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Background and Objectives: The evolution of care networks accompanying older adults' changing care needs-and implications for unmet care needs-are not well described., Research Design and Methods: Using group-based trajectory models, we identify 4 incident care need patterns ("care need trajectory groups") for 1,038 older adults in the 2012-2018 National Health and Aging Trends Study and 5 caregiving patterns ("caregiving trajectory groups") and a transient group among their 4,106 caregivers. We model associations between care need/caregiving trajectory groups and the rate of (approximating the proportion of rounds with) unmet care needs. We illustrate how predicted rates vary by care need trajectory groups and by network composition for networks with 2 caregivers., Results: The percentage of rounds with unmet care needs varies from 13% among older adults with few, stable needs to 62% among those with many, stable needs (p<.01). In models, care need trajectory group is strongly associated with the rate of unmet care needs; among those with steep increasing care needs, network composition is also predictive. For older adults with steep increasing care needs, when one caregiver provides high, variable and another medium, stable care hours, the predicted rate of unmet care needs is low (0.16) and similar to those with few, stable care needs (0.12)., Discussion and Implications: Findings highlight the complexity and heterogeneity of older adults' care needs and caregiving patterns over time. For those with rapidly increasing needs, identifying and assessing the evolving care network may be a fruitful direction for forestalling unmet care needs., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background and Objectives: When older adults face increasing care needs or limited support, remaining safely and comfortably at home becomes challenging. Extant research has primarily concentrated on characteristics of the older adult or their primary caregiver on nursing home admission. This study examines the risk of older adults transitioning to residential care (e.g., assisted living, nursing home), focusing on the influence of their care network or involvement of multiple helpers., Research Design and Methods: Using the National Health and Aging Trends Study, we conducted competing risk regression models that account for mortality, following 7,085 initially community-dwelling older adults across Rounds 1-9 (2011-2019). We assessed network composition, size, shared tasks, and the number of in-network specialists or generalists while controlling for individual sociodemographic and health factors., Results: Individuals with care networks that shared medical tasks had the highest risk of moving to a residential care setting, followed by those sharing household tasks. Conversely, shared mobility or self-care and transportation responsibilities were associated with lower risks. Having more generalists, but not specialists, increased the risk. Larger networks were associated with heightened risk, although having close family members like a spouse was protective., Discussion and Implications: The findings underscore that care network characteristics are critical to older adults' ability to age in place. Specifically, older adults with larger networks, lacking a spouse or child, and providing complex care are at greater risk for relocating. Understanding care networks can guide interventions related to care network coordination and resource allocation to help avoid or postpone a residential care move., Competing Interests: None., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Background: U.S.-focused studies have reported decreasing dementia prevalence in recent decades, but have not yet focused on the implications of the COVID-19 pandemic for trends., Methods: We use the 2011-2021 National Health and Aging Trends Study (N=48,065) to examine dementia prevalence, incidence and mortality trends among adults ages 72 and older, and the contribution to prevalence trends of changes in the distribution of characteristics of the older population ("compositional shifts") during the full and pre-pandemic periods. To minimize classification error, individuals must meet dementia criteria for two consecutive rounds., Results: The prevalence of probable dementia declined from 11.9% in 2011 to 9.2% in 2019 and 8.2% in 2021 (3.1% average annual decline). Declines over the 2011-2021 period were concentrated among those ages 80-89 and non-Hispanic White individuals. Declines in dementia incidence were stronger for the 2011-2021 period than for the pre-pandemic period while mortality among those with dementia rose sharply with the onset of the COVID-19 pandemic. Shifts in the composition of the older population accounted for a smaller fraction of the decline over the full period (28%) than over the pre-pandemic period (45%)., Conclusions: Declines in dementia prevalence continued into years marked by onset of the COVID-19 pandemic, along with declines in incidence and sharp increases in mortality among those with dementia. However, declines are no longer largely attributable to compositional changes in the older population. Continued tracking of dementia prevalence, incidence and mortality among those with and without dementia is needed to understand long-run consequences of the pandemic., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

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., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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.

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., (© 2023 The American Geriatrics Society.)

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/mile 2 ) 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., (© 2023. The Author(s).)

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., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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 U.S. collected by the National Study of Caregiving (NSOC) (N=1,005). 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.

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., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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., (© 2022 The American Geriatrics Society.)

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., Competing Interests: The authors have no conflicts to report. Author disclosures are available in the supporting information., (© 2022 The Authors. Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring published by Wiley Periodicals, LLC on behalf of Alzheimer's Association.)

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., (Copyright © 2022 The Authors.)

Introduction: How care-related time and emotional health over the day differ for those assisting older adults with and without dementia is unclear., Methods: Using 2134 time diaries from the National Study of Caregiving, we compared emotional health and care time for caregivers of older adults with and without dementia., Results: Caregivers to older adults with dementia experienced worse (higher scores) on a composite measure of negative emotional health (4.2 vs 3.3; P < .05) and provided more physical/medical care (33.7 vs 16.2 minutes; P < .05) and less transportation assistance (12.6 vs 24.8 minutes; P < .05) than other caregivers. In models, providing physical/medical care was associated with worse emotional health (β = 0.15; P < .01) and socializing with the care recipient was associated with worse emotional health when the recipient had dementia (β = 0.28; P < .01)., Discussion: Findings highlight the opportunity for targeted interventions to address the emotional consequences of different types of care time in the context of dementia., (© 2021 the Alzheimer's Association.)

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., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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., Contribution: We provide estimates of kinship size and composition for adults with disabilities, assessing the number of kin, types of kin, and sociodemographic differences.

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., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Association for Public Opinion Research. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

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., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Importance: Medicare Advantage (MA) insures an increasing proportion of Medicare beneficiaries, but evidence is lacking on patient or family perceptions of the quality of end-of-life care in MA vs traditional Medicare., Objective: To determine if there is a difference in quality of care reported by family and friends of individuals who died while insured by MA vs traditional Medicare at the end of life., Design, Setting, and Participants: This cross-sectional study used the 2011 to 2017 Medicare-linked National Health and Aging Trends Study to conduct population-based survey research representing 8 668 829 Medicare enrollees. Included individuals were 2119 enrollees who died when aged 65 years or older, with quality of care reported by a family member or close friend familiar with the individual's last month of life. Analysis was conducted in July 2020., Exposures: MA enrollment at the time of death or before hospice enrollment., Main Outcomes and Measures: Perception of end-of-life care was measured with 9 validated items, with the primary outcome variable being overall care rated not excellent. We conducted a propensity score-weighted multivariable model to examine the association of each item with MA vs traditional Medicare enrollment. The propensity score and multivariable model included covariates capturing demographic and socioeconomic factors, function and health, and relationship of the respondent to the individual who died. The sample was then stratified by hospice enrollment and setting of care in the last month., Results: Of 2119 people in the sample, 670 individuals were enrolled in MA at the time of death or prior to hospice (32.7%) and 1449 were enrolled in traditional Medicare (67.3%). In survey-weighted percentages, 53.6% (95% CI, 51.0% to 56.1%) were women and 43.4% (95% CI, 41.5% to 45.3%) were older than 85 years at the time of death. In the adjusted model, family and friends of individuals in MA were more likely to report that care was not excellent (odds ratio, 1.28; 95% CI, 1.01 to 1.61; P = .04) and that they were not kept informed (odds ratio, 1.48; 95% CI, 1.06 to 2.05; P = .02). For those in nursing homes, there was an estimated probability of 57.2% of respondents reporting that care was not excellent for individuals with traditional Medicare, compared with 77.9% of respondents for individuals with MA (marginal increase for those in MA, 0.21; 95% CI, 0.08 to 0.32; P = .001)., Conclusions and Relevance: In this cross-sectional study of people who died while enrolled in Medicare, friends and family of those in MA reported lower-quality end-of-life care compared with friends and family of those enrolled in traditional Medicare. These findings suggest that, given the rapid growth of MA, Medicare should take steps to ensure that MA plans are held accountable for quality of care at the end of life.

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., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Despite the high prevalence of late-life depression and anxiety at threshold and subthreshold levels, their joint role in the disablement process remains unclear. This study aims to examine the association of comorbid occurring depression and anxiety across the full spectrum of symptom severity with disability onset in older adults., Methods: The study included 3663 participants from the 2011 National Health and Aging Trends Study, who reported no limitations in self-care and mobility activities at baseline. Disability onset was defined as a report of receiving help from another person in any of the activities for 3 consecutive months. Depression and anxiety symptoms were measured using the four-item Patient Health Questionnaire, grouped into low, mild, and moderate/severe symptom groups. Cox proportional hazards models were used to estimate relative risks for disability onset over a 5-year period by depression/anxiety symptom groups., Results: A total of 1047 participants developed disability (24.6%; 6.0 per 1000 person-months). At baseline, one-fifth of the sample reported symptoms that were mild (n = 579 [14.9%]; 31.6% with disability onset) or moderate/severe (n = 156 [4.2%]; 38.1% with disability onset). After adjustment for sociodemographics, there was a dose-response relationship between depression/anxiety symptom groups and disability onset (mild versus low: hazard ratio [HR] = 1.43, 95% confidence interval [CI] = 1.20-1.70; moderate/severe versus low: HR = 1.94, 95% CI = 1.45-2.59). The increased risk remained significant after adjustment for health status variables for the mild symptom group (HR = 1.26, 95% CI = 1.07-1.49), but not for the moderate/severe symptom group (HR = 1.30, 95% CI = 0.94-1.79), possibly reflecting lower statistical power., Conclusions: Findings suggest that the full spectrum of depression and anxiety symptoms are associated with increased risk for disability in late life. Their role in the disablement process warrants further investigation.

Importance: Family and unpaid caregivers often play an active role in managing the care of older adults with activity limitations., Objective: To examine caregivers' experiences with older adults' health care workers., Design, Setting, and Participants: This survey study constitutes a secondary analysis of a sample of 1916 family and unpaid caregivers to 1203 community-living older adults with activity limitations who participated in the 2017 National Health and Aging Trends Study. Data analysis was performed January to August 2019., Exposures: Caregiver sociodemographic characteristics, caregiving intensity, and frequency speaking with or emailing older adults' health care workers., Main Outcomes and Measures: Caregiver-reported experiences when interacting with older adults' health care workers in the prior year, including being listened to, being asked about understanding of treatments, and being asked about help needed in managing older adults' care., Results: Caregivers (mean [SE] age, 59.4 [0.5] years; 63.7% women) assisting community-living older adults with activity limitations reported that they never (56.3%), sometimes or rarely (33.0%), or often (10.7%) spoke with or emailed older adults' health care workers in the prior year. Most caregivers who interacted with older adults' health care workers reported being always (70.6%) or usually (18.2%) listened to and always (54.4%) or usually (17.7%) being asked about their understanding of older adults' treatments. Fewer caregivers reported being always (21.3%) or usually (6.9%) asked whether they needed help managing older adults' care, and nearly one-half (45.0%) were never asked. Caregivers who interacted with older adults' health care workers often (vs sometimes or rarely) were more likely to report being always or usually listened to (94.8% vs 86.9%; P = .004), being asked about understanding treatments (80.1% vs 69.5%; P = .02), and being asked about needing help (40.8% vs 24.1%; P < .001). No other exposures were consistently associated with caregiver experiences. Measures of caregiving intensity, including caring for an older adult with dementia, were not associated with being listened to or asked about understanding, but were associated with being asked about needed help. Although caregivers of persons with dementia were more likely than caregivers of persons without dementia to report always being asked about needed help (26.9% vs 19.0%), a high percentage in both groups were never asked (41.2% vs 46.5%) (P = .007)., Conclusions and Relevance: These findings reinforce the need for strategies to better support family and unpaid caregivers, who are the main source of assistance to older adults with physical and/or cognitive limitations.

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., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Disablement has been linked to compromised wellbeing in later life, but whether material resources buffer these negative effects is unclear., Objective: Drawing upon conceptual models of stress and coping, we analyze experienced wellbeing data from time diary interviews with adults ages 60 and older. We expect that experienced wellbeing will be influenced by each stage of the disablement process and that higher income and wealth will buffer the negative effects of disability on experienced wellbeing. Because income is a better reflection of one's liquid resources while assets reflect lifetime accumulation, we expect income to be a more substantial buffer than assets., Methods: We use the Disability and Use of Time Supplement to the Panel Study of Income Dynamics (N = 1607). We consider several measures of the disablement process (activity limitations, impairment severity, duration of limiting condition) and history of work limitation and evaluate both pre-tax income and net worth quartiles. We estimate a series of multi-level regression models that account for clustering of individuals within couples. We calculate the marginal effects of disability on wellbeing at different quartiles of economic resources., Results: We find that impairment severity is associated with worse experienced wellbeing before and after adjusting for covariates, and income buffers these negative effects for those in the middle-income quartiles., Conclusions: Future research should further explore the mechanisms through which income buffers the negative effects of impairment severity and specify the accommodations that enable economically disadvantaged and advantaged older adults alike to withstand physical declines while maintaining wellbeing., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: We evaluate whether non-spousal family support and strain moderate the effect of disability on two daily emotions (happiness and frustration) among older adults, and whether these patterns differ by gender among married persons, and by marital status among women., Background: Stress buffering perspectives predict that harmful effects of stress on well-being are buffered by family support, whereas stress proliferation models suggest these effects are intensified by family strain. The extent to which family relationships moderate associations between stress and well-being may vary on the basis of gender and marital status, as non-spousal family ties are considered especially salient for women and those without a romantic partner., Method: Daily diary data are from the 2013 Disability and Use of Time supplement to the Panel Study of Income Dynamics (n=1,474), a national sample of adults ages 60+. Multivariate regression models are estimated for married/partnered men and women, and formerly married women., Results: Neither family support nor strain moderated the effect of severe impairment on married men's daily emotions. Family support buffered the effect of severe impairment on frustration among divorced and widowed women, but not their married counterparts. Counterintuitively, family arguments mitigated against frustration and increased happiness among married women with severe impairment., Conclusion: Consistent with stress buffering perspectives, family support was most protective for the vulnerable population of formerly married older women with severe impairment., Implications: This study underscores the importance of family support for the large and growing population of formerly married women managing health-related challenges in later life.

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., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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.

Life satisfaction judgments are thought to reflect people's overall evaluation of the quality of their lives as a whole. Because the circumstances of these lives typically do not change very quickly, life satisfaction judgments should be relatively stable over time. However, some evidence suggests that these judgments can be easily manipulated, which leads to low stability even over very short intervals. The current study uses a unique data set that includes multiple assessments of life satisfaction over both long (up to 4 years) and short (over the course of a single interview) intervals to assess whether information that is made salient during the course of an interview affects life satisfaction judgments at the end of the interview. Results suggest that this intervening information has only small effects on the final judgment and that placement within an interview has little influence on the judgment that people provide. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

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., (© 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.)

Objective: To explore the accuracy of rehabilitation service use reports by older adults as well as variation in accuracy by demographic characteristics, time since use, duration, and setting (inpatient, outpatient, home)., Design: Longitudinal observational study., Setting: Participants' homes., Participants: Community-dwelling adults ages 65 and older (N=4228) in the 2015 National Health and Aging Trends Study who were enrolled in Medicare Parts A and B for 12 months before their interview., Interventions: Not applicable., Main Outcome Measures: Respondents were asked whether they received rehabilitation services in the past year and the duration and location of services. Healthcare Common Procedure Coding System codes and Revenue Center codes were used to identify Medicare-eligible rehabilitation service., Results: Survey-based reports and Medicare claims yielded similar estimates of rehabilitation use over the past year. Self-reported measures had high sensitivity (77%) and positive predictive value (80%) and even higher specificity and negative predictive value (approaching 95%). However, in adjusted models, sensitivity was lower for black enrollees, the very old, and those with lower education levels., Conclusions: Survey-based measures of rehabilitation accurately captured use over the past year, but differential reporting should be considered when characterizing rehabilitation use in certain subgroups of older Americans., (Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

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.

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 ages 30 and older in the Panel Study of Income Dynamics, the longest running national panel study in the US (N=10,784). Respondents predicted to be likely to respond by web were invited to a web study and sent a paper copy after 6 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-and-send). An embedded experiment measured the impact of the two protocols among a group of respondents with no clear likely mode (N=889). Over 40% of individuals with no likely mode are under the age of 40, 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 (AAPOR 1 RR=71% vs. 68%, p=0.49), field effort (7.9 vs. 8.4 mean weeks, p=0.251), and distributions of respondent characteristics. Among those responding, cases randomized to web-first were more likely than those randomized to signal-and-send to respond by web (62.7% vs. 42.4% p<.001). We discuss implications for targeted protocols in mixed mode panel surveys.

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.

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., (© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.)

Background: Wellbeing is often described as U-shaped over the life course, suggesting an apparent paradox that wellbeing remains high at older ages despite increases in impairments., Objective/hypotheses: We explore associations among age, lower body impairments-one of the most common late-life impairments-and three measures of wellbeing: life satisfaction, emotional wellbeing and somatic wellbeing. We hypothesize that age effects are positive, become stronger once lower body impairments are controlled, and are concentrated among those who have maintained their mobility. Net of confounding factors, we hypothesize that lower body impairments are associated with worse wellbeing and these effects diminish with advancing age., Methods: We analyze the 2013 Disability and Use of Time supplement to the Panel Study of Income Dynamics (N = 1607 adults ages 60 and older). We estimate nested regression models that include age, severity of lower body impairments and confounding demographic, psychological, and socioeconomic factors and activities; test age-impairment interactions; and estimate age- and impairment-stratified models., Results: Positive age effects were observed after controlling for lower body impairments for life satisfaction (β = 0.90; p < 0.05), although statistical significance weakened (p = 0.07) in fully adjusted models. For emotional wellbeing, adjusted age effects were negative (β = -0.05; p < 0.05) and were concentrated among those with limitations (β = -0.14; p < 0.01). For all three outcomes, severity of impairments reduced wellbeing in adjusted models. These effects were strongest for somatic wellbeing, especially for 65-74 year olds., Conclusions: Our study challenges the notion that wellbeing is U-shaped throughout the life course and underscores the critical role of mobility across wellbeing domains in later life., (Copyright © 2017 Elsevier Inc. All rights reserved.)

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.