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Background Appropriate conceptualization and measurement of disability are critical for population-focused resource allocation and policy development. Self-reported and performance-based measures of functioning have been used to represent disability. Variation in environmental context or self-perception of ability may influence self-reports; however, performance-based measures that attempt to control environmental context may not accurately capture real-world aspects of functioning. This study examined the agreement between self-report and performance-based measures of functioning within 4 domains among older adults. Methods Cross-sectional data from the 2021 National Health and Aging Trends Study was used. Self-reported and performance-based measures of functioning were assessed for vision, hearing, mobility, and memory domains. We examined the diagnostic characteristics of performance-based versus self-reported measures using sensitivity, specificity, and receiver operating characteristics curves. Differences in the agreement of these measures across sociodemographic groups were investigated using logistic regression. Results Among 2 442 respondents 71 years and older (mean 78.5 ± 5.3, 56% female participants), performance measures of hearing and mobility had high sensitivity (89% and 91%, respectively) and low/moderate specificity (36% and 63%, respectively). The sensitivity and specificity of vision measures were 71%. Memory measures had high specificity (89%) and low sensitivity (28%). Performance-based discrimination ranged from 0.59 (memory) to 0.78 (mobility). Agreement varied across sociodemographic factors. Conclusions Performance measures diverge from self-reported functioning among older adults. Discordance may reveal opportunities for environmental intervention where participants' performance does not capture the full extent of barriers in their daily lives. Additional research is needed to investigate individual and environmental factors which could explain the observed differences. [ABSTRACT FROM AUTHOR]

Repeated claims that a dwindling supply of potential caregivers is creating a crisis in care for the U.S. aging population have not been well-grounded in empirical research. Concerns about the supply of family care do not adequately recognize factors that may modify the availability and willingness of family and friends to provide care to older persons in need of assistance or the increasing heterogeneity of the older population. In this paper, we set forth a framework that places family caregiving in the context of older adults' care needs, the alternatives available to them, and the outcomes of that care. We focus on care networks, rather than individuals, and discuss the demographic and social changes that may alter the formation of care networks in the future. Last, we identify research areas to prioritize in order to better support planning efforts to care for the aging U.S. population. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has disproportionately impacted older Black Americans. Given that assistance networks play a crucial role in older adults' ability to respond to challenges, we sought to investigate whether older adults' assistance network size changed during the COVID‐19 pandemic and differed by race. Methods: We analyzed data from the 2018–2020 rounds of the U.S. National Health and Aging Trends Study for Black and White adults aged 70 and older receiving help in the community or residential care settings. We used ordinary least squares regression to compare changes in assistance network size in the 2 years pre‐COVID‐19 (2018–2019, N = 3438) to changes in size at the onset of COVID‐19 (2019–2020, N = 3185). Results: Black older adults had larger assistance networks with a greater number of family helpers before and during the pandemic compared to their White counterparts. Assistance network size for older adults increased before but not during the pandemic mostly due to declines in unpaid nonrelative helpers and lack of increase in paid helpers. These effects did not differ by race. Conclusions: Black and White older adults experienced similarly sized reductions in their assistance networks as a consequence of the COVID‐19 pandemic. Future research should investigate the relationship between these network changes and the unmet needs of older adults. [ABSTRACT FROM AUTHOR]

Adaptive survey designs are increasingly used by survey practitioners to counteract ongoing declines in household survey response rates and manage rising fieldwork costs. This paper reports findings from an evaluation of an early-bird incentive (EBI) experiment targeting high-effort respondents who participate in the 2019 wave of the US Panel Study of Income Dynamics. We identified a subgroup of high-effort respondents at risk of nonresponse based on their prior wave fieldwork effort and randomized them to a treatment offering an extra time-delimited monetary incentive for completing their interview within the first month of data collection (treatment group; N  = 800) or the standard study incentive (control group; N  = 400). In recent waves, we have found that the costs of the protracted fieldwork needed to complete interviews with high-effort cases in the form of interviewer contact attempts plus an increased incentive near the close of data collection are extremely high. By incentivizing early participation and reducing the number of interviewer contact attempts and fieldwork days to complete the interview, our goal was to manage both nonresponse and survey costs. We found that the EBI treatment increased response rates and reduced fieldwork effort and costs compared to a control group. We review several key findings and limitations, discuss their implications, and identify the next steps for future research. [ABSTRACT FROM AUTHOR]

Background: Walking is the primary and preferred mode of exercise for older adults. Walking to and from public transit stops may support older adults in achieving exercise goals. This study examined whether density of neighborhood public transit stops was associated with walking for exercise among older adults. Methods: 2018 National Health and Aging Trends Study (NHATS) data were linked with the 2018 National Neighborhood Data Archive, which reported density of public transit stops (stops/mile2) within participants' neighborhood, defined using census tract boundaries. Walking for exercise in the last month was self-reported. The extent to which self-reported public transit use mediated the relationship between density of neighborhood public transit stops and walking for exercise was examined. Covariates included sociodemographic characteristics, economic status, disability status, and neighborhood attributes. National estimates were calculated using NHATS analytic survey weights. Results: Among 4,836 respondents with complete data, 39.7% lived in a census tract with at least one neighborhood public transit stop and 8.5% were public transit users. The odds of walking for exercise were 32% higher (OR = 1.32; 95% confidence interval: 1.08, 1.61) among respondents living in a neighborhood with > 10 transit stops per mile compared to living in a neighborhood without any public transit stops documented. Self-reported public transit use mediated 24% of the association between density of neighborhood public transit stops and walking for exercise. Conclusions: Density of neighborhood public transit stops was associated with walking for exercise, with a substantial portion of the association mediated by self-reported public transit use. Increasing public transit stop availability within neighborhoods may contribute to active aging among older adults. [ABSTRACT FROM AUTHOR]

Background and Objectives Caregiving research often assumes older adults receiving care have a primary caregiver who provides the bulk of care. Consequently, little is known about the extent to which care responsibilities are shared more evenly within a care network, the characteristics associated with sharing, or the consequences for meeting older adults' care needs. Research Design and Methods We analyze a sample of U.S. older adults receiving care from the 2011 National Health and Aging Trends Study (n = 2,398). Based on variables reflecting differences in care hours, activities, and care provided by the whole network, we create network typologies for those with two or more caregivers (n = 1,309) using K-means cluster analysis. We estimate multinomial and logistic regression models to identify factors associated with network type and the association between type and unmet needs. We conduct analyses overall and for older adults living with and without dementia. Results Analyses reveal four network types: Small, low-intensity shared care network (SCN); large, moderate-intensity SCN; small, low-intensity primary caregiver network (PCN); and moderate-sized, high-intensity PCN. Among all older adults receiving care, 51% have a sole caregiver, 20% have an SCN with no primary caregiver, and 29% have a PCN. Among older adults with dementia receiving intense care, unmet needs are lower among those with an SCN (vs. PCN). Discussion and Implications Findings underscore that the primary caregiver construct, although common, does not apply to a substantial share of care networks. Moreover, having an SCN when needs are high may be beneficial to meeting older adult's needs. [ABSTRACT FROM AUTHOR]

Objective: This study examines work and care patterns and their association with experienced well‐being over the course of the day and tests a moderating effect of gender. Background: Many family and unpaid caregivers to older adults face dual responsibilities of work and caregiving. Yet little is known about how working caregivers sequence responsibilities through the day and their implications for well‐being. Method: Sequence and cluster analysis is applied to nationally representative time diary data from working caregivers to older adults in the United States collected by the National Study of Caregiving (NSOC) (N = 1005). OLS regression is used to test the association with well‐being and a moderating effect of gender. Results: Among working caregivers, five clusters emerged, referred to as: Day Off, Care Between Late Shifts, Balancing Act, Care After Work, and Care After Overwork. Among working caregivers, experienced well‐being was significantly lower among those in the Care Between Late Shifts and Care After Work clusters relative to those in the Day Off cluster. Gender did not moderate these findings. Conclusion: The well‐being of caregivers who split time between a limited number of hours of work and care is comparable to those who take a day off. However, among working caregivers balancing full‐time work—whether day or night–with care presents a strain for both men and women. Implications: Policies that target full‐time workers who are balancing care for an older adult may help increase well‐being. [ABSTRACT FROM AUTHOR]

Background: Assessing activity limitations is central to aging research. However, assessments of activity limitations vary, and this may have implications for the populations identified. We aim to compare measures of activities of daily living (ADLs) and their resulting prevalence and mortality across three nationally-representative cohort studies: the National Health and Aging Trends Study (NHATS), the Health and Retirement Survey (HRS), and the Medicare Current Beneficiary Survey (MCBS). Methods: We compared the phrasing and context of questions around help and difficulty with six self-care activities: eating, bathing, toileting, dressing, walking inside, and transferring. We then compared the prevalence and 1-year mortality for difficulty and help with eating and dressing. Results: NHATS, HRS, and MCBS varied widely in phrasing and framing of questions around activity limitations, impacting the proportion of the population found to experience difficulty or receive help. For example, in NHATS 12.4% [95% confidence interval (CI) 11.5%–13.4%] of the cohort received help with dressing, while in HRS this figure was 6.4% [95% CI 5.7%–7.2%] and MCBS 5.3% [95% CI 4.7%–5.8%]. When combined with variation in sampling frame and survey approach of each survey, such differences resulted in large variation in estimates of the older population of older adults with ADL disability. Conclusions: In order to take late-life activity limitations seriously, we must clearly define the measures we use. Further, researchers and clinicians seeking to understand the experience of older adults with activity limitations should be careful to interpret findings in light of the framing of the question asked. [ABSTRACT FROM AUTHOR]

Objectives Prepandemic research suggests assistance networks for older adults grow over time and are larger for those living with dementia. We examined how assistance networks of older adults changed in response to the onset of the coronavirus disease 2019 (COVID-19) pandemic and whether these changes differed for those with and without dementia. Methods We used 3 rounds of the National Health and Aging Trends Study. We estimated multinomial logistic regression models to test whether changes in assistance networks during COVID-19 (2019–2020)―defined as expansion, contraction, and adaptation―differed from changes prior to COVID-19 (2018–2019). We also estimated ordinary least squares regression models to test differences in the numbers of helpers assisting with one (specialist) versus multiple (generalist) domains before and during COVID-19. For both sets of outcomes, we investigated whether pandemic-related changes differed for those with and without dementia. Results Over all activity domains, a greater proportion of assistance networks adapted during COVID-19 compared to the pre-COVID-19 period (relative risk ratio = 1.19, p <.05). Contractions in networks occurred for those without dementia. Transportation assistance contracted for those with and without dementia, and mobility/self-care assistance contracted for those with dementia. The average number of generalist helpers decreased during COVID-19 (β = −0.09, p <.001). Discussion Early in the pandemic, assistance networks of older adults adapted by substituting helpers, by contracting to reduce exposures with more intimate tasks for recipients with dementia, and by reducing transportation assistance. Future research should explore the impact of such changes on the well-being of older adults and their assistance networks. [ABSTRACT FROM AUTHOR]

We examine older partnered parents’ time spent with adult children in biological and step families, treating time together as an indication of relationship strength. Using a unique national sample of U.S. time diaries from the Panel Study of Income Dynamics, we investigate time with all adult children combined and with each adult child. We find that time together depends on family structure and parent–adult child dyadic relationship type embedded in family structure. In analyses of all adult children combined, an older parent is more likely to spend time with adult children in biological families than in stepfamilies only when there is no shared biological child in the stepfamily. In dyadic analyses, a parent’s tie with an adult child who is a biological child of both partners is stronger in stepfamilies than in biological families. Moreover, among stepfamilies, ties are not uniformly stronger with biological children relative to stepchildren; differences emerge only in more complex families when each partner has biological children from previous relationships. Our findings challenge the view that ties with older parents are always weaker with stepchildren in stepfamilies and point to the importance of considering parent–child relationships in the broader family context. [ABSTRACT FROM AUTHOR]

Objectives To understand changes during the coronavirus disease 2019 (COVID-19) pandemic in weekly contact with nonresident family and friends for U.S. adults aged 70 and older in residential care and community settings. Methods Participants in the National Health and Aging Trends Study COVID-19 mail supplement (N = 3,098) reported frequency of phone, electronic, video, and in-person contact with nonresident family and friends in a typical week before and during the pandemic. We examined less than weekly contact by mode for those in residential care settings and community residents with and without limitations. We estimated multinomial logit models to examine predictors of change to less than weekly contact (vs. maintaining weekly or more contact) by mode, overall, and stratified by setting. Results Weekly in-person contact fell substantially (from 61% to 39%) and more so in residential care (from 56% to 22%), where nearly 4 in 10 transitioned to less than weekly in-person contact (doubling to 8 out of 10). Weekly or more contact was largely stable for electronic and telephone modes across settings. Weekly or more video contact increased mainly for community residents without limitations. Compared to community residents without limitations, those in assisted living or nursing homes had more than 5 times the odds (adjusted odds ratio [AOR] = 5.3; p =.01) of changing to less than weekly in-person contact; those in independent living also had higher odds of changing to less than weekly in-person (AOR = 2.6; p =.01) and video (AOR = 3.4; p =.01) contact. Discussion The pandemic revealed the importance of ensuring that communication technologies to maintain social ties are available to and usable by older adults, particularly for those living in residential care settings. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various topics within the issue, including the National Health and Aging Trends Study (NHATS), the care of people with dementia, and the trajectories of paid and family care hours of people living with dementia.

Objective Despite cross-sectional evidence that persons living with dementia receive disproportionate hours of care, studies of how care intensity progresses over time and differs for those living with and without dementia have been lacking. Method We used the 2011–2018 National Health and Aging Trends Study to estimate growth mixture models to identify incident care hour trajectories ("classes") among older adults (N = 1,780). Results We identified 4 incident care hour classes: "Low, stable," "High, increasing," "24/7 then high, stable," and "Low then resolved." The high-intensity classes had the highest proportions of care recipients with dementia and accounted for nearly half of that group. Older adults with dementia were 3–4 times as likely as other older adults to experience one of the 2 high-intensity trajectories. A substantial proportion of the 4 in 10 older adults with dementia who were predicted to be in the "Low, stable" class lived in residential care settings. Discussion Information on how family caregiving is likely to evolve over time in terms of care hours may help older adults with and without dementia, the family members, friends, and paid individuals who care for them, as well as their health care providers assess and plan for future care needs. [ABSTRACT FROM AUTHOR]

Objectives Increased likelihood of having step children among more recent cohorts of older adults, alongside lower levels of assistance from step children, has led to concerns about greater unmet needs for older parents in step families. However, few studies have directly examined family structure and unmet needs. We examined the associations between having step children (vs. only biological children) and receiving care from adult children, and unmet needs for assistance. Methods Using the 2015 National Health and Aging Trends Study, we investigated among older parents with care needs whether levels of care received from adult children and unmet needs differed between those with biological versus step families. We also explored whether a partner or paid care compensated for observed differences. Results Older parents in need of care were more than twice as likely to receive care from their adult children if they had biological instead of step families. Unmet needs among older parents did not differ by family structure, nor did levels of partner or paid care. Discussion Results illustrate that concerns about the implications of the rising prevalence of step families for care parents receive from their children may be warranted. However, there is a lack of evidence of greater unmet need for care for older parents in step families, as risks of unmet needs are high for older parents regardless of family type. [ABSTRACT FROM AUTHOR]

Introduction: Investigations into consequences of the US COVID‐19 pandemic for older adults with dementia have been limited. Methods: We used the National Health and Aging Trends Study to examine self‐reported COVID‐19 infection; measures taken to limit its spread; social, behavioral, and emotional responses to the pandemic; and changes in health‐care use and provider communication. We compared adults aged ≥70 with and without dementia in community and residential care settings. Results: In residential care settings, infection was substantially higher and social contact less common for those with dementia. In community and residential care settings, those with dementia had 2 to 3 times the odds of reporting sleeping more often. In residential care settings, those with dementia were less likely to put off care and more likely to start telehealth. Discussion: Findings highlight the disproportionate social and behavioral consequences of the COVID‐19 pandemic for those living with dementia, particularly in residential care settings. HIGHLIGHTS: Data are from the nationally representative National Health and Aging Trends Study.COVID‐19 infection was higher in residential care settings for those with dementia.Social contact was less common for those with dementia in residential care.Pandemic‐related coping behaviors differed by dementia and residential status.In residential care, those with dementia were less likely to delay health care. [ABSTRACT FROM AUTHOR]

BACKGROUND The number of adults living with limitations in daily activities in the United States is large, and projected to increase. Families, which are becoming more complex, are critical to the wellbeing of this population. OBJECTIVE We present national estimates of the size and composition of kin networks for adults with activity limitations. METHODS We use the 2013 Panel Study of Income Dynamics to assess kin relationships of adults aged 40 and older with an activity limitation. We assess kin relations up and down one generation and horizontally, including spouses, adult children, parents, siblings, step-kin, parent-in-laws, children-in-law, and sibling-in-laws. We estimate kinship size and differences across race/ethnicity, education, and marital status. We also estimate the number of helpers. RESULTS Adults with activity limitations have a substantial number of adult kin: 9.1 on average, while only 12% have fewer than four kin. Spouses and adult biological children, the most common caregivers, account for less than one-third of these kin. Kin networks are much larger among those who report their background as Hispanic rather than non-Hispanic white or Black, married rather than unmarried, and less-than-college rather than college-educated. CONCLUSIONS Despite concerns about increasing family complexity, we find that 88% of individuals with a limitation have four or more family members, and as kin size increases the average number of kin helping increases from one to two. [ABSTRACT FROM AUTHOR]

Maintenance of visual and auditory function is important for preventing the onset of activity limitations and preserving quality of life in later life. To date, national panel studies focused on health and aging have mostly collected subjective (self-reported) measures of visual and auditory function. The National Health and Aging Trends Study (NHATS), a study of Medicare beneficiaries ages sixty-five and older, recently developed a protocol for measuring objective visual and auditory function for its annual, in-home data collection conducted by trained interviewers. The protocol includes three vision tests—distance and near acuity and contrast sensitivity—and one hearing test—pure-tone audiometry—conducted using a tablet platform with results recorded in a scannable booklet. To identify operational issues and evaluate data quality for the proposed set of vision and hearing tests, NHATS incorporated a pilot study into its 2019 round (N  = 417 participants and N  = 9 interviewers). Using these pilot study data, the objectives of this paper are to: (1) describe the NHATS protocols to collect objective measures of visual and auditory function; (2) evaluate the quality of the data collected; and (3) assess whether results are influenced by interviewers. We found that respondents were highly likely to participate, with cooperation rates for each test about 90 percent. Data were high quality, with low rates of missingness, test results significantly associated with age and self-reported items, and percentages with poor vision or hearing consistent with prior population-based studies. Objective measures were more likely than self-reports to classify participants as having visual and auditory impairments and had stronger relationships with demographic correlates. Interviewer effects were small and not statistically significant in this small sample. Results of this study have demonstrated that objective visual and auditory functioning can be successfully incorporated into an interviewer-administered home-based protocol. [ABSTRACT FROM AUTHOR]

Background and Objectives Screening for functional disability is a promising strategy to identify high-need older adults. We compare 2 disability measures, activities of daily living (ADLs), and life space constriction (LSC), in predicting hospitalization and mortality in older adults. Research Design and Methods We used the nationally representative National Health and Aging Trends Study of 30,885 observations of adults aged 65 years and older. Outcomes were 1-year mortality and hospitalization. Predictors were ADLs (receiving help with bathing, eating, dressing, toileting, getting out of bed, walking inside) and LSC (frequency of leaving home). Results Of respondents, 12.4% reported 3 or more ADLs and 10.8% reported rarely/never leaving home. ADL disability and LSC predicted high rates of 1-year mortality and hospitalization: of those with 3 or more ADLs, 46.4% died and 41.0% were hospitalized; of those who never/rarely left home, 40.7% died and 37.0% were hospitalized. Of those with both 3 or more ADLs and who never/rarely left home, 58.4% died. ADL and LSC disability combined was more predictive of 1-year mortality and hospitalization than either measure alone. ADL disability and LSC screens identified overlapping but distinct populations. LSC identified more women (72.6% vs 63.8% with ADL disability), more people who live alone (40.7% vs 30.7%), fewer who were White (71.7% vs 76.2%) with cancer (27.6% vs 32.4), and reported pain (67.1% vs 70.0%). Discussion and Implications LSC and ADLs both independently predicted mortality and hospitalization but using both screens was most predictive. Routine screening for ADLs and LSC could help health systems identify those at high risk for mortality and health care use. [ABSTRACT FROM AUTHOR]

Objectives We provide national estimates of caregiving networks for older adults with and without dementia and examine how these networks develop over time. Most prior research has focused on primary caregivers and rarely on change over time. Method We identify a cohort of older adults continuously followed in the National Health and Aging Trends Study between 2011 and 2015 and receiving help from family members or unpaid caregivers in 2015 (n = 1,288). We examine differences by dementia status in network size, types of assistance and task sharing, and composition—differentiating between "specialist" and "generalist" caregivers helping in one versus multiple activity domains. Multinomial regression is used to estimate change over time in network task sharing and composition. Results In 2015, older adults with dementia had larger caregiving networks involving more task sharing than those without dementia and more often relied on generalist caregivers, especially the subset assisting with medical, household, and mobility or self-care activities. Uniformly greater reliance over time on these more intensely engaged generalist caregivers chiefly accounts for larger dementia networks. Discussion Findings lend support to the need for caregiver training on managing multiple task domains and—for dementia caregivers in particular—task-sharing skills. More generally, the design of new approaches to better support older adults and their caregivers should consider the complexity, heterogeneity, and change over time in caregiving networks. [ABSTRACT FROM AUTHOR]

Background: Vision impairment (VI) in older adults is associated with declines in well-being. However, the pathways through which poor vision leads to declines in well-being have not been well-described. The purpose of this study was to determine whether activity limitations and social participation restrictions mediate the impact of self-reported VI on subjective well-being.Methods: The National Health and Aging Trends Study (NHATS) is a nationally representative longitudinal study of Medicare beneficiaries 65 and older that includes detailed measures of the disablement process. A longitudinal mediation model was conceptualized linking self-reported VI and subjective well-being. Structural equation modeling was used to test the mediating effects of activity limitations and social participation restrictions while adjusting for relevant covariates.Results: The final sample included 5,431 respondents. At baseline, 8.0% of Medicare beneficiaries had self-reported VI. Subjective well-being scores were significantly lower among respondents with self-reported VI (15.7; 95% confidence interval [CI]: 15.2, 16.2) compared with those without VI (17.6; 95% CI: 17.5, 17.7). Self-reported VI had a significant indirect effect on subjective well-being through limiting mobility (β = -0.04; 95% CI: -0.07, -0.03) and household activities (β = -0.05; 95% CI: -0.08, -0.03), but not self-care limitations (β = 0.0; 95% CI = 0.0, 0.0) or participation restrictions (β = 0.0; 95% CI = -0.01, 0.00). Total indirect effects from all mediation paths accounted for 42% of the effect of VI on well-being.Conclusions: Mobility and household activity limitations are significant mediators that explain a considerable portion of the impact of poor vision on well-being. Interventions to promote successful accommodation may result in greater overall well-being for older adults with poor vision. [ABSTRACT FROM AUTHOR]

Background and Objectives The diminished wellbeing of caregivers is well documented, but studies typically draw upon coarse measures of time use and thus provide limited understanding of the role of specific care activities in the daily lives of care providers. This study uses time diary data to explore whether there are signature care patterns throughout the day and whether these care patterns have implications for caregivers' experienced wellbeing. Research Design and Methods Using a national sample of 511 time diaries from older caregivers in the Disability and Use of Time supplement to the Panel Study of Income Dynamics, we examine minutes of care provided on the prior day, overall and for four broad care categories (household, personal care, transportation, and visiting), and patterns of care over the day, the latter based on sequence and cluster analysis. Results Older caregivers spend on average 2.3 hr providing care to another adult on care days. Caregiving follows a roller-coaster pattern over the day, peaking at mealtimes. Sequence analysis suggests five distinctive caregiving patterns, which vary by both demographic characteristics of the caregiver (gender, work status) and care arrangement type (relationship to recipient, whether sole caregiver to recipient). The 40% who provide only marginal assistance of about 1 hr report lower experienced wellbeing than the 28% who provide sporadic assistance with a mix of activities for about 2 hr. Discussion and Implications A substantial share of older caregivers provides only 1 hr of assistance on a given day but appears to be at risk for reduced wellbeing. Better understanding of the reason for their marginal involvement and reduced wellbeing is warranted. [ABSTRACT FROM AUTHOR]

Experienced well-being measures tap a distinct form of subjective well-being (SWB) and have different age-related properties than the more widely studied evaluations of life satisfaction. Unlike evaluations of the quality of life as a whole, experiential measures capture affective reactions soon after they occur. Recent advances in measurement have allowed for the inclusion of such experiential measures even in large-scale studies. However, respondent burden remains a concern; hence, surveys have also employed shorter experiential modules. The psychometric properties of these brief measures are not well understood. We examine the psychometric characteristics, including the factor structure and correlations with theoretically relevant criteria, of experienced wellbeing measures included in two supplements to the Panel Study of Income Dynamics (PSID). The first supplement included a detailed time diary whereas the second included a brief review of the prior day. Results show that for the detailed time diaries a single index of affective experience provides a useful summary of the associations among individual affect items, both within and between participants. For the abbreviated method, two or more subscales better describe the underlying structure. [ABSTRACT FROM AUTHOR]

The article discusses the impact of disability on older adults daily mood such as frustration and happiness. Topics include exploration of gender and marital status differences, harmful effects of stress on well-being, and family relationships and support.

Background: Racial and ethnic differences in disability persist and are possibly widening in recent years, but evidence is limited for racial and ethnic differences in disability progression through the entire disablement process and potential influential factors. The objective of this study is to examine racial and ethnic differences in patterns of late-life disability transitions, using a new disability spectrum that incorporates successful accommodation with assistive devices in response to capacity limitations to prolong independence.Methods: The study cohort consisted of a nationally representative sample of Medicare beneficiaries aged 65 and older in the United States who were enrolled in the 2011 National Health and Aging Trends Study and followed up annually until 2015 (n = 6,198). First-order Markov transition models were used to determine racial/ethnic differences in transitions among three stages of self-care and mobility limitations (fully able, successful accommodation, difficulty/assistance) and death.Results: After adjustment for age and sex, non-Hispanic Black and Hispanic respondents had higher probabilities of unfavorable transitions and lower probabilities of remaining in the successful accommodation stage than non-Hispanic White respondents. The racial and ethnic differences in probabilities of maintaining successful accommodation remained statistically significant after adjustment for socioeconomic and health factors (Black: 0.56, 95% CI = 0.52-0.60; Hispanic: 0.53, 95% CI = 0.44-0.61; White: 0.63, 95% CI = 0.61-0.65).Conclusions: Successful accommodation with assistive devices may provide possibilities for implementing interventions to enhance older adults' capacities and reducing racial/ethnic differences in late-life disability. [ABSTRACT FROM AUTHOR]

The Panel Study of Income Dynamics (PSID) is the world’s longest running household panel survey. Since it began in 1968, it has collected data on the same families and their descendants, making it an essential part of America’s data infrastructure for empirically based social science research. The PSID arose from the War on Poverty as a tool for evaluating poverty dynamics, and this year (2018) marks 50 years of data collection. Because of its long history and distinctive design of following adult children as they form their own households, the PSID is uniquely positioned to address emerging social and behavioral research questions and related policy issues. This overview presents the design and structural aspects and its evolution over the past 50 years, the successes of the current survey, possible future directions, and the value of using the PSID to understand the challenges facing American families. [ABSTRACT FROM AUTHOR]

Objectives: To examine associations between healthcare transitions at the end of life (EOL; late transitions) and bereaved family members' and friends' assessment of EOL quality of care (QOC). Design: National Health and Aging Trends Study (NHATS), a prospective cohort of Medicare enrollees aged 65 and older. Setting: United States, all sites of death. Participants: Family members and close friends of decedents from NHATS Rounds 2 through 6 (N=1,653; weighted 6.0 million Medicare deaths). Measurements: Multivariable logistic regression with survey weights was used to examine the association between having a late transition and reports of perceived unmet needs for symptom management, spiritual support, concerns with communication, and overall QOC. Results: Seventeen percent of decedents had a late transition. Bereaved respondents for decedents experiencing late transitions were more likely to report that the decedent was treated without respect (21.3% vs 15.6%; adjusted odds ratio (AOR)=1.59, 95% confidence interval (CI)=1.09–2.33), had more unmet needs for spiritual support (67.4% v 55.2%; AOR=1.48, 95% CI=1.03–2.13), and were more likely to report they were not kept informed about the person's condition (31.0% vs 20.9%; AOR=1.54, 95% CI=1.07–2.23). Bereaved respondents were less likely to rate QOC as excellent when there was a late transition (43.6% vs 48.2%; AOR=0.79, 95% CI=0.58–1.06). Subgroup analyses of those experiencing a transition between a nursing home and hospital (13% of all late transitions) revealed such transitions to be associated with even worse QOC. Conclusion: Transitions in the last 3 days of life are associated with more unmet needs, higher rate of concerns, and lower rating of QOC than when such late transitions are absent, especially when that transition is between a nursing home and hospital. [ABSTRACT FROM AUTHOR]

The article looks at several studies that aim to broaden the evidence base for understanding dementia trends. Topics covered include caseload and prevalence projections that are crucial to planning appropriate public and private sector responses, estimates of life expectancy and aggregate changes in life expectancy with dementia at ages 65 and 85, and short-term trends in the prevalence and one-year incidence of dementia among the 70 and older population.

Objectives Studies have reported decreasing dementia prevalence in recent decades in the United States. We explore with a new national data source whether declines have occurred since 2011, whether trends are attributable to shifts in dementia incidence or mortality, and whether trends are related to shifts in population composition or subgroup prevalence. Methods We use the 2011–2015 National Health and Aging Trends Study (N = 27,547) to examine prevalence of probable dementia among the 70 and older population. To minimize the influence of potential learning effects on prevalence rates, we require individuals to meet probable dementia criteria at two consecutive rounds. Results: Prevalence of probable dementia declines over this period by 1.4% to 2.6% per year. Declines are concentrated among women, non-Hispanic white and black groups, and those with no vascular conditions or risk factors. The latter group also has experienced declines in dementia incidence. Declines in prevalence are largely attributable to age- and education-related shifts in population composition. Discussion Given the role of age and educational composition in short-term declines, the United States is likely to continue to experience short-term declines in dementia prevalence. However, persistently high rates among minority groups, especially of Hispanic origin, are concerning, and, barring new treatments, long-run trends may reverse course. [ABSTRACT FROM AUTHOR]

Relatively low response rates in mixed mode studies remain a concern. Whether targeting protocols to match respondents' likely mode is an effective strategy remains unclear. For those without a clear likely mode, how the details about sequencing influence response rates, mode, field work effort, and potential response bias remain important questions. This article describes a targeted sequential design implemented in a 2016 mixed mode supplement with individuals aged 30 years and older in the Panel Study of Income Dynamics, the longest running national panel study in the United States. Respondents predicted to be likely to respond by web were invited to a web study and sent a paper copy after six weeks (web-first); those likely to respond by paper were also invited to participate by web but told that a paper copy would be sent shortly (signal-andsend paper). An embedded experiment measured the impact of the two protocols among a group of respondents with no clear likely mode. More than 40 percent of individuals with no likely mode are under the age of 40 years, and the group falls between the likely web and paper groups in terms of education and internet use and includes more women and single respondents. Compared to the likely web and paper groups, those with no likely mode had lower response rates and required more fieldwork effort. Among those randomly assigned, the signal-and-send protocol increased response over the web-first protocol from weeks 4 through 7. By week 16, both protocols yielded similar response rates, field effort and distributions of respondent characteristics. Among those responding, cases randomized to web-first were more likely than those randomized to signal-and-send paper to respond by web. We discuss implications for targeted protocols in mixed mode panel surveys. [ABSTRACT FROM AUTHOR]

Background: Despite its importance, little is known about the prevalence of, and factors associated with, end-of-life care that is consistent with patients' wishes. Objective: To document the proportion of bereaved respondents who reported care inconsistent with patients' wishes and characterize the predictors of end-of-life care associated with inconsistent care. Design: Retrospective analysis of nationally representative survey data of persons aged >65 years. Settings/Subjects: Bereaved family members responding to the last month of life component of the National Health and Aging Trends Study. Methods/Measurements: Bereaved family members assessed treatment decisions and their consistency with patients' wishes, unmet needs, and quality of care. We examined differences between patients receiving inconsistent versus consistent care. Results: A total of 1212 family members were interviewed, representing (when weighted) 4.8 million decedents. Thirteen percent stated that care was inconsistent with decedent's wishes. Consistent care was unassociated with patient's sex, age, or race/ethnicity. Death at home was more likely to represent consistent care, and death in the hospital or nursing home was more likely to represent inconsistent care ( p = 0.052). Respondents reporting inconsistent care were more likely to rate the quality of care as fair or poor (19.1% vs. 4.8%, p < 0.001), reported more unmet needs for pain management (30.5% vs. 19.4%, p = 0.037), and reported more concerns with communication (29.8% vs. 17.0%, p = 0.003). Conclusions: One in eight respondents stated care in the last months of life was inconsistent with patients' wishes; such care was associated with worse ratings of care, pain management, and communication with clinicians. [ABSTRACT FROM AUTHOR]

Objectives To examine racial differences in the use of rehabilitation services and functional improvement during receipt of services. Design Secondary analysis of the 2016 National Health and Aging Trends Study ( NHATS). Setting Standardized in-person home interviews. Participants Community-dwelling Medicare enrollees (N = 6,309), 1,276 of whom reported receiving rehabilitation services in the previous 12 months. Measurements Self-reported use of rehabilitation services, setting (inpatient, outpatient, home based), reason for use, and perceptions of change in functioning after receiving services. Results Controlling for sex, dual eligibility for Medicaid, age, number of chronic conditions, functional mobility at the prior round, income, and geographic region, the odds of receiving rehabilitation services in any setting was 1.38 times as great in whites as in blacks (95% confidence interval = 1.09-1.75). Of those receiving therapy, whites were more likely to receive home-based and inpatient rehabilitation services, but there were no racial differences in improvement in function. Conclusion Strategies are needed to identify possible barriers to use of rehabilitation services for vulnerable groups of aging individuals who need rehabilitation services, particularly older blacks. [ABSTRACT FROM AUTHOR]

We use daily diary data from the Disability and Use of Time supplement to the 2013 Panel Study of Income Dynamics ( n = 1,162) to evaluate (1) the extent to which marital/partner support and strain moderate the effects of disability on five activity-related emotions (happiness, calm, sadness, frustration, worry) and overall negative and positive emotion among older married, cohabiting, and dating persons and (2) whether such patterns differ significantly by gender. Marital support buffers against negative emotions and increases feelings of calm among severely impaired women. By contrast, support intensifies negative emotions and decreases feelings of calm among severely impaired men. Relationship strain also intensifies the effect of severe impairment on men's frustration, sadness, worry, and negative mood but has negligible effects on the negative emotions of men with low impairment and women. Frequent support and criticism may threaten highly impaired older men's sense of autonomy and emotional well-being. [ABSTRACT FROM AUTHOR]

This article describes the results of an experiment designed to examine the impact of the use and amount of delayed unconditional incentives in a mixed mode (push to web) supplement on response rates, response mode, data quality, and sample bias. The supplement was administered to individuals who participate in the U.S. Panel Study of Income Dynamics, the longest running national household panel in the world. After 10 weeks of data collection, individuals who had not yet completed the interview were sent a final survey request and randomly assigned to one of three treatment conditions: no incentive, US$5, and US$10. The impact of the incentives on response rates and mode, effects on data quality, and sample bias are described. The implications for the use of incentives in mixed mode surveys and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Objectives: To provide a profile of older adults who successfully accommodate declines in capacity by using assistive devices. Method: Using the National Health and Aging Trends Study, we provide national estimates of prevalent, incident, and persistent successful accommodation of mobility and self-care activity limitations. For incident and persistent accommodation groups, we describe their subjective wellbeing and participation restrictions, health and functioning, demographic and socioeconomic characteristics, and acquisition of assistive devices and environmental features. We estimate regression models predicting incident and persistent successful accommodation and the extent of wellbeing and participation restrictions for incident and persistent groups (vs. those who are fully able). Results: Nearly one-quarter of older adults have put in place accommodations that allow them to carry out daily activities with no assistance or difficulty. In adjusted models, incident and persistent successful accommodation is more common for those ages 80-89, those with more children, and those living in homes with environmental features already installed; well-being levels for these groups are similar and participation restrictions only slightly below those who are fully able. Discussion: A focus on facilitating successful accommodation among those who experience declines in capacity may be an effective means of promoting participation and wellbeing in later life. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives. To examine changes in active life expectancy in the United States over 30 years for older men and women (aged ≥ 65 years). Methods. We used the 1982 and 2004 National Long Term Care Survey and the 2011 National Health and Aging Trends Study to estimate age-specific mortality and disability rates, the overall chances of survival and of surviving without disability, and years of active life for men and women. Results. For older men, longevity has increased, disability has been postponed to older ages, disability prevalence has fallen, and the percentage of remaining life spent active has increased. However, for older women, small longevity increases have been accompanied by even smaller postponements in disability, a reversal of a downward trend in moderate disability, and stagnation of active life as a percentage of life expectancy. As a consequence, older women no longer live more active years than men, despite their longer lives. Conclusions. Neither a compression nor expansion of late-life disability is inevitable. Public health measures directed at older women to postpone disability may be needed to offset impending long-term care pressures related to population aging. [ABSTRACT FROM AUTHOR]

Objectives. We evaluate (a) associations between marital quality (emotional support, strain, and overall appraisal) and three negative aspects of experienced well-being (frustration, sadness, and worry) among older husbands and wives and (b) the relative importance of own versus spouse's marital quality assessments for understanding experienced well-being in later life. Method. Data are from the 2009 Disability and Use of Time daily diary supplement to the Panel Study of Income Dynamics (N = 722). We estimate actor-partner interdependence models, using seemingly unrelated regression. Results. Own reports of marital strain are associated with own frustration, sadness, and worry among wives and are associated with frustration only among husbands. Own reports of marital support are associated with negative emotion among husbands only: higher levels of marital support are associated with less worry. Results from partner effects analyses also are mixed. Husbands' reports of marital strain are associated with wives' elevated frustration levels, whereas wives' reports of greater marital support are associated with their husbands' higher frustration levels. Discussion. One's own and spouse's marital appraisals play a complex role in shaping negative emotions among older adults. Findings suggest that frustration is a particularly complex emotion and a promising area for further study among older married couples. [ABSTRACT FROM AUTHOR]

Objectives. Studies of late-life disablement typically address the role of advancing age as a factor in developing disability, and in some cases have pointed out the importance of time to death (TTD) in understanding changes in functioning. However, few studies have addressed both factors simultaneously, and none have dealt satisfactorily with the problem of missing data on TTD in panel studies. Methods. We fit latent-class trajectory models of disablement using data from the Health and Retirement Study. Among survivors (~20% of the sample), TTD is unknown, producing a missingdata problem. We use an auxiliary regression equation to impute TTD and employ multiple imputation techniques to obtain final parameter estimates and standard errors. Results. Our best-fitting model has 3 latent classes. In all 3 classes, the probability of having a disability increases with nearness to death; however, in only 2 of the 3 classes is age associated with disability. We find gender, race, and educational differences in class-membership probabilities. Discussion. The model reveals a complex pattern of age- and time-dependent heterogeneity in late-life disablement. The techniques developed here could be applied to other phenomena known to depend on TTD, such as cognitive change, weight loss, and health care spending. [ABSTRACT FROM AUTHOR]

Background: Striking changes occurred in health care in the United States between 2000 and 2013, including growth of hospice and hospital-based palliative care teams, and changes in Medicare payment policies. Objective: The aim of this study was to compare informants' reports and ratings of the quality of end-of-life care for decedents between 2000 and 2011-2013. Methods: The study design comprised retrospective national surveys. Subjects were decedents age 65 years and older residing in the community from two time periods. Similar survey questions were asked at the two time periods. Bivariate and multivariate analyses were conducted, using appropriate survey weights to examine response differences between time periods, after adjusting for the decedent's age, race, pattern of functional decline, and the presence of a cancer diagnosis, as well as the respondent's relationship to the decedent. Results: A total of 1208 informants were interviewed; 622 in 2000 and 586 in 2011-2013. Respondents from deaths in 2011-2013 were more likely to state that their loved ones experienced an unmet need for pain management (25.2% versus 15.5% in 2000, adjusted odds ratio [AOR] 1.9, 95% confidence interval [CI] 1.1-3.3). More respondents reported that religion and spirituality were addressed in the later time period (72.4% not addressed compared with 58.3%, AOR 1.4, 95% CI 1.1-1.9). High rates of unmet need for palliation of dyspnea and anxiety/depression remained. The overall rating of quality did not improve but decreased (with 56.7% stating care was excellent in 2000 and 47.0% in the later survey, AOR 0.70, 95% CI 0.52-0.95). Conclusions: Substantial unmet needs in end-of-life care remain. Continued efforts are needed to improve the quality of end-of-life care. [ABSTRACT FROM AUTHOR]

This paper reviews measures of the physical and cognitive abilities of adults in the context of a national household panel survey and considers whether a new household panel survey is needed to answer scientific and policy questions related to disability. To address this topic, we first review illustrative scientific and policy issues related to disability and functioning and review gaps in the nation's disability-related data system. Next, we offer a set of key domains to be measured, review several additional covariates of interest, and describe existing summary measures to identify the population living with disability. Finally, we take up the challenging issue of tradeoffs in starting a new household survey versus enhancing existing studies or developing specialized studies with a focus on disability to address these issues. [ABSTRACT FROM AUTHOR]