisfaction compared with those with lower levels of marital satisfaction. Discussion: This pattern of findings highlights the dyadic implications of AR and the vital role of marital satisfaction in the context of chronic illness.
Objective: When examining the depressive symptoms of left-behind elderly, this article goes beyond a focus on disruption to traditional patterns of living arrangements and investigates the heterogeneities in the patterns of migration distance, as well as the role of community contexts in buffering the loss of migrant children’s support. Method: This study uses the first wave of the China Health and Retirement Longitudinal Survey, and employs random effects multi-level modeling. Results: Having migrant children is associated with increased depressive symptoms among older adults, above and beyond living arrangements. Having their migrant children all live outside the province further puts older adults in disadvantaged mental conditions. This disadvantage can be further compounded by residence in impoverished communities. Discussion: In assessing depression among rural older adults in China, examination of living arrangements may be insufficient. It may be necessary to reference to children’s migration status as well as community poverty levels.
Objective: The aim of this study was to explore the relationship between work stressors in late midlife and physical functioning in old age. Method: Two linked nationally representative Swedish surveys were used: the 1991 Level of Living Survey (age 57-65) and the 2011 Swedish Panel Study of Living Conditions of the Oldest Old. Work stressors were measured with the job demand–control model and physical functioning in old age with physical performance tests, lung function tests, and self-reported mobility. Ordered logistic and linear regressions were performed (n = 166-214). Results: High demands, low control, and high strain (i.e., high demands combined with low control) were associated with limited physical functioning in women. Low control and passive jobs were associated with limited physical functioning in men. Discussion: Work stressors in late midlife are important predictors of physical functioning in older adults. However, women and men seem to be vulnerable to different work stressors.
Objective: Fine motor ability (FMA) is essential in certain activities of daily living (ADL) and is considered mostly as a component of physical function. We hypothesize that cognitive ability explains significant variance in ADL-related FMA, above and beyond what is explained by physical ability (grip strength). Method: Origins of Variance in the Old Old Study (OCTO)-Twin participants (n = 218), aged 80+ (dementia, stroke, Parkinson’s disease excluded) were assessed on depressive symptoms (Center for Epidemiologic Studies–Depression Scale [CES-D]), a cognitive battery, grip strength, and FMA. Results: In a series of ordinary least squares regression models, FMA was not associated with gender or depressive symptoms, but was associated with age (marginally; β = –.164, p = .051), grip strength (β = –.381, p < .01), and one cognitive measure, perceptual speed (β = –.249, p < .01). Discussion: In nondemented older adults, cognitive speed predicts ADL-related FMA after controlling for age and physical ability. Physical rehabilitation of FMA in ADL tasks should consider the importance of cognitive ability, even in nondemented older adults.
Objective: This study analyzes the links between planning, the built environment, and availability of health-related community services across U.S. urban and rural communities. Method: We analyze the first national survey of health-related community services for seniors (2010 Maturing of America), covering 1,459 U.S. cities and counties. We tested the influence of morbidity (diabetes and obesity), city management, socioeconomic characteristics, planning and the built environment, metro status, and government finance. Results: Community health-related services are more common in places that plan for and involve seniors in planning processes. Places with higher need and government capacity also show higher levels. Service levels in rural communities are not lower after controlling for other population characteristics. Morbidity measures (diabetes and obesity) do not explain differences in service availability. Discussion: Policies promoting planning for aging and elder involvement in the planning process have the greatest impact on the level of community health-related services for seniors.
Objective: To assess the role of unhealthy behaviors in the relationship between chronic stress and significant depressive symptoms by race/ethnicity among older adults. Method: Participant data from the 2006 to 2008 Health and Retirement Study were analyzed. Unhealthy behaviors included current smoking, excessive/binge drinking, and obesity. Chronic stress was defined by nine previously used factors. The eight-item Center for Epidemiologic Studies Depression (CES-D) Scale measured depressive symptoms, where ≥4 symptoms defined significant. Multivariable logistic regression assessed the effects of chronic stress and unhealthy behaviors in 2006 on depressive symptoms in 2008. Results: A higher chronic stress index score predicted depressive symptoms in 2008 among African Americans, Latinos, and Whites (adjusted odds ratio [aOR] = 1.78, 95% confidence interval [CI] = [1.48, 2.15]; aOR = 1.54, 95% CI = [1.15, 2.05]; and aOR = 1.40, 95% CI = [1.26, 1.56], respectively). Unhealthy behaviors moderated this relationship among Latinos (aOR = 1.54, 95% CI = [1.02, 2.33]). Discussion: Unhealthy behaviors were not effective coping mechanisms for chronic stress in terms of preventing significant depressive symptoms. Instead, they strengthened the relationship between chronic stress and significant depressive symptoms among Latinos.
Objective: The objective of the current investigation was to explore performance-based predictors of decline in the performance quality of everyday tasks as a first step for early identification, screening, and referral to minimize disability in community-dwelling older adults. Method: This was a secondary analysis of data from 256 community-based older women. Mobility, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) were measured using the Performance Assessment of Self-Care Skills (PASS). Logistic regression models explored cognitive and motor predictors of performance quality while controlling for demographics and diagnoses. Results: Functional reach (p = .049) and cognition (p = .012) were predictive of mobility quality, whereas balance (p = .007) and the Keitel Function (p = .005) were predictive of ADL quality. Manipulation and cognitive measures were predictive of cognitive and physical IADL quality. Discussion: Cognitive and physical screens are both important to identify older adults at risk for disability.
Objective: To investigate the impact of disability transitions on annual Medicare Part A and B cost. Method: We analyzed 6,385 community-dwelling beneficiaries who were continuously enrolled in fee-for-service Medicare Part A and B from 2008 to 2009. We estimated adjusted effects of disability transitions on Medicare cost using a generalized linear model. Results: Transitions to more severe disability states were associated with significantly higher average annual Medicare cost ranging from US$2,639 to US$5,405. Lower spending levels were observed for beneficiaries with improvements in functioning. Beneficiaries who transitioned from severe to moderate activities of daily living (ADLs) disability cost significantly less (–US$6,045) than those who remained severely disabled. Discussion: Interventions aimed at preventing disability progression and efforts to restore functional capacity are promising strategies for containing costs and generating savings for Medicare. Future research is needed to assess the longer term impact of disability in association with the progression of chronic conditions.
Objective: We investigate whether obesity is associated with sexual activity, sexual frequency, and the range of sexual behaviors in heterosexual older couples. We assess to what extent associations between obesity and sexuality are explained by physical, psychological, and sexual health, and by relationship quality. Method: We use data from 1,698 older adults in 849 partnered dyads in the 2010-2011 wave of the National Social Life, Health, and Aging Project and conduct couple-level analysis featuring women’s and men’s characteristics. Results: Women’s obesity—particularly at severe levels—is negatively associated with coupled sexual activity, and that the association is not mediated by hypothesized mediators. Men’s obesity did not have any association with sexual activity. There was no significant difference between overweight and normal weight adults across all three sexuality measures. Discussion: The growing number of older adults with high levels of body mass index, particularly women, may face certain difficulties in maintaining active sexual lives.
Objective: This study aimed to determine the prevalence of high blood pressure (HBP), self-reported hypertension, and associated factors among in elderly enrolled in the Family Health Strategy (FHS) Program. Method: This is a cross-sectional study with in elderly enrolled in the FHS Program of Campina Grande/Paraíba/Brazil. This study determined the prevalence of HBP and self-reported hypertension and their associations with demographic, socioeconomic variables, lifestyle, and number of self-reported morbidities. Three blood pressure measurements were performed, and the average value was used for analysis. To control possible confounding factors, data were modeled by the method of linear models generalized with Poisson log modeling to determine prevalence ratios and confidence intervals. The SPSS 22.0 statistical application was used, and 5% significance level was adopted. Results: High prevalence of HBP (80.9%) was observed, which was associated with the number of self-reported morbidities, both in the univariate and multivariate analyses. High prevalence of self-reported hypertension (66.4%) was also observed. In the final model, positive association between hypertension and demographic and socioeconomic variables and lifestyle was verified. Discussion: Monitor hypertension should be a priority action given its association with genetic, social and behavioral conditions presented by individuals.
Objectives: This study extends the field of retirement and health by examining the impacts of daily stressors on morning cortisol levels in 253 retirees between 55 and 75 years of age (M = 66.80, SD = 4.96) and the moderating roles of age and gender. Method: Participants derived from the second wave of the Daily Diary Study portion of the National Survey of Midlife Development in the United States (MIDUS-II). Across eight consecutive evenings, participants completed telephone interviews about their daily experiences and provided saliva samples across 4 days. Results: Findings from the multilevel models showed that in the context of navigating the day-to-day responsibilities, older retirees were at a greater risk for subsequent hypothalamic pituitary adrenal (HPA) dysregulation than younger retirees. Discussion: Together, better identification of the associations between daily stressors and physiological functioning will help contribute to the knowledge on ways to promote greater quality of life in retirement.
Objective: Systemic inflammation is an important risk factor for cardiovascular diseases and inequalities by race/ethnicity, gender, and education have been documented. However, there is incomplete knowledge as to how these disparities present across age, especially in late life. This study assesses whether differences in C-reactive protein (CRP), a marker of inflammation, are contingent on age among older persons. Method: Data are from the 2006/2008 Health and Retirement Study (n = 10,974) biomarker assessment. CRP was regressed on interactions between age and other status characteristics. Results: Racial/ethnic differences in inflammation do not vary significantly by age. However, gender and education differences are greatest at younger ages and then narrow steadily with increasing age. Discussion: There is considerable heterogeneity in how disparities in inflammation present across age and characteristics such as race/ethnicity, gender, and education. Understanding status differences in the influence of age on factors affecting late-life health is useful for health disparities research.
Objective: To investigate associations of perceived usefulness to other people with active versus passive coping strategies among adults with knee osteoarthritis (OA). Additional aims explored contributions of personality variables to this dynamic. Method: 199 persons (70.3 years ± 10.4) with knee OA reported personality, coping, and psychosocial data using the Big Five Inventory, subscales from the Social Provisions Scale, and the Coping With Illness measure. Regression analyses identified predictors of perceived usefulness and its independent and interactive associations with active versus passive coping and personality variables. Results: Better subjective health predicted perceived usefulness. Older adults with higher reported perceived usefulness employed more active than passive pain coping strategies. Passive coping was associated with neuroticism and greater functional disability. Discussion: Usefulness predicted active OA pain coping, suggesting that it may promote well-being among persons with chronic pain. Further study investigating perceived usefulness in promoting positive health behaviors is needed.
Objective: Long-term care (LTC) facilities are increasingly intent on creating a "homelike" atmosphere for residents. Although residential staff are integral to the construction of a home within LTC settings, their perceptions have been relatively absent from the literature. Method: Thirty-two LTC staff participants were interviewed about their experiences and perceptions of the physical environment and conceptualizations of home, and thematic analyses were conducted. Results: An overarching category—interpersonal relationships—emerged from our analyses emphasizing the importance of relationships in creating a homelike environment within institutional settings. Sub-themes that inform our understanding include the following: (a) Staff members’ perceptions of home; (b) "Their second home": Adjustment to and familiarity in LTC; and (c) "We become family": Relationality makes a home. Discussion: The study provides evidence to inform current policies and practices in LTC. Specifically, enough time and space should be given to residents and staff to create and maintain personal relationships to make residential care homelike.
Objective: Despite a growing literature on the epidemiology of falls, little is known about injurious falls in residential care facilities (RCFs). Addressing this gap, this study examined demographic, interpersonal, institutional, and community factors associated with injurious falls in RCFs. Method: We conducted analyses using a nationally representative sample (n = 733,309) of RCF residents (2010) examining whether or not a resident experienced a fall that resulted in any injury (past year). Results: Overall, 15% of RCF residents experienced an injurious fall. Residents needing assistance with activities of daily living were more likely to experience injurious falls (adjusted-OR = 1.85), whereas males (adjusted-OR = 0.74) and those residing in smaller facilities (adjusted-OR = 0.68) were less likely. Other resident sociodemographic characteristics, payment status, social connectedness, and rurality were not significant independent predictors. Discussion: Research further exploring multifactorial fall prevention screening and treatment programs in RCFs is recommended for reducing injurious falls in this understudied setting.
Objective: We examined the association between older adults’ mealtime interactions at senior centers in Shanghai and their life satisfaction. Competing hypotheses, derived from socioemotional selectivity theory and activity theory, were tested. Method: Data were obtained from the 2011 Shanghai senior center service utilization survey (N = 320). Relationships between respondents’ mealtime interactions and life satisfaction were tested using multilevel regression modeling. Results: After adjusting for demographics, interactions with tablemates (companionship, self-disclosure, and instrumental support) were positively associated with respondents’ life satisfaction. These associations varied by senior centers. However, the number of tablemates was not significantly associated with respondents’ life satisfaction. Discussion: Findings support the activity-theory-based hypothesis that mealtime interactions are related to older adults’ life satisfaction independent of the number of tablemates. This study illuminates the value of social interactions in the context of community dining programs for the rapidly increasing older population in urban China.
Objective: This study used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate a promotora-led community health program designed for Latinas ages 50 and older that sought to improve physical activity, nutrition, and stress management. Method: A mixed-methods evaluation approach was administered at participant and organizational levels with a focus on the efficacy, adoption, implementation, and maintenance components of the RE-AIM theoretical model. Results: The program was shown to be effective at improving participants’ eating behaviors, increasing their physical activity levels, and lowering their depressive symptoms. Promotoras felt motivated and sufficiently prepared to deliver the program. Some implementation challenges were reported. More child care opportunities and an increased focus on mental well-being were suggested. Discussion: The promotora delivery model has promise for program sustainability with both promotoras and participants alike expressing interest in leading future programs.
Objective: This study examines the link between marital disruption and biological risk, and asks whether the association of this precarious life event with health is contingent on marital loss duration and history. Method: Data are drawn from the National Social Life, Health, and Aging Project (N = 1,414), and Poisson regressions are presented for allostatic load and logistic regressions for individual biomarkers. Results: The currently unmarried with more distant marital disruptions exhibit higher levels of allostatic load than the currently married, which is primarily driven by dysregulation of cardiovascular and metabolic indicators. Results also reveal the differing ways marital disruption "gets under the skin" with widowhood associated with compromised inflammatory, metabolic, and cardiovascular functioning, and divorce with cardiovascular and neuroendocrine markers. Discussion: Findings lend support for both the crisis and chronic strain models, and likely reflect normative expectations of the timing of life events, decrements in marital resources, and selection processes.
Objective: In Australia, the social gradient of chronic disease has never been as prominent as in current times, and the uptake of preventive health messages appears to be lower in discrete population groups. In efforts to re-frame health promotion from addressing behavior change to empowerment, we engaged community groups in disadvantaged neighborhoods to translate published preventive guidelines into easy-to-understand messages for the general population. Method: Our research team established partnerships with older aged community groups located in disadvantaged neighborhoods, determined by cross-referencing addresses with the Australian Bureau of Statistics, to translate guidelines regarding osteoporosis prevention. Results: We developed an oversized jigsaw puzzle that we used to translate recommended osteoporosis prevention guidelines. Discussion: Successful participatory partnerships between researchers, health promotion professionals, and community groups in disadvantaged neighborhoods build capacity in researchers to undertake future participatory processes; they also make the best use of expert knowledge held by specific communities.
Objective: To examine the association among nursing home residents between strength of relationship with a primary care provider (PCP) and inpatient hospital and emergency room (ER) utilization. Method: Medicare administrative data for beneficiaries residing in a nursing home between July 2007 and June 2009 were used in multivariate analyses controlling for beneficiary, nursing home, and market characteristics to assess the association between two measures—percentage of months with a PCP visit and whether the patient maintained the same usual source of care after nursing home admission—and hospital admissions and ER visits for all causes and for ambulatory care sensitive conditions (ACSCs). Results: Both measures of strength of patient–provider relationships were associated with fewer inpatient admissions and ER visits, except regularity of PCP visits and ACSC ER visits. Discussion: Policy makers should consider increasing the strength of nursing home resident and PCP relationships as one strategy for reducing inpatient and ER utilization.
Objective: The aim of this study was to analyze whether the associations between perceived environmental and individual characteristics and perceived walking limitations in older people differ between those with intact and those with poorer lower extremity performance. Method: Persons aged 75 to 90 (N = 834) participated in interviews and performance tests in their homes. Standard questionnaires were used to obtain walking difficulties; environmental barriers to and, facilitators of, mobility; and perceived individual hindrances to outdoor mobility. Lower extremity performance was tested using Short Physical Performance Battery (SPPB). Results: Among those with poorer lower extremity performance, the likelihood for advanced walking limitations was, in particular, related to perceived poor safety in the environment, and among those with intact performance to perceived social issues, such as lack of company, as well as to long distances. Discussion: The environmental correlates of walking limitations seem to depend on the level of lower extremity performance.
Objective: The objective of this study was to assess the associations between cardiovascular health and all-cause and cardiovascular disease mortality among community-dwelling elderly. Method: Secondary data analysis was performed using data collected as part of the InCHIANTI cohort procedures and included 928 participants (55% female) aged 65 years and older. Overall cardiovascular health was assessed using seven health behaviors and factors, scored 0 to 14, with higher scores indicating better cardiovascular health, modeled categorically as tertiles. Vitality status was ascertained using registry information. Cox proportional hazards models were used to examine the associations between cardiovascular health and all-cause and cardiovascular disease mortality. Results: After an average follow-up of 9.1 years, better overall cardiovascular health (highest tertile) was inversely associated with all-cause (hazard ratio [HR] = 0.68, 95% confidence interval [CI] = [0.51, 0.92]) and cardiovascular disease mortality (HR = 0.61, 95% CI = [0.38, 0.97]) compared with the lowest tertile. Discussion: Cardiovascular health, even in the elderly, is inversely associated with mortality.
Objective: There are few studies on relationships between deprivation and the self-reported health of people aged above 64 years, and no studies fully representative of Northern Ireland’s older population. This article addresses this gap. Method: Deprivation of older people as reported in the 2001 and 2011 Censuses and the relationship with self-reported health are analyzed over a 10-year span using multilevel modeling. The data are from the Northern Ireland Longitudinal Study (NILS) linked to 2001-2011 Census returns. Deprivation measures include housing tenure; property value; access to a car; and educational, employment, and area-level income deprivation. Results: Older people suffering deprivation face a significant health disadvantage over a 10-year time span. Discussion: This health disadvantage is stronger in men than in women, likely due to conservative gender roles that are prevalent among Northern Ireland’s older population, leading to psychological distress especially among deprived men. The analysis found strongly significant area-level effects, aggravating the health impact of deprivation.
Objective: This study identified the prevalence of and relationship between mood disorders and multimorbidity in middle-aged and older veterans. Method: Cross-sectional data were obtained from veterans who received primary care services at VA Pittsburgh Healthcare System from January 2007 to December 2011 (n = 34,786). Results: Most veterans had three or more organ systems with chronic disease (95.3%), of which 4.1% had a depressive disorder, 2.5% had an anxiety disorder, and 0.7% had co-occurring depression and anxiety. The odds of having a mood disorder increased with each additional organ system with chronic disease, with odds being the greatest in those with 10 to 13 organ systems with chronic disease. Younger age, female gender, non-married marital status, and having a service connected disability were also significant predictors of having a mood disorder. Discussion: These findings suggest a need to integrate mental health assessment and treatment in chronic health care management for veterans.
Objective: The aim of this study is to evaluate mortality and survival rates of patients aged 65 years or older who sustained a hip fracture and were treated at a hospital in Bogotá, Colombia, after the establishment of an Orthogeriatric Program. Method: In total, 298 patients were treated according to the program’s protocol. The primary outcome was 1-year mortality. Mortality predictors were estimated using Cox proportional hazards model, and survival was measured with Kaplan–Meier analysis. Results: The annual survival rate increased from 80% to 89% (p = .039) 4 years after its implementation. There was a significant decrease in mortality risk (Hazard Ratio = 0.54, p = .049). Arrhythmia, valvular heart disease, history of myocardial infarction, and age greater than 85 years were predictors of mortality. Discussion: This is the first study in Latin America to show decreased mortality rates 1 year after the implementation of an Orthogeriatric Program. Our rates were lower than developed countries, suggesting the existence of additional factors that influence long-term outcomes.
Objective: African Americans experience high rates of type 2 diabetes mellitus (T2D). Self-management strategies, such as medication adherence, are key to mitigating negative T2D outcomes. This article addresses a gap in the literature by examining the intersections of drug abuse histories and medication adherence among urban, older African Americans with T2D. Method: In-depth interview data were collected as part of a larger ethnographic study examining the subjective experience of T2D among urban older adults. Two representative focal cases were selected and thematic analysis performed to illustrate how former illicit drug addicts perceive prescription medication usage. Results: Narratives reveal that participants are displeased about having to take prescription drugs and are making lifestyle changes to reduce medication usage and maintain sobriety. Discussion: Previous drug abuse not only complicates medication adherence but is also a significant part of how older African Americans who are former drug users frame their understanding of T2D more broadly.
Objective: This study investigated the risk of cognitive and functional impairment in older Mexicans diagnosed with arthritis. Participants included 2,681 Mexicans, aged ≥60 years, enrolled in the Mexican Health and Aging Study cohort. Method: Participants were categorized into arthritis and no arthritis exposure groups. Primary outcome included participants categorized into "cognitively impaired" or "cognitively normal" groups. Secondary outcomes included participants categorized into Normal, Functionally Impaired only, Cognitively Impaired only, or Dementia (both cognitively and functionally impaired) groups. Multivariable logistic and multinomial regression models were used to assess the relationships. Results: Overall, 16% or 7% were diagnosed with cognitive impairment or dementia. Compared with older Mexicans without arthritis, those who were diagnosed with arthritis had significantly increased risk of functional impairment (adjusted odds ratio [OR] 1.82, 95% confidence interval [CI] = [1.45, 2.29]), but not of dementia. Conclusion: Arthritis is associated with increased risk of functional impairment, but not with dementia after 11 years in older Mexicans.
Objective: The objective of this study was to develop and assess a composite measure of physical capacity using self-report and physical performance items. Method: Item response theory (IRT) is used to evaluate measurement properties of self-report and performance items and to develop a composite measure for 7,609 participants in the National Health and Aging Trends Study. Results: Self-reports distinguish differences at the lower end of physical capacity but not at mid-to-high levels. Performance-based measures discriminate across a fuller spectrum. An IRT-based composite score, drawing on both, provides increased measurement precision across the physical capacity spectrum and detects age group differences if either self-report or performance does so—suggesting it is better suited for studying age-related changes than either measure alone. Discussion: Self-report and performance measures have different strengths on the physical capacity spectrum. IRT provides a means of combining these different measurement approaches for analyses of physical capacity across a broad range of functioning in later life.
Objective: This article focuses on retirement transition from the Conservation of Resources (COR) perspective to better understand how aged participants’ perceptions of retirement losses and gains significantly explain retirement well-being. In this article, the mediation of social support in the losses–well-being relationship is explored. Method: The study was conducted with a two-wave longitudinal design. Participants at T1 were aged Spanish workers (>64 years) and at T2 were retirees, with a final sample of 275, who had retired during the previous 6 months. Results: Findings supported the assertion that losses better explain well-being than gains. In addition, specific losses revealed a higher explaining power of life satisfaction and health complaints depending on their content. Social support mediated between perceived losses and well-being. Discussion: This study suggests that both perceived losses and gains associated with retirement and social support during retirement should be taken into account when addressing postretirement well-being.
Objective: This study identified associations between chronic diseases (diabetes, asthma, depression, and arthritis) and workforce participation patterns with a gendered perspective. Method: We used data from 1,261 middle-aged participants of the Australian Life Histories and Health (LHH) Survey, aged 60 to 64 years in 2011. Latent class analysis identified dominant workforce patterns and associations between chronic diseases and these patterns were explored by multinomial regression models. Results: Diabetes, asthma, depression, and arthritis were less prevalent in men and women in class "mostly full-time work," compared with other workforce patterns. The odds of "mostly full-time work" were lower for men reporting depression or arthritis, whereas among women, depression was associated with "increasing part-time work" after adjusting early and adult life factors. Discussion: The results strengthen the importance of gender focused policies aimed to promote and preserve health of young and middle-aged workers, and creating supportive environment for those with chronic health issues over the life course.
Objective: The aim of this study was to understand the relationships among depressive symptoms, cognition, and functional performance in a community-based sample of older adults. Method: Older adults (N = 885) from the Staying Keen in Later Life study completed tests of executive function, speed of processing, and memory. The Center for Epidemiologic Depression Scale assessed depressive symptoms. The Timed Instrumental Activities of Daily Living Test assessed participants’ everyday functional performance. Results: Depressive symptoms had significant associations with measures of executive function, speed of processing, memory, and everyday functional performance. Cognitive performance completely mediated the association between depressive symptoms and everyday function. Discussion: Among community-dwelling older adults, depressive symptoms were associated with impaired cognition across multiple domains, which detrimentally affected everyday function. Health care providers should be aware of these associations to monitor and manage changes in depressive symptoms and cognitive performance and thereby potentially mitigate functional decline.
Objective: Rates of advance directive completion have increased over the past decade, but significant race differences remain. This study examined how overall increases in advance directive completion have affected disparities between White and African American older adults. Method: Data were taken from the Health and Retirement Study (HRS). Using logistic regression models, the odds of having an advance directive among a sample of older African Americans and Whites who died between 2001 and 2012 were compared (N = 5,832). Results: Odds for African Americans were 16% of the odds for Whites, p < .001, 95% confidence interval (CI) = [0.11, 0.23]. There were no significant interactions between race and year of death before 2010. During 2010-2012, the increase in the odds for African Americans was greater than for Whites, odds ratio (OR) = 1.95, p = .02, 95% CI = [1.14, 3.35]. Discussion: Although race disparities remain, the gap between Whites and African Americans has begun to narrow.
Objective: To compare the effects of behavioral interventions targeting decreased sedentary behavior versus increased moderate-to-vigorous intensity physical activity (MVPA) in older adults. Method: Inactive older adults (N = 38, 68 ± 7 years old, 71% female) were randomized to 12-week interventions targeting decreased sedentary behavior (Sit Less) or increased MVPA (Get Active). The SenseWear armband was used to objectively assess activity in real time. Assessments included a blinded armband, the Community Health Activites Model Program for Senior (CHAMPS) questionnaire, 400-meter walk, and the Short Physical Performance Battery (SPPB). Results: Objectively measured MVPA increased in Get Active (75 ± 22 min/week, p < .001); self-reported MVPA increased in both groups (p < .05). Sedentary behavior did not change in either group (all p > .05). Only the Sit Less group improved the SPPB score (0.5 ± 0.3, p = .046). Discussion: Targeting reduced sedentary behavior had a greater effect on physical function among inactive but high functioning older adults over 12 weeks. Future studies of longer duration and combining increased MVPA with reduced sedentary behavior are needed.
Objective: Fatigue is a common condition contributing to disability among older patients. We studied self-reported task-specific fatigue and its relation with mobility task performance among community-dwelling primary care patients. Method: Cross-sectional analysis of baseline demographic and health data from a prospective cohort study of 430 primary care patients aged 65 years or older. Fatigue was measured using the Avlund Mobility–Tiredness Scale. Performance tasks included rising from a chair, walking 4 m, and climbing two flights of stairs. Results: Among demographic and health factors, pain was the only attribute consistently predictive of fatigue status. Self-reported chair rise fatigue and walking fatigue were associated with specific task performance. Stair climb fatigue was not associated with stair climb time. Discussion: Pain is strongly associated with fatigue while rising from a chair, walking indoors, and climbing stairs. This study supports the validity of self-reported chair rise fatigue and walking fatigue as individual test items.
Objective: This study examined out-of-pocket premium burden of mid-life Asian Americans by comparing six sub-groups of Asians after controlling for geographic clustering at the county and state levels. Method: The 2007-2011 National Health Interview Survey was linked to community-level data and analyzed for 4,628 Asians (ages 50-64), including 697 Asian Indians, 1,125 Chinese, 1,393 Filipinos, 434 Japanese, 524 Koreans, and 455 Vietnamese. Non-Hispanic Whites were included as a comparison group (n = 48,135). Three-level multilevel modeling (state > county > individual) was conducted. Results: Koreans and Vietnamese were found as vulnerable sub-groups considering their lower private health insurance rates and higher uninsured rates. Among those with private insurance, Asians, specifically Filipinos, paid significantly less than non-Hispanic Whites. Moderate but significant variations in the county- and state-level variance in out-of-pocket premiums were found, especially among mid-life Asians. Discussion: This study demonstrates the importance of examining within-group heterogeneity and geographic variations in understanding premium burden among mid-life Asians.
Objective: To examine the relationship between health care access and diabetes management among a geographically diverse sample of American Indians (AIs) aged 50 and older with type 2 diabetes. Method: We examined the relationship between access to care and diabetes management, as measured by HbA1c, using 1998-1999 data from the Strong Heart Family Study. A series of bivariate and multivariate linear models examined the relationships between nine access-related variables and HbA1c levels. Results: In bivariate analyses, out-of-pocket costs were associated with higher HbA1c levels. No other access-related characteristics were significantly associated with diabetes management in bivariate or in multivariate models. Discussion: Access-related barriers were not associated with worse diabetes management in multivariate analyses. The study concludes with implications for clinicians working with AI populations to enhance opportunities for diabetes management.
Objective: This study examined the relationships between social activities, incident cardiovascular disease (CVD), and non-CVD mortality among older adults in the United States. Method: Data from the Health and Retirement Study (2006-2010) were employed. Two measures of social engagement, volunteering and informal helping, along with two measures of social participation, attendance at religious services and social group meetings, were included. Mediation models for health behaviors were estimated. Results: Multinomial logistic regression models demonstrated that volunteering provided the most consistent results in terms of a lower risk of incident CVD and mortality. Furthermore, volunteering at higher time commitments is related to lower CVD incidence and death; informally helping others at a modest time commitment is related to lower risk of death only. Health behaviors mediated the relationships. Social participation was not related to either CVD or mortality. Discussion: Social activity is a modifiable behavior that may be considered a potential health intervention.
Objective: This study investigates how the causal effects of cholesterol screening differ by likelihood of using this preventive care service in terms of accessibility gaps and effects on health-related outcomes across groups with advantaged and disadvantaged backgrounds. Method: We use propensity score matching to analyze a nationally representative sample using data from 2008, 2010, and 2012 waves of the Health and Retirement Study (N = 3,907). Results: We find that respondents who are least likely to get their cholesterol tested benefit most from the use of cholesterol screening when they do use it, while its effects are smallest for those who are most likely to use this service. Discussion: Understanding the heterogeneous effects of preventive health service has important policy implications, particularly in terms of how to maximize the public health benefits of preventive care.
Objective: The objective of the study is was investigate the association between hearing impairment and anxiety. Method: We conducted a cross-sectional analysis of 1,732 community-based adults aged 76 to 85 years who participated in the Health Aging and Body Composition (ABC) study. Logistic regression models were adjusted for demographic and cardiovascular risk factors. Hearing impairment was defined by the speech-frequency pure tone average. Anxiety was defined as reporting two symptoms of at least "a little" or one symptom "quite a bit" on the three-item Hopkins Symptom Checklist. Results: Compared with individuals with no hearing impairment, the odds of prevalent anxiety were higher among individuals with mild hearing impairment (odds ratio [OR] = 1.32, 95% confidence interval [CI] = [1.01, 1.73]) and moderate or greater hearing impairment (OR = 1.59, 95% CI = [1.14, 2.22]). Hearing aid use was not significantly associated with lower odds of anxiety. Discussion: Hearing impairment is independently associated with greater odds of anxiety symptoms in older adults.
Objective: The aim of this study was to examine the decision-making (DM) styles of younger (18-39 years), middle-aged (40-59 years), and older (≥60 years) cancer survivors, the type and role of social support, and patient satisfaction with cancer treatment DM. Method: Adult cancer survivors (N = 604) were surveyed using Qualtrics online software. Results: Older adults reported significantly lower influence of support on DM than younger adults. The most common DM style for the age groups was collaborative DM with their doctors. Younger age was a significant predictor of independent (p < .05), collaborative with family (p < .001), delegated to doctor (p < .01), delegated to family (p < .001), and demanding (p < .001) DM styles. Discussion: Despite having lower received social support in cancer treatment DM, older adults were more satisfied with their DM than younger and middle-aged adults. Health care workers should be aware of different DM styles and influence of social networks to help facilitate optimal patient DM and satisfaction.
Objective: Subjective health is a complex indicator predicting longevity independent of objective health. Few studies examine genetic and environmental mechanisms underlying different facets of subjective health across the life course. Method: Three subjective health measures were examined in 12,900 twins (Mage = 63.38, range = 25-102) from nine studies in the Interplay of Genes and Environment across Multiple Studies Consortium: self-rated health (SRH), health compared with others (COMP), and health interfering with activities (ACT). Results: Analyses indicated age and sex differences in mean scores depending on the measure. SRH and ACT showed significant linear and non-linear moderation by age for individual differences in both genetic and environmental variance. Significant sex differences in components of variance were found for SRH and ACT, but not COMP. Discussion: Subjective health appears to be dependent on frame of reference and reflect different aspects of health. Results suggest different genetic and environmental mechanisms underlie each facet.
Objectives: This study examined the processes linking age, stressor exposure, psychosocial coping resources, and two dimensions of anger proneness (i.e., experienced anger and expressed anger). Method: Longitudinal change regression analysis of data from a two-wave community panel study including a sample of people aged 18 to 93 (N = 1,473) is performed. Results: Age is significantly associated with declines in both experienced anger and expressed anger over the 3-year study period. These associations are substantially mediated by the lower levels of chronic stressors and discrimination-related stressors experienced among older adults. In contrast, self-esteem amplifies the association between age and expressed anger. Discussion: These findings clarify the circumstances in which age matters most for changes over time in the experience and expression of anger. They highlight how certain forms of stressor exposure and psychosocial resources are linked with anger proneness and in ways that vary by age.
Objective: To estimate the cost of dementia care and its relation to dependence. Method: Disease severity and health care resource utilization was retrieved from the Swedish National Study on Aging and Care. Informal care was assessed with the Resource Utilization in Dementia instrument. A path model investigates the relationship between annual cost of care and dependence, cognitive ability, functioning, neuropsychiatric symptoms, and comorbidities. Results: Average annual cost among patients diagnosed with dementia was 43,259, primarily incurred by accommodation. Resource use, that is, institutional care, community care, and accommodation, and corresponding costs increased significantly by increasing dependency. Path analysis showed that cognitive ability, functioning, and neuropsychiatric symptoms were significantly correlated with dependence, which in turn had a strong impact on annual cost. Discussion: This study confirms that cost of dementia care increases with dependence and that the impact of other disease indicators is mainly mediated by dependence.
Objective: The objective of this study was to investigate the association between chronic diseases and sleep difficulty in older women. Method: A total of 10,721 women from The Australian Longitudinal Study on Women’s Health, aged 70 to 75 years at baseline (1996), who answered sleep questionnaire data over 15 years follow-up, were surveyed. Longitudinal sleep difficulty class was regressed on baseline diseases. Results: Arthritis and heart disease were the strongest predictors of sleep difficulty; odds ratios for belonging to the greatest sleep difficulty class were 2.27 (95% confidence interval [CI] = [1.98, 2.61]) and 1.8 (95% CI [1.5, 2.16], respectively. Bronchitis/emphysema, osteoporosis, asthma, diabetes, and hypertension also predicted greater sleep difficulty. Conclusion: Older women diagnosed with the aforementioned significant diseases may also be at greater risk of sleep difficulty. These women may need counseling or treatment for their sleep difficulty, to prevent depression, cognitive function decline, falls, frailty, and increased mortality, as well as greater risk of nursing home placement, well known to be reinforced by sleep trouble, and the associated health care costs and societal impacts poor sleep quality has for older adults.
Objective: Improving health behaviors can delay or prevent lifestyle diseases. Previous quantitative studies suggest that interventions at retirement may be particularly effective. This study introduces the voices of older people to explore the potential of retirement as a change point. Method: This qualitative study of current and anticipated health behaviors among 55 people approaching retirement in England reports thematic analysis of semi-structured interviews. Results: Many respondents expected improved health behaviors whether from conscious changes or simply as a beneficial side effect of retiring, while a smaller group felt retirement carried inherent health risks, with a need to guard against these. Discussion: The retirement transition can potentially establish positive health behaviors, but interventions need careful targeting to maximize their benefit. Further research is required to explore how far intentions translate into practice and the barriers and facilitators to doing so.
Objective: Hip fracture usually affects psychological functions of the elderly, and comorbidities often interfere with their recovery. However, little is known about the influence of number of comorbidities on their psychological outcomes. Method: Data from a previous study of 461 hip-fractured elders treated at a medical center in northern Taiwan were analyzed by the generalized estimating equation approach. Outcomes were assessed at 1, 3, 6, 12 months following discharge by the Geriatric Depression Scale (GDS), Mini-Mental State Examination, and two subscales of the Medical Outcomes Study Short Form 36: role limitations due to emotional problems, and Mental Health (MH). Results: Hip-fractured elders with more comorbidities were more likely to have cognitive impairment (β = 0.224, p = .004), higher GDS scores (β = 0.328, p = .001), and worse MH (β = –1.784, p = .009) during the first year following discharge. Discussion: Having more comorbidities negatively influenced the psychological outcomes of elderly patients with hip fracture.
Objective: To investigate disparities in life satisfaction among older Hispanic immigrants in the United States relative to their native-born Hispanic and non-Hispanic White counterparts, and to identify factors associated with such disparities. Method: Cross-sectional data from 9,798 individuals age 60 and above from the Health and Retirement Study (HRS) were used to estimate ordinary least squares (OLS) regression models. Results: Hispanic immigrants reported the highest levels of life satisfaction of all groups. Wealthier older adults, who were socially engaged, had social support, and experienced fewer functional limitations and lower exposure to discrimination, were more satisfied with their lives in the overall sample. Interaction effects revealed that although education was associated with greater life satisfaction only among non-Hispanic Whites, co-residing with children was associated with greater life satisfaction only among Hispanics. Discussion: Although older Hispanic immigrants had the least amount of socioeconomic resources of all groups in our study, they were the most satisfied with their lives. Possible explanations and directions for future research are discussed.
Objective: To model the impact of dementia on past societies. Method: We consider multiple lines of evidence indicating elderly individuals to have been more common throughout the past than is frequently accepted. We then apply known dementia incidence/prevalence rates to plausible assumptions of past population structures to suggest prevalence in the past. Results: Dementia prevalence in premodern societies is likely to have been around 5% of the rate seen in modern, developed countries but with a total past incidence running into billions. Discussion: Dementia is often seen as a "modern" challenge that humans have not had to contend with before. We argue that this condition has had considerably greater effects than previously envisaged and is a challenge that humans have already withstood successfully, on one hand at a lower incidence but on the other without the considerable clinical, technological, and social advances that have been made in recent times.
Objectives: This study examined the associations of two measures of vision impairment (i.e., a clinical measure of visual acuity and self-reported vision status) and social isolation in a nationally representative sample of Americans aged 60 and older. Method: Five cycles of the National Health and Nutrition Examination Survey (NHANES IV; 1999-2008) were used to estimate successive logistic regression models, holding constant demographic characteristics, chronic illness, functional limitations, and disability. Results: Effects of both measures of vision impairment in predicting social isolation were substantially reduced or eliminated in adjusted models. Where significant effects of vision impairment on social isolation remained, a strong effect was found for self-reported poor vision (odds ratio = 1.53; 95% confidence interval = [1.08, 2.16]). Discussion: As one of the better vision-related predictors of social isolation, self-reported vision is among the easiest and inexpensive to assess. The use of self-reported vision as a screening criterion for social isolation is discussed.
Objective: To investigate the associations between perceived environment features and walking in older adults. Method: A cross-sectional population-based study was performed in Florianopolis, Brazil, including 1,705 older adults (60+ years). Walking was measured by the International Physical Activity Questionnaire (IPAQ), and perceived environment was assessed through the Neighborhood Environment Walkability Scale. We conducted a multinomial logistic regression to examine the association between perceived environment and walking. Results: The presence of sidewalks was related to both walking for transportation and for leisure. Existence of crosswalks in the neighborhood, safety during the day, presence of street lighting, recreational facilities, and having dog were significant predictors of walking for transportation. Safety during the day and social support were significantly associated with walking for leisure. Discussion: The perceived environment may affect walking for specific purposes among older adults. Investments in the environment may increase physical activity levels of older adults in Brazil.
Objective: The aim of this study is to compare an empirically derived classification of amnestic mild cognitive impairment (aMCI) from a sample of adults with subjective cognitive complaints by using cluster analysis of their performance on the California Verbal Learning Test (CVLT) with a classification of aMCI based on standard clinical criteria. Method: Three hundred ninety-one individuals aged 48 years and older were diagnosed as aMCI or healthy controls. Cluster analysis of the CVLT performance was conducted, followed by logistic regression analysis. Results: A two-cluster solution performed on the CVLT measures correctly classified 98.0% of the aMCI patients and 73.4% of the healthy controls diagnosed by using standard aMCI criteria. Discussion: The empirically derived classification of aMCI is consistent with the classification based on standard criteria; however, standard criteria should also be considered to prevent false positives.
Objective: To examine whether older parents in China would benefit more from daughters’ care than from sons’ emotional care. Method: Analysis of the unique data sets of the Chinese Longitudinal Healthy Longevity Survey conducted in 2002, 2005, and 2008-2009 in 22 provinces. Results: As compared with having son(s), having daughter(s) is significantly more beneficial at older ages in China, with regard to maintaining higher cognitive capacity and reducing mortality risk. Such daughter advantages in providing emotional care to older parents are more profound among the oldest-old aged 80+ as compared with the young-old aged 65 to 79 and surprisingly more profound in rural areas as compared with urban areas, even though son preference is much more common among rural residents. Discussion: We describe how educational campaigns aimed at informing the public about the benefits of daughter(s) for older parents’ health outcome could help promote gender equality and reduce traditional son preference, especially in rural China.
Objectives: While poor health contributes to early work exits, it is less clear how early work exits affect health. This study therefore examines changes in health associated with retirement. Method: Survey data from gainfully employed individuals aged 57 to 66 in 2002 were used to assess changes in health status and behaviors associated with retirement (49%) 5 years later (N = 546). Results: Compared with workers, retirees were more likely to report improvements in mental health (odds ratio [OR] = 1.67), and less likely to report mental health deteriorations (OR = 0.56). Retirees were more likely to both increase (OR = 2.03) and reduce (OR = 1.87) their alcohol intake, and to increase physical activity (OR = 2.01) and lose weight (OR = 1.75). Discussion: As welfare states aim to extend working life to counteract repercussions of population aging, findings on possible health benefits for retirees may warrant more focus on the pros and cons of a prolonged working life.
Objective: The objective of this study is to (a) examine racial/ethnic differences in trajectories of cognitive function and (b) evaluate the role of education and health behaviors (physical activity [PA] and smoking) as mediators of racial/ethnic differences in the rate of decline in cognitive function in older adults. Method: Data for this study came from the Health and Retirement Study (n = 3,424). Hierarchical linear models were used to define the trajectory of cognitive function between 2002 and 2008. Participants were classified based on PA as non–vigorously active, intermittent vigorously active, and consistently vigorously active. Results: After adding education, the Hispanic’s and Black’s disparities in cognitive performance were slightly attenuated (Hispanics, β = –1.049, p < .001; Blacks, β = –3.397, p < .001) but were still different from Whites. Smoking was not associated with the cognition intercept or rate of decline. Discussion: We found education had a partial mediating effect on racial differences in levels of cognition but not on the rate of change over time.
Objective: This study provides estimates of associations of education with life expectancy and the percentage of remaining life from age 40 with disability. Method: We used the Panel Study of Income Dynamics, 1999-2011 (n = 8,763; 94,246 person-years), measuring five education levels. We estimated probabilities of disability and death with multinomial logistic Markov models, and used microsimulations beginning at age 40, controlling for gender, race/ethnicity, age, and disability. Results: With college education, African American and White women, and African American and White men, respectively, lived 46.6%, 44.0%, 55.2%, and 50.4% more years from age 40 than those educated at less than the ninth grade (p < .001). Corresponding percentages of life with disability were lower with high education, by 37.9%, 38.9%, 41.0%, and 39.9% (p < .001). There was little evidence of outcome differences between African Americans and Whites within education levels. Discussion: Low education is associated with shorter lives with much more disability.
Objective: To examine the association between organized social activity, walking exercise, and insomnia symptoms. Material and Method: Data for analysis are derived from the National Health Aging Trends Study (NHATS). At baseline, demographic characteristics, socioeconomic status, health-related behaviors, sleep-related problems, and health status were assessed using questionnaires. Results: Data for 7,162 community-dwelling older adults were available for analysis. Difficulty falling asleep, trouble staying asleep, and both insomnia symptoms were reported by 12%, 5%, and 11% of the participants, respectively. The proportion of participants who reported engaging in organized social activity, walking exercise, and both activities were 11%, 35%, and 26%, respectively. Participants who reported engaging in organized social activity and/or walking exercise were significantly less likely to report insomnia symptoms. Conclusion: These results have important implications for future studies that plan to implement nonpharmacological interventions for management of insomnia among older adults.
Objective: The current study examined racial differences in the relationship between late-life stress and health functioning and the moderating role of perceived social support (PSS) in older adults. Method: A biracial sample of community-dwelling older adults (65+) from the first two waves of the Duke University’s Established Populations for Epidemiologic Studies of the Elderly (EPESE; N = 2,952) was analyzed. Baseline levels of PSS and stress were obtained. Health status was assessed at baseline and follow-up. Results: Analyses revealed a positive effect of PSS on health functioning. There was a three-way interaction among race, stress, and PSS on health functioning. Probing the interaction, for Caucasians, PSS was beneficial at low stress, but not high stress. For African Americans, PSS had a positive effect regardless of stress level. Discussion: PSS is an important protective factor for preserving positive health in late-life; however, benefits may differ by race and intensity of stressor.
Objective: The hostile-world scenario (HWS) denotes a personal belief system regarding threats to one’s physical and mental integrity. We examined whether the HWS predicted health among older adults. Method: The Israeli branch of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel) provided data on 1,286 participants, aged 50+, interviewed in two waves 4 years apart. A special measure assembled items pertinent to the HWS throughout the SHARE survey. Nine outcomes indicated physical health (e.g., activities of daily living, medical conditions) and mental health (e.g., depressive symptoms, satisfaction with life). Results: The HWS at Wave 1 predicted all physical and mental outcomes at Wave 2, except cognitive functioning, beyond effects of sociodemographics and the respective outcome’s baseline at Wave 1. This predictive effect was stronger among older participants. Discussion: The results support the conception of the HWS as a psychological monitor that senses approaching functional declines in later life.
Objectives: Guided by the acknowledged importance of measures of aging alternative to chronological age, we explored the association between subjective age, on the one hand, and having grandchildren and provision of grandchild care, on the other, by gender and age groups. Method: Data from the Health and Retirement Study (HRS; N = 1,701 men and 2,395 women aged 50-85) and linear regression models were used to test two hypotheses. Results: Grandparents feel older than their grandchildless counterparts at younger ages, but such association is reversed in later life if they look after their grandchildren. A cumulative negative association between subjective age and both having grandchildren and providing grandchild care holds for older women. Discussion: This study extends prior research by examining age and gender differences in factors associated with subjective age. The findings suggest that grandparenthood is central in shaping the personal experience of aging. Future studies should address the causality of the factors analyzed.
Objective: To examine the impact of a new chronic disease diagnosis on substance use (i.e., smoking and drinking), utilization of preventive medical procedures, and physical activity among middle-aged and older adults. Method: Individual-level data came from 1996 to 2010 waves of the U.S. Health and Retirement Study. Disease diagnosis was ascertained from self-reports of physician-diagnosed diseases. A case-control difference-in-differences approach estimated in logistic regression was applied to test study hypotheses. Results: After a diagnosis of chronic disease, participants decreased substance use and increased utilization of preventive medical procedures. Physical activity declined after a diagnosis of lung disease, cancer, and stroke. Discussion: Chronic disease diagnosis may be an important teachable moment that can motivate individuals to adopt multiple risk-reducing health behaviors. Future research needs to elucidate the mechanisms through which disease diagnosis affects behaviors and test the modifying effect of time since diagnosis on intervention effectiveness.
Objective: To determine effects of late-middle-aged adults’ baseline drinking behavior on their subsequent 10-year depressive symptom trajectories. Method: Health and Retirement Study participants (N = 7,939) were assessed on baseline demographic, health, and drinking characteristics, and biennially assessed for the next 10 years on their depressive symptoms. Results: Growth mixture modeling generated four classes of depressive symptom trajectories: Consistently low (72%), consistently elevated (6%), increasing (12%), and decreasing (10%). Baseline abstinence from alcohol, possibly enforced by poorer health and a history of drinking problems, and heavier drinking, "binge" drinking, and having a history of drinking problems, raised risk of membership in the "consistently elevated" class. Abstinence by participants without history of drinking problems—and light, moderate, and heavier drinking—protected against membership in the "increasing" class. Abstinence by participants without history of drinking problems elevated—and moderate drinking reduced—likelihood of membership in the "decreasing" class. Discussion: Late-middle-aged adults’ alcohol use is associated with the subsequent long-term course of their depressive symptoms.
Objective: The aim of this study is to examine whether a persons’ most frequently used mode of transportation is associated with life-space mobility and whether the association differs between persons with or without walking difficulties. Method: Life-space mobility was measured with the Life-Space Assessment in 848 community-dwelling men and women aged 75 to 90 years. Six separate mobility groups were formed according to the most frequently used mode of transportation (car driver, car passenger, public transportation) combined with the presence or absence of difficulties walking 2 km. Results: Car drivers without walking difficulties had the highest life-space mobility scores, and car passengers with walking difficulties had the lowest scores. Mode of transportation influenced the odds for restricted life space differently depending on whether or not the person had walking difficulties. Discussion: To support community mobility among older persons, it would be important to improve different transportation options to meet older persons’ individual wishes, needs, and resources.
Objective: Dementia is increasingly recognized as a public health priority, but little is known about persons with early-onset dementia (EOD). The objectives of this article are (a) to compare the socio-demographic and health characteristics of people with EOD and late-onset dementia (LOD) and (b) to examine the relationships between EOD and overall health and life stress. Method: Data were from the Survey on Living With Neurological Conditions in Canada (SLNCC). Logistic regression models were used to identify the characteristics associated with EOD and LOD, and to assess the impact of EOD on overall health and life stress. Results: Compared with LOD, individuals with EOD were more likely to be male, to have a mood disorder, and to have a longer illness duration. EOD was associated with high life stress, but not with negative overall health. Discussion: This study identified attributes associated with EOD that have important implications for service planning.
Objective: The objective of this study is to determine factors associated with loneliness in older adults presenting for hearing loss treatment. Method: A cross-sectional analysis was conducted of 145 participants (aged 50-94) who presented for hearing aids or cochlear implants and were enrolled in the Studying Multiple Outcomes After Aural Rehabilitative Treatment (SMART) study from 2011 to 2013. Social, communicative, physical, and mental health functioning were assessed using self-administered questionnaires, and loneliness using the University of California, Los Angeles (UCLA) Loneliness Scale. Results: Younger age and greater hearing loss were significantly associated with greater loneliness. Metrics of depressive symptoms and hearing-related quality of life, communication difficulties, and emotional well-being, mental health, and 36-Item Medical Outcomes Study Short-Form (SF-36) scores were moderately or highly correlated with loneliness. Discussion: Younger age and greater hearing loss are independently associated with higher levels of loneliness in older adults presenting to clinic for hearing loss treatment. Further studies needed to determine whether hearing treatment can reduce loneliness in older adults.
Objective: The objective of this study is to identify features of the environment associated with community participation of older adults. Method: A systematic review of studies that examined associations between environment and community participation in older adults was conducted. Environmental features were extracted and grouped using the International Classification of Functioning, Disability, and Health’s environmental categories. Meta-analysis of environmental categories was conducted by calculating combined effect size (ES) estimates. Results: Significant, small to moderate, random ESs were found for six of seven environmental categories: neighborliness (ES = 0.52, 95% confidence interval [CI] = [0.18, 0.87]), social support (ES = 0.38, 95% CI = [0.13, 0.62]), land-use diversity (ES = 0.29, 95% CI = [0.16, 0.42]), transportation (ES = 0.29, 95% CI = [0.15, 0.43]), civil protection (e.g., safety; ES = 0.27, 95% CI = [0.0, 0.54]), and street connectivity/walkability (ES = 0.20, 95% CI = [0.15, 0.26]). Discussion: Community initiatives that address specific features of the social environment and street-level environment may increase community participation of older adults.
Objective: In many countries, pedestrian light crossings require a minimum walking speed of 1.2 m/s. This study examined the proportion of adults in a nationally representative sample whose usual and dual-task walking speeds are <1.2 m/s. Method: Community-dwelling adults aged ≥50 years in The Irish Longitudinal Study on Ageing (TILDA) completed walking speed tests on a GAITRite® walkway (N = 4,909). Results: One third of Irish adults aged 65 to 74 years and 61% of adults aged ≥75 years walked slower than 1.2 m/s. In dual-task walking, 54% of adults aged <65 years and 91% of adults aged ≥75 years walked slower than 1.2 m/s. Discussion: Based on these data, many older people would have insufficient time to cross the road at light-controlled pedestrian crossings. Increasing the time provided would be an advantage for many older pedestrians.
Objective: This study examines patterns of multimorbidity among elderly male inmates across four domains of health (chronic medical conditions, drug- and alcohol-related diseases, impairments, and mental and behavioral health) to understand the complex health care needs of this growing population. Method: We use the 2004 Survey of Inmates in State Correctional Facilities and Latent Class Regression Analysis to examine 22 health problems among 1,026 men aged 50 and older. Results: There are four groups of elderly male inmates: (a) relatively healthy (45.1%), (b) substance users with behavioral health issues (23.4%), (c) chronic unhealthy with impairments and violence/injury (23.6%), and (d) very unhealthy across all domains (7.9%). These groups have unique sociodemographic background and incarceration history characteristics. Conclusion: This study demonstrates the complexity of health for elderly inmates. Prison health should continue to be monitored to aid correctional and community health programs in understanding clinical risks, exposures, and health care needs for this population.
Objective: The aim was to investigate whether associations of hearing impairment (HI) with functional outcomes in older adults differ when using self-report versus pure-tone audiometry. Method: We examined 1,669 participants ≥70 years in National Health and Examination Survey from 2005-2006 and 2009-2010 whose hearing was assessed by self-report and pure-tone audiometry. We explored functional outcomes associated with audiometric HI (low physical activity, poor physical functioning, and hospitalization). Results: In adjusted models, we found significant associations of audiometric HI with both subjective and objective outcomes (e.g., dichotomous HI with self-reported difficulty in activities of daily living [ADLs], odds ratio [OR] = 1.47, 95% confidence interval [CI] [1.05, 2.06], and low accelerometer-measured physical activity, OR = 2.19, 95% CI [1.11, 4.34]). In contrast, self-reported HI was only associated with subjective outcomes and not with objective outcomes (e.g., dichotomous HI with difficulty in ADLs, OR = 1.63, 95% CI [1.12, 2.38], and low accelerometer-measured physical activity, OR = 0.95, 95% CI [0.66, 1.35]). Discussion: Results using self-reported hearing should not be considered representative of results using audiometry and may provide distinct aspects of HI in older adults.
Objective: Excess sedentary time predicts negative health outcomes independent of physical activity. The present investigation examined informal caregiving duties and transportation-related factors as potential correlates of sedentary behavior in older adults. Method: Average daily sedentary time was measured via accelerometer in adults ages 66 years and older (N = 861). Caregiving variables included dog ownership and informal family caregiving status. Transportation variables included driver status, walking distance to public transit, and reported presence of pedestrians and bicyclists in one’s neighborhood. Results: In multivariate models, owning a dog and being a driver were associated with less sedentary time (p ≤ .01). Educational status and geographic region modified the association between dog ownership and sedentary time, and age modified the association between driver status and sedentary time. Discussion: This study identified that older adult dog owners and drivers were less sedentary. Both factors may create opportunities for older adults to get out of their homes.
Objective: This study examined whether there are daily fluctuations in everyday cognition that are consistent with daily fluctuations often observed in traditional measures of basic cognitive abilities. Method: Two hundred six independently living older adults (age range = 60-91 years) were asked to complete a computerized cognitive battery over eight occasions within a 2- to 3-week period. Results: Using multilevel model, significant within-person variability was observed across the Daily Everyday Cognition Assessment (DECA; 46%), with 54% between-person variability. At each occasion, better performance on the DECA was significantly associated with better performance on simple reaction time ( p < .01) and memory (Auditory Verbal Learning Task, p < .01) even after accounting for time, age, education, and performance on other cognitive measures. Conclusion: These findings demonstrate that within-person performance fluctuations can be observed for everyday cognition tasks, and these fluctuations are consistent with daily changes in basic cognitive abilities.
Objective:To understand the longitudinal relationship between loneliness and isolation. Method: Participants included 5,870 adults 65 years and older (M = 72.89 ± 5.59 years) from the first 5 years of the Cardiovascular Health Study. Loneliness was assessed using a dichotomized loneliness question. Social isolation was assessed using six items from the Lubben Social Network Scale. Yearly life events were included to assess abrupt social network changes. Mixed effects logistic regression was employed to analyze the relationship between isolation and loneliness. Results: Higher levels of social isolation were associated with higher odds of loneliness, as was an increase (from median) in level of social isolation. Life events such as a friend dying were also associated with increased odds of loneliness. Discussion: These results suggest that average level of isolation and increases in the level of isolation are closely tied to loneliness, which has implications for future assessment or monitoring of loneliness in older adult populations.
Objective: The purpose of this study is to understand the functional health of older adults in China and to assess the potential for advancing healthy and active aging. Method: Data of 13,739 older adults aged 50 years and older from the China Health and Retirement Longitudinal Study in 2011 were analyzed. Life expectancy in good perceived health, chronic-disease-free life expectancy, active life expectancy, and severe impairment-free life expectancy were calculated using Sullivan’s method. Results: At age 50 years, older adults had a life expectancy in good perceived health of 7.0 and 6.7 years in men and women, respectively. They would remain chronic-disease-free for 8.4 and 8.6 years, without activity limitation for 23.6 and 26.0 years, and severe impairment-free for 21.4 and 24.2 years. Discussion: The world’s largest aging population was spending a substantial proportion of remaining life years in suboptimal health and well-being, while remaining largely independent in basic self-care without severe impairments.
Objective: Outdoor mobility is critical for healthy aging, yet little is known about the factors influencing mobility in the frail elderly. We investigated the role of individual and community risk factors on trajectories of mobility in a population of vulnerable community-dwelling elderly. Method: Using data from 1,188 older adults in Detroit, MI, who qualify for federally funded home care, a latent class growth analysis was used to model the frequency of going outside over a 15-month period. Results: Four latent trajectories were found: those with a low, high, and declining frequency of going outdoors over time, and those who do not go outdoors on a regular basis. Risk factors for membership in the homebound and infrequent mobility groups were older age, more severe mobility impairment, and fear of falling. Barriers at the entry to the home were associated with being homebound. Discussion: Declining health status and functional limitations are risk factors that pose a threat to outdoor mobility in the frail elderly, while housing barriers and community accessibility also merit attention.
Objective: This study analyzed how oral hygiene (i.e., brushing, rinsing, and flossing) influences the trajectories of dental caries (i.e., numbers of decayed, missing, and filled teeth) among older Americans within the context of social stratification. Method: Data came from Piedmont Dental Study that involved a sample of 810 older Americans who were dentate in 1988 with up to four repeated observations through 1994. Hierarchical linear models were used for data analysis. Results: Brushing, flossing, and rinsing were associated with the trajectories of dental caries in distinct ways. In addition, oral hygiene was correlated with race, education, household income, and use of dental care. The effects of brushing and flossing on decayed and missing teeth remained robust, even when socio-demographic and health attributes were controlled. Conversely, socioeconomic disparities in dental caries persisted, when oral hygiene was adjusted. Discussion: Both social stratification and oral hygiene need to be considered in promoting oral health.
Objective: The aim of this study is to determine the extent to which men’s later-life cognitive trajectories vary by veteran status. Method: We use Health and Retirement Study (HRS) data to estimate growth curve models examining men’s later-life cognitive trajectories by veteran status, war service status, and period of service. Analyses control for early-life characteristics that influence selection into military service and later-life cognition, and mid- to late-life characteristics that potentially mediate the relationship between military service and later-life cognition. Results: Veterans have higher cognition scores relative to nonveterans around retirement age, but their cognition scores decline more rapidly with increasing age, such that cognition scores are similar in both groups among the oldest old. Veterans who served during the Korean War have lower cognition scores around retirement age, but less steep age-related declines, than veterans who served during World War II. Discussion: Findings are discussed in relation to the extant literature, future research, potential service needs, and study limitations.
Objective: The death or illness of a spouse negatively affects a partner’s health, but little is known about the effect on blood glucose (glycemic) levels. This study investigates the extent to which a spouse’s declining health or death is associated with changes in the glycemic levels of older adults. Method: Data come from a nationally representative longitudinal sample of 597 Taiwanese (aged 54 to 90). We use changes in spousal health and death of a spouse to predict changes in glycosylated hemoglobin (HbA1c) levels over a 6-year period. Results: A decline in spousal health is associated with increased HbA1c levels for women, but not for men. The death of a healthy spouse is associated with increased HbA1c levels for both genders. Discussion: Stressful life transitions may compromise the glycemic levels of older adults. Taking on a caregiving role may erode some of the benefits of marriage and interfere with women’s maintenance of their own health.
Objective: We examine the ways that romantic relationship biographies are related to whether, how, and with whom individuals complete advance care planning (ACP), preparations for end-of-life medical care. Method: Data are from an Internet survey of 2,144 adults aged 18 to 64, all of whom were either married to or cohabiting with an opposite-sex partner. Results: Cohabitors were less likely than married people to complete ACP. Relationship quality was an important influence on ACP, but did not account for the differences between married and cohabiting persons. Differences were largely explained by the age composition of the groups. Discussion: Couples who foresee a long and stable future together are those most likely to engage in end-of-life planning, a preventative health behavior with long-term consequences for well-being.
Objective: The aim is to describe the prevalence of chronic diseases and conditions that may affect the oral health and oral health self-care of independent living Chilean older adults. Method: In all, 4,766 residents aged 60 years and older took part in the study. Participants were interviewed using an 11-module instrument, including demographic data, quality of life, nutritional status, systemic diseases, and lists of medications. Results: Participants with cognitive impediments (n = 553) were eliminated from further analysis. Of the remaining 4,213, 61.2% were female. The mean age was 71.1 (SD = 7.8) years. A total of 19.6% reported no medical conditions, 53.1% reported one or two conditions, and 27.3% reported between three and nine conditions. The most commonly reported conditions were high blood pressure (78.0%), diabetes (26.5%), depression (23.4%), and cardiovascular disease (18.7%). Seventy-six percent reported taking medication, with an average of 3.4 drugs per person. Among those taking medication, 70.2% were taking at least one that may cause salivary hypofunction. Discussion: With the aging of Chile and the reciprocal links between oral disease and chronic diseases, policies and innovative initiatives need to be implemented so that programs become affordable and accessible for this population.
Objective: Older adults with higher self-efficacy may be more likely to benefit from some cognitive training approaches. We examined whether self-efficacy serves as a mediator or moderator of responsiveness to cognitive speed of processing training (SOPT). Method: We used data from the Staying Keen in Later Life (SKILL) study (N = 128) and the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (N = 1,400). Both studies assessed cognitive speed of processing (Useful Field of View Test—UFOV) and self-efficacy among community-dwelling older adults who were either randomized to SOPT or control conditions. We constructed regression models examining self-efficacy as a predictor of training responsiveness. Results: Analyses from both studies indicated that participants’ self-efficacy scores were not predictive of training gains from SOPT, as measured by UFOV performance. Discussion: Self-efficacy does not affect older adults’ ability to benefit from cognitive SOPT.
Objective: The aim of this study is to examine context effects created by the question order for self-rated health (SRH) by race/ethnicity and language. Method: Differences in SRH estimates for non-Hispanic Whites and Hispanics were first examined with multiple observational data that asked SRH in different contexts. To examine context effects by socio-demographics and health-related characteristics, we conducted experiments on SRH question order. Results: While Hispanics reported poorer health than non-Hispanic Whites, this difference, in part, depended on question contexts. With SRH asked after rather than before specific health questions, Hispanics, especially Spanish-speaking Hispanics, reported better health, while non-Hispanic Whites’ reports remained consistent. Among Spanish-speaking Hispanics, the context effect was larger for unmarried and less educated persons and those with comorbidities. Discussion: Question contexts influence SRH reports by Spanish-speaking older adults. Cross-cultural inquiries on the meaning of health and its dynamics with question contexts may explain what SRH measures for increasingly diverse populations.
Objective: The aim of this study was to measure the prevalence of social isolation in community-dwelling elderly and related factors based on household composition differences. Method: We used the six-item Lubben Social Network Scale to measure social isolation in 2,000 individuals. Multiple logistic regression analysis was performed to examine factors related to social isolation with household composition after adjusting for gender and age. Results: The prevalence of social isolation was 31.0% for elderly living alone and 24.1% for those living with family. For both, poor mental health and lack of social support from nonfamily members were associated with social isolation risk. For elderly living with family, low intellectual activities and poor health practice were associated with social isolation risk. Discussion: This study showed high prevalence of social isolation. For prevention, promoting mental health and encouraging them to make friends may be important. For elderly living with family, promoting intellectual activities and good health practice is recommended.
Objective: This study aims to explore the impact of differential degrees of obesity on health-related quality of life (HRQL) by sex in the Korean elderly. Method: We analyzed data on those aged between 65 and 74 years from the Korean National Health and Nutrition Examination Survey (KNHANES) using multiple regression analysis. Results: Compared with the lowest waist circumference (WC) quintile, the women in the fourth and fifth quintiles demonstrated significantly lower unadjusted HRQL but not the men in any quintiles. Whereas higher WC quintiles impaired mobility, usual activities, and pain/discomfort in women, the fourth WC quintile improved usual activities in men. After adjustment, only the women of the highest WC quintile reported impaired mobility. Discussion: Extreme obesity worsens mobility, and comorbidity in combination with obesity worsens HRQL in elderly women. Monitoring and controlling comorbidity and maintaining adequate WC decreases the risks of lowered HRQL in Korean elderly women.
Objective: This study aimed to characterize the use of mandated quality indicators (QIs) in public sector nursing homes by describing their adherence to established principles of measurement and whether nursing homes respond to QI data to improve care. Method: Data were collected from a descriptive cross-sectional quantitative study using a confidential survey questionnaire distributed electronically to senior staff in all public sector nursing homes in Victoria, Australia. Results: Staff from 113 of 196 facilities completed the survey (58%). Adherence to principles of measurement was suboptimal, with variation in applying QI definitions and infrequent random audits of data (n = 54, 48%). QI data triggered reviews of individual residents (62%-79%), staff practice (44%-65%), and systems of care (45%-55%). Most facilities (58%-75%) reported that beneficial changes in care occurred as a result of using QIs. Discussion: QI performance data are positively received and used to improve care. Standardization of data collection, analysis, and reporting should strengthen the program’s utility.
Objective: To estimate the short-term (14 months) impact of anemia on mortality among Mexican older adults (OAs). Method: Longitudinal analyses using data from a quasi-experimental study in a non-contributory pension program in Mexico with a sample of 3,621 OAs aged 65 to 74 years. Data on health, nutrition, life conditions, and mortality were gathered at both baseline and follow-up. Logistic regression model was used to estimate the impact of anemia and hemoglobin quintiles on mortality. Results: Overall mortality rate was 2.1%. Both mild anemia and moderate/severe anemia increased mortality risk at 14 months (odds ratio [OR] = 2.04, 95% confidence interval [CI] = [1.1, 4.1]; and OR = 6, 95% CI = [2.1, 16.9], respectively). Discussion: In the short term, degree of severity of anemia is an independent predictor of mortality risk. Because anemia is a modifiable factor, further research is required to better understand this condition in terms of main causes, prevention, treatment, and impact on OAs’ survival.
Objective: This study investigates whether the rate of decline in older persons’ hearing status is associated with the rate of decrease in their psychosocial health and explores moderation by baseline hearing status, health-related factors, and sociodemographic factors. Method: Multilevel analyses were applied to data of 1,178 older participants from the Longitudinal Aging Study Amsterdam (LASA), covering 3 to 7 years of follow-up. Results: Faster decrease in speech-in-noise recognition was significantly associated with more increase in loneliness for persons with a moderate baseline speech-in-noise recognition (emotional and social loneliness) and for persons who recently lost their partner (emotional loneliness). No relationship was found with depression. Discussion: The results indicate that faster hearing decline results in more increase in loneliness in specific subgroups of older persons: in persons with an already impaired hearing and in widow(er)s. Monitoring older persons’ hearing seems important and may be a relevant starting point for targeted loneliness prevention efforts.
Objective: This study expands upon existing narrative data concerning health care preparation by developing a multi-theme framework of plans for future care needs. Method: Inductive content analysis was conducted on 185 interviews with European American and African American older women. Results: An explanatory framework emerged of five themes, describing varied approaches to planning for future care needs: (a) Autonomous Care Planners, (b) Externally Reliant Planners, (c) Aware of Preference, (d) Wishful Thinkers, and (e) Avoidant. A distinct group included women performing only end-of-life planning. Barriers to planning included low-perceived vulnerability, financial constraints, being uninformed of needed actions, and fear of burdening. Discussion: Although the majority undertook active steps to prepare for future care needs, many missed key steps or achievement of planning goals recommended by experts. Findings may be applied to long-term care planning research by providing added, rich detail on how aging women construct their options, make choices, and address this important area for future well-being.
Objective: The objective of this study was to determine the environmental features that best support aging in place. Method: We conducted a realist synthesis, a theory-driven interpretive method of evidence synthesis, of 120+ articles (published 1991-2011) that attempts to explain how place may influence older adults’ decisions about mobility (e.g., physical activity). We developed an initial program theory, reviewed the literature, identified outcomes, analyzed and synthesized patterns, and created a final program theory. Results: Safety was a central mechanism, serving as one of the bridges between environmental components (e.g., connectivity, aesthetics, retail and services) and decisions about mobility. Population density, sidewalk presence, and park proximity did not emerge as key factors. Discussion: Safety considerations are one of the most prominent influences of older adults’ decisions about mobility. Street connectivity, pedestrian access and transit, and retail and services were also important. These factors are amenable to change and can help promote mobility for older adults.
Objective: This study explores the role of religious attendance across a wide range of biological markers. Method: The data are drawn from the National Social Life, Health, and Aging Project to assess continuous and categorical biomarker specifications. Results: Across specifications, higher levels of attendance are associated with lower levels of pulse rate and overall allostatic load. Depending on the specification, higher levels of attendance are also associated with lower levels of body mass, diastolic blood pressure, C-reactive protein, and Epstein–Barr virus. Attendance is unrelated to dehydroepiandrosterone, systolic blood pressure, and glycosylated hemoglobin across specifications. Discussion: The study confirms that religious attendance is associated with healthier biological functioning in later life. Additional research is needed to verify these patterns with other data sources and to test viable mediators of the association between religious attendance and biological risk.
Objective: We examined which types of social support were associated with older women’s self-report of physical and mental health and whether the effects of social support were moderated by race/ethnicity. Method: Women completed a health behavior survey that included the Medical Outcomes Study–Short Form–12 (MOS SF-12). Single race/ethnic group regressions examined whether different types of social support were related to health. We also examined Pratt’s relative importance measures. Results: Emotional support had the strongest effect on both physical and mental health, explaining the highest amount of variation, except among African Americans. Race/ethnicity moderated the association of informational support for Asian women’s reports of their mental health. Discussion: For clinicians, assessing individuals’ emotional support is important for maintaining or increasing physical and mental health. Clinicians can also assess Asian women’s stress, providing informational support accordingly as too much information could be detrimental to their health. For researchers, the inclusion of emotional support items is the most important.
Objective: The aim of this study was to examine inflammation and coagulation, which are positively linked to disability and inversely linked to increased religious attendance, as mediators in the cross-sectional relationships between religious attendance and functional status. Method: Frequency of attendance and limitations in basic activities of daily living (ADLs), instrumental activities (IADLs), and mobility were assessed in 1,423 elders. Results: More frequent attendance was associated with fewer ADL, IADL, and mobility limitations, and with lower levels of inflammation and coagulation including interleukin-6, soluble vascular cell adhesion molecule, and D-dimer. Inflammation and coagulation partially mediated the associations between attendance and function. Eight percent of the effect of attendance on ADL (p = .014), 5% of the effect on IADL (p = .003), and 8% of the effect on mobility (p = .001) limitations were due to inflammation and coagulation. Discussion: Relationships between attendance and function may be due in part to lower levels of inflammation and coagulation among elders who attend services.
Objective: This research examined gender differences in self-rated health (SRH) using the differential exposure and differential vulnerability explanations of gender differences in health. Method: Trajectories of SRH were estimated using data that spanned 12 years (1992-2004) from the Health and Retirement Study. Results: There was no gender difference in SRH at baseline, but SRH declined faster for males over time. Factors that mediated the gender difference included changes in employment status, smoking behavior, and the onset of health conditions. Moreover, were it not for gender differences in various structural and health status factors, females would have better SRH at baseline and over time. Discussion: Our results differ from previous research, which often shows a female disadvantage that is reduced or disappears at older ages. Furthermore, gender differences in the predictors of SRH (exposure) contribute more to understanding gender differences in SRH than different responses to the predictors (vulnerability).
Objective: To examine the association between 6-min walk test (6 MWT) performance and all-cause mortality, coronary heart disease mortality, and incident coronary heart disease in older adults. Method: We conducted a time-to-event analysis of 1,665 Cardiovascular Health Study participants without prevalent cardiovascular disease with a 6 MWT. Results: During a mean follow-up of 8 years, there were 305 incident coronary heart disease events, and 504 deaths of which 100 were coronary heart disease–related deaths. The 6 MWT performance in the shortest two distance quintiles was associated with increased risk of all-cause mortality (290-338 m: hazard ratio [HR] = 1.7; 95% confidence interval [CI] = [1.2, 2.5]; <290 m: HR = 2.1; 95% CI = [1.4, 3.0]). The adjusted risk of coronary heart disease mortality incident events among those with a 6 MWT < 290 m was not significant. Discussion: Performance on the 6 MWT is independently associated with all-cause mortality and is of prognostic utility in community-dwelling older adults.
Objective: Cognitive deficits pose serious problems for older adults with heart failure (HF). Cognitive speed of processing training improves cognition among older adults but has not been examined among older adults with HF. Method: Data from the ACTIVE study were used to examine the effects of cognitive speed of processing training on cognitive and functional performance among older adults with HF. Results: Of the 54 participants included in the analyses, 23 who were randomized to cognitive training performed significantly better on a composite of everyday speed of processing from pre- to post-training compared with 31 participants who were randomized to the control group, F(1, 51) = 28.67, p ≤ .001,
Objective: Comparatively little longitudinal data exist focusing on grandparent caregiving, to say nothing of health’s impact over time on grandparent and grandchild well-being. Accordingly, the present study explored relationships among grandparent caregiver physical health, well-being, and adjustment, as well as with grandchild well-being across a 1-year period. Method: Participants were 79 grandparents who had full-time responsibility for their grandchildren. Measures of grandparent physical health, well-being, and grandchild well-being were completed across two assessments, 1 year apart. Results: Cross-lagged analyses exploring potential causality over time suggested that with one exception, the relationships between health and well-being appeared to be bidirectional. Discussion: In general, these longitudinal data indicate that better perceived health may provide an adaptive advantage for both grandparent caregivers and their grandchildren, yet also underscore to the potentially causal role that proactivity in the face of adversity plays in the maintenance and improvement of grandparent caregiver health over time.
Objective: Multiple barriers in research participation have excluded the Chinese older adults from benefitting the recent advancement of aging sciences. The paucity of systematic understanding of Chinese aging population necessitated the
Objectives: To describe change in balance confidence, and to identify associated factors and disabling consequences. Method: Secondary analysis of 2 years of data collected from 272 older women enrolled in a randomized clinical trial of fall prevention. Balance confidence and disability measures were assessed at baseline, after the 12 week intervention, and at 1 and 2 years follow-up. Associated factors were measured at baseline. Results: Balance confidence varied at baseline and decreased 5% over 2 years, but no variables predicted this decline. Baseline balance confidence was associated with poor physical function and mental health. Decreasing balance confidence was associated with increasing impairments in balance and hip flexion strength, increasing functional limitations in mobility and chair rises, reduced physical activity levels, increased activity restrictions, and decreasing social networks. Discussion: Decreasing balance confidence plays an important role in disablement. More research is needed to identify predictors of decreasing balance confidence.
Objective: To assess racial/ethnic disparities in preventive care practices among U.S. nursing home residents. Method: To implement the Institute of Medicine definition of health care disparity, we used the rank-and-replace adjustment method to assess the disparity in receipt of eight preventive care services among residents and evaluate trends in disparities. The sampling design (stratification and clustering) was accounted for using Stata 11. Results: The 2004 National Nursing Home Surveys data show White residents were more likely to have pain management, scheduled toilet plan/bladder retraining, influenza vaccination, and pneumococcal vaccination than Black residents. White residents were also more likely to have scheduled toilet plan/bladder retraining than residents of Other race/ethnicity. Significant Black–White disparities in receipt of influenza vaccination and pneumococcal vaccination were found. Time trend analysis showed that disparities were neither exacerbated nor reduced. Conclusion: Persistent racial/ethnic disparities in preventive care among nursing home residents exist. We urge the development and implementation of targeted interventions to improve the quality of preventive care in nursing homes.
Objectives: The purpose of this study is to see if the social life in religious institutions is associated with practical wisdom and if practical wisdom is, in turn, associated with better health. Method: Interviews were conducted with a nationwide sample of people aged 50 and older (N = 1,154). A new measure of practical wisdom was developed. Results: Support is found for the following relationships: (1) people who go to church more often will receive more spiritual support from fellow church members, (2) individuals who get more spiritual support at church will have greater wisdom, (3) greater wisdom is associated with a stronger sense of hope, and (4) hopeful people have better self-rated health. Discussion: The findings suggest that practical wisdom may have social roots and practical wisdom may be associated with self-rated health in middle and late-life.
Objective: To examine the associations of stressful experiences and social support with cognitive function in a sample of middle-aged adults with a family history of Alzheimer’s disease (AD). Method: Using data from the Wisconsin Registry for Alzheimer’s Prevention (WRAP; N = 623), we evaluated relationships between stressful events experienced in the past year, as well as social support, and cognitive performance in four domains: speed and flexibility, immediate memory, verbal learning and memory, and working memory. We assessed interactions between psychosocial predictors, and with APOE 4 status. Results: Greater number of stressful events was associated with poorer performance on tests of speed and flexibility. Greater social support was associated with better performance in the same domain; this relationship was diminished by the presence of the 4 allele. No associations were seen in the remaining three domains. Discussion: Psychosocial factors may influence cognition in at-risk individuals; influence varies by cognitive domain and 4 status.
Objective: The study examined the relationships between social contact types and psychological distress among mid-older adults. Method: Self-completed data from 236,490 Australian adults aged 45+ years. Results: There was a consistent relationship between increased frequency in phone contacts, social visits, and social group contacts and reduced risk of psychological distress adjusted for demographic and health factors. However, stratified analyses by age showed, with one exception, that no significant associations were found between social group contact frequency and risk of psychological distress for those aged 85 years and older. Furthermore, significant interaction terms revealed that women experience a steeper reduction in risk than men at age 65 to 74 years and 75 to 84 years compared with those aged 45 to 64 years. Discussion: Social contacts have age and gender differential effects on psychological distress of mid-older Australian adults. Interventions addressing social interaction need to be sensitive to gender and age differences.
Objectives:To describe informal caregiver and patient characteristics associated with high caregiver burden in homebound elders and to examine associations between high caregiver burden and patient health care utilization at the practice level. Method: We used a cross-sectional and prospective cohort design to study 214 caregiver-patient dyads in a home-based primary care program. Results: Informal caregivers with the highest burden were more likely to help with more activities of daily living and instrumental activities of daily living and spend >40 hr/week in caregiving. Patients whose caregivers experienced the highest burden were more likely to be non-White males without 24-hr paid homecare. There were no significant independent associations between high burden and high calls, high visits, or social work involvement. Discussion: In this medically complex and highly dependent population, further study of how families and other caregivers impact health care utilization is needed.
Objectives: This study provides a current analysis of the size and characteristics of the board-certified geriatrician and geriatric psychiatrist workforce in Texas, and thereby its capacity to meet increasing health needs of elders. Method: Secondary data on Texas board-certified geriatricians and geriatric psychiatrists from American Board of Medical Specialties database were analyzed. Results: The study found 1 geriatrician per 5,132 elders, and 1 geriatric psychiatrist per 21,327 elders, in Texas. Over 62% of geriatricians had active certification, 30% were females and the average age was 55.2 years. Rural geriatricians were disproportionately scarce (p < .001). Discussion: The study indicated a serious shortage of board-certified geriatricians and geriatric psychiatrists in Texas. This shortage is worse than that at the national level, and more marked along the Texas–Mexico border and counties lacking large health facilities. Addressing this workforce deficiency requires improvements in the geriatric training pipeline, reimbursements, and practice environments.
Objectives: To estimate the health impact, in terms of depression, self-rated health, and health services utilization, of providing care to older adults (75+) requiring human assistance in at least one activity of daily living (ADL) limitation. Method: Data from 1,077 caregivers and 318 noncaregivers, interviewed in the Singapore Survey on Informal Caregiving, was used to examine differences in depressive symptoms, self-rated health, and number of outpatient visits in the last 1 month between caregivers and noncaregivers. Multivariate models for the outcomes, adjusting for characteristics of the caregiver/noncaregiver and care-recipient/potential care recipient, were run. Results: Caregivers were more depressed, had poorer self-rated health, and had a higher rate of outpatient visits in the past month compared to noncaregivers. Discussion: The study indicates the need for support services to family caregivers of older adults with ADL limitations.
Objective: To explore the role of working conditions in the association between socioeconomic position and health after retirement age using over 20 years follow-up. Method: Two Swedish nationally representative Level of Living Surveys (total N = 1,131) were used. Ordered logistic regression was used to assess the association between socioeconomic position and health (self-rated health, psychological distress, musculoskeletal pain, circulatory problems, physical and cognitive impairment). The role of physical and psychological working conditions was also assessed. Results: Lower socioeconomic position was associated with more adverse physical, but not psychological, working conditions. Physical working conditions partially explained the differences in physical impairment and musculoskeletal pain in old age attributed to socioeconomic position, but not differences in self-rated health, circulatory problems, psychological distress, and cognitive impairment. Socioeconomic position was a stronger correlate of health than psychological working conditions alone. Discussion: Improving physical working conditions may be important for reducing the influence of socioeconomic position on health after retirement.
Objective: This study used data for 1996-2010 from a U.S. longitudinal sample of elderly individuals from the Health and Retirement Study (HRS) merged with Medicare claims data to assess changes in several dimensions of physical functioning and general health up to 68 months following total knee arthroplasty (TKA) receipt. Method: Using propensity score matching, we assessed outcomes at follow-up for Medicare beneficiaries receiving TKA and a comparable group of beneficiaries with the same osteoarthritis diagnoses (controls). Results: Receipt of TKA was most often associated with improvements in physical functioning, especially in physical functioning measures most directly related to the knee. General health of TKA recipients only improved relative to controls on 1 of the 3 study general health measures. Discussion: Improvements in physical functioning of TKA recipients persisted in this longer term analysis of outcome in a nationally representative population study.
Objectives:To identify age differences in physical activity (PA) participation for women. Methods: Data from 3,952 women 25+ from the 2003-2006 National Health and Nutrition Examination Surveys (NHANES) were used to analyze participation patterns for 17 PA types. Results: The top five leisure PAs by participation rate for all ages were walking (42%), dancing (20%), treadmill (15%), biking (11%), and yoga (10%). Participation in running, dancing, treadmill, and team sports declined around ages 35 to 44, and participation in household PA, walking, weightlifting, and hiking declined around ages 55 to 64. At age 75+ further substantial decline in most activities occurred. Nativity status was the most important moderator for age-related PA decline. Conclusions: Total PA declines with age but significant decline does not occur until ages 55 to 64. Major decline in leisure PA participation starts earlier at ages 35 to 44. While age-related declining patterns differ for different activities, the top five most popular leisure activities are similar for all age groups.
Objective: To examine how the experience of a negative health event (i.e., onset of heart disease, diabetes, lung disease, cancer, or stroke) of one spouse affects the mental and physical well-being of the other partner as measured by depressive symptoms and self-reported health. Methods: We employ latent growth curve analysis and examine adults 50+ using six waves of data (1998-2008) from the Health and Retirement Study. Results: One spouse’s health shock affects the health of the other partner. Results indicate that a spouse’s onset of a severe health condition worsens the mental health of women and the self-reported health of men. Discussion: These findings illustrate that the family context of spouses is important to consider when examining health.
Objectives: Adults hold negative attitudes toward sexual expression in late life. We investigated knowledge and attitudes about older adult sexuality and dementia among staff in nursing homes (NHs). Method: We acquired staff demographics, knowledge of dementia and sexuality, and attitudes of sexuality. Staff participated in focus groups and received continuing education credit. Results: The three NHs had an average census of 178 beds. Participants’ (N = 100) mean age was 38.53. The most common type of sexual contact reported was nondemented male with nondemented female (67.5%), followed by demented male with demented female (53.6%). Participants endorsed neutral attitudes about late-life sexuality. Focus groups revealed a need for more training and effective interventions to balance resident safety and autonomy. Discussion: Staffs’ knowledge of sexuality and dementia, desire for guidance in "managing" sexual expression, and neutral attitudes toward late-life sexuality supports the need for educational interventions on sexuality and dementia in NH.
Objectives:This study investigates factors related to the positive mental health of older Australian gay men, who are challenged by both age- and sexuality-related stigma. Methods: A national online survey was conducted among 422 gay-identified men aged 40 years and older. Positive mental health was measured using the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). Results: Regression analyses revealed men were psychologically healthier if they were employed full-time, had a higher income, were in a relationship, received greater social support, had many close friends, felt connected to the gay community, believed the public felt positively toward their group, and had not experienced discrimination in the past year. A multivariate linear regression found social support to be the most important of all these factors, with support from friends particularly critical. Discussion: These findings provide new guidance to health agencies that seek to improve the mental health and well-being of older gay men.
Objective:This study estimates the likelihood of starting and stopping smoking when respondents and their partners report new chronic illnesses. Method: Analysis of longitudinal data from the Health and Retirement Study tests whether starting or stopping smoking is more likely when (a) the respondent, (b) their partner, (c) or both report a new chronic condition, and whether these patterns differ by gender. Results: Both men and women are more likely to quit smoking when reporting a new chronic condition, relative to when reporting none. However only women are more likely to quit smoking when their partners fall ill. Women are also more likely than men to start smoking at this time. Discussion: Among older couples, women’s smoking changes are more sensitive to health shocks in the partnership. Interventions aimed at preventing unhealthy behaviors should pay attention to how each partner deals with the stress of health shocks.
Objectives: To determine if the association between frequency of leisure-time physical activity and mortality risk differs across adulthood. Method: 9,249 adults from the NHANES III (1988-1994) were categorized as middle-aged (40-64 years), old (65-79 years) or very old (≥80 years), and as inactive (0 bouts of physical activity/week), lightly active (1-2 bouts/week), moderately active (3-4 bouts/week) or very active (5+ bouts/week). Results: In all age categories, lightly, moderately, and very active adults had a lower mortality risk compared to inactive adults (p < .001). In very old adults only, being very active was associated with a lower mortality risk compared to being lightly active (HR 0.80, 95% CI 0.64-0.98; p = .03) and moderately active (HR 0.80, 95% CI 0.65-0.98; (p = .03). Discussion: The association between physical activity frequency and mortality risk is strongest in very old adults. All adults and particularly very old adults may benefit from participating in physical activity five or more times a week.
Objective: This study aims to investigate: (a) the association of eating disorders with childhood sexual abuse and recent stressful life events; (b) the coexistence of eating disorders and other common psychiatric disorders; and (c) the impact of eating disorders on obesity, medical conditions, and health service utilization. Method: We conducted secondary data analyses based on population-based study, which consists of a nationally representative sample of 2,870 community-dwelling adults aged 50 and above, interviewed in 2006 to 2007. Results and conclusion: The 12-month prevalence of eating disorders was 2.61%. Multivariate analyses revealed that eating disorders were more common among younger age groups, women, and those who reported stressful life events. In addition, eating disorders were significantly related to anxiety disorders, agoraphobia, panic disorder, obesity, and cancer. Discussion: This study supports the notion that eating disorders in older adults are associated with a number of psychosocial, psychiatric, and medical conditions.
Objectives: Physical activity (PA) may reduce risk of developing Alzheimer’s disease (AD). The objectives of this study were to: (a) Compare the content of English and Spanish PA-focused articles in American Association of Retired Persons (AARP) magazines; and (b) Determine whether these articles discuss PA as a potential correlate of AD. Method: AARP (English) and AARP Segunda Juventud (Spanish) magazines were assessed for PA coverage from 2009 to 2010. Articles were analyzed using nonparametric tests. Results: A total of 63 articles discussed PA (48 English; 15 Spanish). In AARP English, 70.8% of articles discussed formal exercise, while 53.3% of Spanish articles discussed formal exercise. Only three English articles mentioned that PA has the potential to reduce risk of AD. No Spanish articles mentioned this association. Discussion: Spanish content did not adequately present cognitive health information. Culturally appropriate media coverage is needed to inform diverse populations about cognitive health and risks of AD.
Objectives: To explore whether the accumulation of sensory difficulties predicts fear of falling (FOF), and whether the traits correlate with each other regardless of familial factors. Methods: Self-reported hearing, vision and balance difficulties, and FOF were assessed using structured questionnaires at the baseline and after a 3-year follow-up in 63- to 76-year-old women (n = 434). Results: Among the women without FOF at baseline (n = 245), 41% reported FOF at follow-up. Increasing numbers of sensory difficulties at baseline predicted higher incidence of FOF. The relationship between accumulated sensory difficulties and FOF was not mediated by familial factors. Discussion: The accumulation of multiple sensory difficulties may hinder older people from receiving compensatory information about body position and environment, thus jeopardizing a person’s confidence in maintaining a balanced position. Regular screening of sensory functions followed by appropriate actions may prevent the development of FOF, and thus contribute to prevention of falls and promotion of healthy aging.
Objectives: To determine the prevalence and relationship of frailty and health-related quality of life (HRQOL) among residents of long-term care [nursing homes (NH) and assisted living (AL)] facilities. Methods: Residents of NH and AL facilities in La Crosse County, Wisconsin, were recruited 1/2009-6/2010 and assessed for frailty (gait speed, unintended weight loss, grip strength), comorbidity (Charlson index), and HRQOL [Short Form (SF)-36]. Results: Among 137 participants, 85% were frail. Frail residents were older, had more comorbidities (2.0 vs. 0, p < .001) and lower mean SF-36 Physical Component Score (PCS, 32 vs. 48, p < .001). Following adjustments for age, sex, and comorbidities, compared to nonfrail residents, frail residents had lower SF-36 PCS (mean difference –14.7, 95% CI. –19.3,–10.1, p < .001). Frailty, comorbidity, and HRQOL did not differ between NH and AL facilities. Discussion: Frail residents had lower HRQOL, suggesting that preventing frailty may lead to better HRQOL among residents of long-term care facilities.
Objective: The objective of this study was to consider race differences in age-trends of autonomic nervous system functioning, using a national data set with a broad age range. Methods: Measures of baseline heart rate variability (HRV) and HRV reactivity were derived from electrocardiograph (ECG) recordings taken at rest and during cognitive stress tasks. Age-trends in HRV and HRV reactivity were compared among 204 African Americans and 833 Whites ages 34 to 83 years (M = 53.7, SD = 11.4), before and after controlling for socioeconomic status (SES). Results: For HRV-reactivity, age-trends were steeper among African Americans and lower SES participants than Whites and higher SES participants. For baseline HRV, age-trends varied by SES but not race. Discussion: Results relating to HRV-reactivity (but not baseline HRV) were consistent with hypotheses suggesting that African Americans are exposed to higher levels of stress and experience accelerated declines in health across the life span. The relevance of the findings to research on social stress and health disparities is discussed.
Objectives: To estimate transition probabilities between disability states, total life expectancy, and the latter’s decomposition into years spent disabled and disability-free by age, sex, and education among older adults in São Paulo, Brazil, and urban areas in Mexico. Methods: Applied a micro-simulation method (Interpolative Markov Chains) using longitudinal data. Results: We found large between-country educational differences in incidence of and recovery from disability with higher rates in Mexico than in São Paulo, but no differences in mortality. Older adults in Mexico spent longer time being disability-free than in São Paulo for both levels of education. Males and females in São Paulo spent a larger fraction of their remaining life disabled at every age than their counterparts in urban areas in Mexico. Discussion: There were educational differences in the prevalence of disability in São Paulo and urban areas in Mexico, and significant educational differences in disability incidence and recovery across sites.
Objective: We aim to examine whether distrust of health care system (hereafter distrust) is associated with prostate cancer screening and whether different dimensions of distrust demonstrate similar relationships with prostate cancer screening. Method: With data on 1,784 men aged 45 to 75 from the Philadelphia metropolitan area, we first applied factor analysis to generate factor scores capturing two distrust subscales: competence and values. We then implemented logistic regressions to estimate the relationships between distrust and prostate cancer screening, controlling for covariates related to demographics (e.g., race and age), socioeconomic status (e.g., poverty status and education), health care resources (e.g., insurance status), and health status (i.e., self-rated health). Results: Without considering any other covariates, both competence and values distrust were negatively associated to the receipt of prostate cancer screening. After accounting for other covariates shown above, values distrust remained negatively associated with the odds of receiving prostate cancer screening (OR = 0.89, 95% CI [0.81, 0.98]) but competence distrust was not a significant predictor. Conclusions: Values distrust was independently associated with prostate cancer screening. Macro-level change in the health care system may influence men’s health behaviors. Our findings suggested that efforts to make the health care system more transparent and enhanced communications between men and health providers may facilitate prostate cancer screening.
This study examines the relationship between weight status in adolescence and later life functional limitations.
We use the Wisconsin Longitudinal Study to characterize the relationship between standardized relative body mass ascertained from high school photograph portraits in 1957 and self-reported functional imitations in 2004.
Compared to individuals with normal body mass, those who were overweight in high school had poorer later life physical function, with observed gender differences. Women who were underweight in adolescence had better functioning in older adulthood than their normal weight counterparts. This relationship, however, was not found among men.
These findings underscore the long-term consequences of being overweight in adolescence on the functional disadvantages conferred in late life.
Objective: The purpose of this cross-sectional study was to determine the extent and manner in which mobility is related to quality of life (QOL) in a representative sample of older adults. Method: Two models were assessed using structured equation modeling. The first hypothesized that mobility would have a direct effect on QOL along with other variables, including; number of health conditions and satisfaction with functional capacity, life essentials (e.g., transport, access to health services, and conditions of living space) and personal relationships. The second hypothesized that mobility would have its greatest influence on QOL through satisfaction with functional capacity. Results: While both models found that mobility and all three measures of life satisfaction were significantly associated with QOL, goodness of fit indices were higher for the second model. Discussion: The findings from this study suggest that mobility interventions designed to enhance QOL should address satisfaction with functional capacity as well.
This article has been removed from OnlineFirst because of erroneous early publication. It will be published in a forthcoming supplement of the Journal of Aging and Health.
This article has been removed from OnlineFirst because of erroneous early publication. It will be published in a forthcoming supplement of the Journal of Aging and Health.
This article has been removed from OnlineFirst because of erroneous early publication. It will be published in a forthcoming supplement of the Journal of Aging and Health.
Objectives: In this article, the authors investigate the association between age at migration and mortality during a 13-year period in a sample of Mexican American immigrants aged 65 and older at baseline. Methods: The authors use the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) to control for mortality-related health and social factors. Results: Analyses show that the immigrant generation does not represent a homogeneous mortality risk category. Individuals who migrated to the United States in mature adulthood have a considerably lower risk of death than individuals who migrated in childhood or midlife. Chronic conditions or functional capacity do not account for these differences. Conclusion: Findings suggest that standard risk pools may differ significantly on the basis of genetic and unmeasured life-course factors. A better understanding of the late life immigrant mortality advantage has important implications for more effective and targeted social and medical interventions.