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Objectives: This paper provides new estimates of disability prevalence for the archipelago and mainland-residing Puerto Rican populations ages 40 and above and compares disability by place of birth and place of residence to investigate drivers of middle and older age health. Methods: Large nationally representative samples from 2013 to 2017 American Community Survey and Puerto Rico Community Survey data are used to estimate age-specific disability prevalence for archipelago-born/archipelago-residing, archipelago-born/mainland-residing, mainland-born/mainland-residing Puerto Ricans. Results: Mainland-born/mainland-residing Puerto Ricans have the lowest age-adjusted disability rates and archipelago-born/archipelago-residing Puerto Ricans have the highest rates. Differences in education explain part of this disparity. Discussion: Similarities in disability prevalence are strongest based on where one was born as opposed to current residence, pointing to early life as a critical period in the disablement process for later-life health. Early life socio-economic disadvantage on the archipelago may have an enduring impact on later-life disability prevalence for archipelago-born Puerto Ricans. [ABSTRACT FROM AUTHOR]

Objective: Previous research in various countries has found that employment–family trajectories characterized by early or single motherhood, or weak ties to employment, are associated with poor well-being among older women. Our paper explores whether this differs (1) in France, characterized by a high female employment rate and supportive family policies; (2) across dimensions of well-being. Method: We used the Health and Occupational Itinerary survey to identify 10 common patterns of employment–family trajectories (derived from multi-channel sequence analysis) and analysed their association with six indicators of well-being in 2010 (N = 2882 50–78 years old women). Results: Continuous full-time employment is associated with better well-being, except for women who had a first child around 24 years old, who reported increased anxiety and lack of support. Discussion: Employed mothers' well-being seems to be protected in a context of family friendly policies, but we identified one group with lower well-being, which merits further study. [ABSTRACT FROM AUTHOR]

Objectives: This paper examines the longitudinal effects of changes in the association between loneliness and depressive symptoms during the pandemic among older adults (65+). Methods Baseline (2011–2015) and Follow-up 1 (2015–2018) from the Canadian Longitudinal Study on Aging (CLSA), and the Baseline and Exit waves of the CLSA COVID-19 study (April–December, 2020) (n = 12,469) were used. Loneliness was measured using the 3-item UCLA Loneliness Scale and depression using the CES_D- 9. Results Loneliness is associated with depressive symptoms pre-pandemic; and changes in level of loneliness between FUP1 and the COVID Exit survey, adjusting for covariates. No interaction between loneliness and caregiving, and with multimorbidity, on depressive symptoms were observed, and several covariates exhibited associations with depressive symptoms. Discussion Strong support is found for an association between loneliness on depressive symptoms among older adults during the pandemic. Public health approaches addressing loneliness could reduce the burden of depression on older populations. [ABSTRACT FROM AUTHOR]

Objective: Immigrant health discussions often focus on acculturation and omit discussions on historical events that may underlie health differences among immigrant older adults. This paper provides a historical overview of immigration policy and flows to the U.S. and examines insurance access and health difficulties by sending country. Methods: We analyzed the "Immigrants Admitted to the United States, Fiscal Years 1972–2000" and 2015–2019 American Community Survey datasets to examine the number of admitted immigrants, sociodemographic profiles for current immigrant older adults, and the predicted probabilities of health insurance access and health difficulties. Results: Our results highlight alignment of immigration flows with immigration legislation and vast heterogeneity in migration, health, and healthcare access of immigrants by sending country. Discussion/Implications: Public health practitioners must consider how historical events and social factors contribute to the healthcare access and health of immigrant populations, as demographic shifts will require interventions that promote equitable healthy aging. [ABSTRACT FROM AUTHOR]

Objectives: We investigated the contribution of five health domains to self-rated health (SRH) cross-sectionally and longitudinally and whether these contributions differ by gender or age. Methods: Employing dominance analyses, we quantified the contributions of functioning, diseases, pain, mental health, and behavior to both SRH at a point in time and for changes in SRH using data from the Canadian National Population Health Survey (NPHS, 1994–2011). Results: Cross-sectionally and longitudinally, functioning was the most important health domain, followed by diseases and pain. There were no meaningful differences in the ranking by gender while functioning, diseases, and pain were more relevant in older cohorts. Discussion: Functioning, diseases, and pain systematically were the most important health domains in both cross-sectional and longitudinal analyses. While these results held for women and men, they were more salient for older adults. This points to a gender-invariant but age-graded process, confirming previous research with European data. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates the associations between five types of childhood interpersonal trauma (CIT) and depression in mid-later life, as well as the mediation roles of social integration in the associations. Methods: Two waves of data from a nationally representative survey in China were used, with participants aged 45 years and older (N = 14,180). Measures of CIT included physical abuse, physical neglect, emotional neglect, bullying victimization, and exposure to interparental violence. Binary logistic regression and Karlson–Holm–Breen mediation analysis were used as statistical methods. Results: People who were bullied, physically abused, and witnessed interparental violence during childhood were more likely to develop depression in mid-later years. The associations between CIT and depression were mediated by satisfaction with marriage, satisfaction with children, and perceived social support. Discussion: Although CIT elevates the risk of depression in later life, effective interventions that strengthen integration across family and social domains could benefit mental health. [ABSTRACT FROM AUTHOR]

Objectives: Based on protection motivation theory, we investigate how indicators of threat perception (perceived severity, perceived vulnerability, and fear arousal) and coping appraisal (hope) are associated with older people's motivation to engage in protective behavior after the outbreak of COVID-19. Methods: We use multivariate regression analyses with a sample of 40,282 individuals from 26 countries participating in the SHARE Corona Survey. Results: We find that 15% of all respondents stayed home completely—mainly the oldest and vulnerable people with prior health risk conditions. On average, older Europeans responded strongly to the recommended protective behavior measures (6 out of 7 measures adopted). Among the threat perception indicators, fear arousal is the main motivator for protective behavior, whereas the coping appraisal indicator hope shows an equally strong association. Discussion: Given the negative health effects of fear, our findings may help evaluate and revise governmental policy responses and communication strategies. [ABSTRACT FROM AUTHOR]

Objectives: This study examined whether trajectories of depressive symptoms of one spouse are associated with the other spouse's memory. Methods: Longitudinal data from the Health and Retirement Study (2004–2016) were used (N = 5690 heterosexual couples). Latent-class growth analysis and structural equation models examined the actor and partner effects of depressive symptom trajectories on memory. Results: Four depressive symptom trajectories were identified (i.e., persistently low, increasing, decreasing, and persistently high). Compared to the low trajectory group, the increasing and persistently high trajectories were associated with worse memory for both men and women. While none of the wives' depressive symptom trajectories was significantly associated with husbands' memory (p >.05), husbands' decreasing trajectory was linked to wives' better memory (β = 0.498, 95% CI = 0.106, 0.890). Discussion: Older adults with increasing and persistently high depressive symptoms may experience worse memory. Psychosocial interventions targeting depressive symptoms among older men may be beneficial to their spouses' memory. [ABSTRACT FROM AUTHOR]

Objectives: In Germany, roughly 8.3 million people are in need of care, but only one-third of them receive state care benefits. The study investigates whether the individual network of a care-seeking person, as well as its resources, interact with health status on the likelihood of accessing formal care services. Methods: German data from the Survey of Health, Ageing and Retirement in Europe (SHARE) from 2015 were used in several Firth logistic regressions with interaction terms. Results: Health limitations are a significant predictor for the probability of receiving formal care benefits. As moderating factors, caregivers from the immediate family as well as caregivers with lower levels of education tend to contribute to an increase in this probability. Discussion: Findings are based on a limited data set and indicate the importance of further research in this area to examine the mechanisms of access to formal care more precisely. [ABSTRACT FROM AUTHOR]

Objectives: We examined individual-level factors associated with hearing aid use by race and ethnicity in a nationally representative sample of Medicare beneficiaries. Methods: We used the Medicare Current Beneficiary Survey (cycles 2016–2018) for 10,301 older adults with hearing loss and hearing aid use as the primary outcome. Covariates included education, income, urban residence, chronic conditions, functional limitations, and Medicaid eligibility. Multivariable logistic regression stratified by race and ethnicity was used to identify factors associated with hearing aid use. Results: Factors associated with hearing aid use included higher education among White (OR = 1.35, 95%CI:1.16, 1.58), Black (OR = 1.76, 95%CI:1.02, 3.05), and Hispanic (OR = 1.77, 95%CI:1.17, 2.68) beneficiaries. Urban residence was associated with hearing aid use for Black participants (OR = 3.06, 95%CI:1.17, 8.03) and Medicaid eligibility for Hispanic participants (OR = 1.58, 95%CI:0.97, 2.59), although the confidence interval included the null hypothesis. Discussion: ndividual-level factors associated with hearing aid use differed by race and ethnicity among Medicare beneficiaries. [ABSTRACT FROM AUTHOR]

Objectives: The effects of the COVID-19 outbreak on non-COVID-19-related healthcare need further investigation. Methods: Using the Survey of Health, Ageing and Retirement in Europe's COVID-19 module (2020) (N = 57,025), country-level data from the European Social Survey (2008) and OECD (2020), and logistic regressions, this study examines predictors of older Europeans' forgone, postponed, and denied healthcare during the pandemic. Results: Country-level availability of physicians, healthcare systems' generosity, and beliefs that older persons burden healthcare systems all increased forgone healthcare. Healthcare system generosity increased postponed and denied healthcare. Greater medical resources decreased denied healthcare. Furthermore, missed healthcare varied by individual-level gender (higher rates among women), age, education, and health. Discussion: This study reveals predictors of missed healthcare during the pandemic. To decrease unintended health consequences of a pandemic, both individual-level determinants, such as gender and health, and contextual-level determinants, such as healthcare systems' characteristics, should be considered in research and practice. [ABSTRACT FROM AUTHOR]

Objectives: Age-associated accelerated declines in physical health vary across individuals, and researchers have suggested that individual differences in decline may vary as a function of stressors. The relation of one such stressor, negative social exchanges, to accelerated declines in self-rated health is investigated. Method: Participants are from a 2-year, 5-wave, national, longitudinal study of social relationships among older adults. Growth curve analyses are used to examine the relation of negative and positive social exchanges to accelerated changes in self-rated health, controlling for age, sex, race/ethnicity, education, and depressive symptoms. Results: Individuals reporting more frequent negative social exchanges showed significantly accelerated declines in physical health. Positive social exchanges were not related to linear or accelerated declines in self-rated health over time. Discussion: The association between negative social exchanges and accelerated deterioration in self-rated health provides general support for hypotheses that interpersonal stressors play an important role age-related physical health decline. [ABSTRACT FROM AUTHOR]

Objective: To determine whether cognition is associated with mortality among older US adults. Methods: We studied 5,989 National Health and Nutrition Examination Survey participants age 60+ in years 1999–2014 with mortality follow-up through 2015. Cognitive function was measured in one standard deviation decrements using the Digit Symbol Substitution Test (DSST), Animal Fluency (AnFl), and two Consortium to Establish a Registry for Alzheimer's Disease (CERAD) tests. Results: Each decrement in cognitive function was associated with increased risk of mortality overall (DSST HR: 1.36, 95% CI: 1.25, 1.48), among women only (AnFl: 1.51, 95% CI: 1.02, 2.24), and among those with less than a high school education only (AnFl HR: 1.46, 95% CI: 1.09, 1.97; CERAD-WL HR: 1.34, 95% CI: 1.07, 1.67; and CERAD-DR HR: 1.38, 95% CI: 1.05, 1.82). Discussion: Among US adults, lower cognitive functioning was associated with mortality; associations were stronger among women and those with less education. [ABSTRACT FROM AUTHOR]

Objectives: Sensory impairments are prevalent among older adults and have been associated with cognitive challenges in later life, yet mechanisms are less well understood. We examined the mediating role of social isolation in the longitudinal relationship between self-reported sensory difficulty and impaired cognitive functioning among older adults. Methods: Data were taken from the NHATS Study, an annual survey of Medicare beneficiaries' age ≥ 65. Participants (N = 6,338) provided data at Rounds 5, 6, and 7 (2015, 2016, 2017). Structural equation models were estimated to test longitudinal direct and indirect associations. Results: All sensory difficulties were negatively associated with all cognitive functioning measures cross-sectionally through social isolation. Longitudinally, vision difficulty and dual sensory difficulty were indirectly associated with cognitive functioning across time. Hearing difficulty had no longitudinal indirect associations with cognitive functioning through social isolation. Discussion: Social isolation is an important pathway through which late-life vision difficulty is associated with decreased cognitive function. [ABSTRACT FROM AUTHOR]

Objective: To assess the relationship between discrimination and falling among older people. Methods: A cross-sectional nationwide population-based face-to-face survey, 2015. The SABE (Salud, Bienestar y Envejecimiento) Colombia Study, 19,004 community-dwelling adults aged ≥60 years. Recurrent falling was defined as ≥2 falls during the prior year. Main independent variable was discrimination. Results: Multivariate logistic regression models showed that recurrent falling was significantly associated with a number of reasons for experiences of everyday discrimination (due to racial, socioeconomic status, gender, age, religion, sexual orientation, or disability) (OR = 1.27, 95% CI 1.21–1.33), childhood discrimination score (never = 0 to many times = 3) (OR = 1.23, 95% CI 1.13–1.33), and number of situations for discrimination during the last 5 years due to skin color (group activities, public places, inside the family, or health centers) (OR = 1.12, 95% CI 1.08–1.17). Discussion: Discrimination experiences were associated with higher odds of recurrent falling. [ABSTRACT FROM AUTHOR]

Objectives: The present study aims to examine possible pathways that potentially account for the relationship between perceived age discrimination in healthcare settings (as one form of ageism) and health outcomes. Methods: We relied on 1570 complete surveys, which constitute a representative national sample of adults aged 50 and above in Israel. Results: We found a direct link between perceived age discrimination and health outcomes. This link was partially mediated by self-perceptions of aging and subsequently by health behaviors (e.g., eating vegetables) and preventive health behaviors (e.g., medical check-ups). The link between perceived age discrimination and health behaviors was moderated by age, thus, particularly detrimental for older people over the age of 65 as compared with those between the ages of 50 and 65. Discussion: This study adds to the literature as it examines comprehensive mechanisms to account for the path between perceived age discrimination and health status. Our findings point to the unique aspects associated with perceived age discrimination, which potentially make older people more susceptible to its negative effects. [ABSTRACT FROM AUTHOR]

Objectives : This is the first national population-based study to examine cognitive impairment disparities among sexual minority mid-life and older adults. Methods : Using the National Health Interview Survey (2013–2018), we compared weighted prevalence of subjective cognitive impairment by sexual orientation and gender, among those aged 45 plus, applying logistic regressions adjusting for age, income, education, race/ethnicity, and survey years. Results : Sexual minorities (24.5%) were more likely to have subjective cognitive impairment than heterosexuals (19.1%). Sexual minority women had higher odds of greater severity, frequency, and extent of subjective cognitive impairment. Sexual minorities were also more likely to report activity limitations resulting from cognitive impairment and were no more likely to attribute limitations to dementia or senility. Discussion : Cognitive health disparities are of particular concern in this historically and socially marginalized population. The investigation of explanatory factors is needed, and targeted interventions and policies are warranted to address cognitive challenges faced by sexual minorities. [ABSTRACT FROM AUTHOR]

Objectives: To examine post-traumatic stress disorder (PTSD) among Black adults in younger, middle, and older ages. Methods: Using nationally representative data from the National Survey of American Life, we estimated lifetime and 12-month prevalence of PTSD in Black men and women ages 18–34, 35–49, and 50+. We determined PTSD persistence and severity by age group, then associations of PTSD with socio-economic status, chronic stress, and racial discrimination in middle age. Results: The lifetime prevalence of PTSD was higher in Black women/men ages 18–34 (prevalence=14.0%/6.3%) and 35–49 (12.8%/4.6%) versus 50 and older (8.7%/5.1%). Those ages 35–49 were more likely than younger/older Black adults to have severe interference in work, relationships, and activities domains. In middle age, PTSD was associated with unemployment, lower education, poverty, and stress in Black men, and unemployment, divorce, poverty, stress, and discrimination in Black women. Discussion: Black women experience a disproportionate burden of PTSD in middle age. [ABSTRACT FROM AUTHOR]

Objectives: African Americans experience relatively low rates of mental disorder despite being disproportionately exposed to psychosocial stressors. Coping is an understudied area that may help explain the mental health resilience among this population. Methods: Using data from the National Survey of American Life, I use negative binomial logistic regression to investigate the relationships between stress exposure/appraisal, ten coping responses, and mental health among older African American adults. Results: Seven of 10 coping responses were predictive of psychological distress. I also found evidence of moderation for six responses. Active coping, instrumental social support, looking for something good in what has happened, and two measures of acceptance were protective against psychological distress associated with high levels of stress. Substance use generally exacerbated the association between stress and psychological distress. Discussion: Problem-focused coping and acceptance responses were effective coping strategies for older African Americans under high levels of stress exposure/appraisal. [ABSTRACT FROM AUTHOR]

Objective: Despite a growing body of research, the effects of retirement on health are not clear. The study explores the role played by the path out of the labour market (formal retirement vs. unemployment or family reasons), accounting for individual heterogeneity. Methods: Propensity score matching approach is employed on longitudinal data from the Survey of Health, Ageing and Retirement in Europe (2004–2015). Results: While health does not change significantly for those who formally retire, it worsens considerably for those who leave the labour market for other reasons. Moreover, health outcomes turn out to be highly heterogeneous, depending on individual socio-economic and job-related characteristics. Discussion: Leaving the labour market in one's mature years is a complex transition. Future research should focus on understanding and combating the causes of premature exit from the labour market, a relevant concern both in economic terms and on health grounds, in the light of our results. [ABSTRACT FROM AUTHOR]

Objectives: Given what little is known about the experiences of sexual and gender minority (SGM) caregivers of people with Alzheimer's disease and related dementias (ADRD), the aim of the current study was to describe psychosocial measures among these caregivers. Methods: We used an online survey and social media recruitment strategies. Results: Of 286 caregivers, the majority were gay men. Most respondents were white, with a third identifying as Latino American. The plurality of caregivers identified as a spouse/partner and were providing care for someone who identified as a sexual minority; one-fifth cared for someone transgender. Sexual orientation, perceived stress, caregiver stigma, and microaggressions were psychosocial factors associated with family quality of life and depressive symptoms in the caregivers. Discussion: This study is the first to provide a focused description of the characteristics and psychosocial needs of SGM caregivers of someone with ADRD, supporting development of targeted interventions for this population. [ABSTRACT FROM AUTHOR]

Objectives: To examine social and physical environmental fall-risk factors in a nationally representative sample of community-living older adults overall and by racial group. Methods: We used data from the 2015 and 2016 rounds of the National Health and Aging Trends Study (n = 5581) linked to census tract measures from the American Community Survey. Recurrent falls are defined as 2+ self-reported falls over 12 months. Results: Older adults with recurrent falls were more likely to have lower education, lower income, financial hardship, live in homes with disorder and disrepair and in neighborhoods without sidewalks, with high social deprivation, and in nonmetropolitan counties. Home disrepair, lack of sidewalks, and residence in a nonmetropolitan county were important fall-risk factors among White older adults only. Financial hardship was an important risk factor among Black older adults. Discussion: Environmental factors are associated with recurrent falls among older Americans and should be incorporated into fall-risk profiles and prevention efforts. [ABSTRACT FROM AUTHOR]

Objectives: Current tobacco use (CTU) and secondhand smoke (SHS) exposure among older adults in India (≥60 years) are prevalent in India and indicate the importance of addressing associated factors. Methods: Pooled Global Adult Tobacco Survey India 2009–2010 and 2016–2017 data (n = 17,299) for older adults examined prevalence of CTU and SHS exposure at home and/or in public places and associated socioeconomic and demographic correlates. Results: CTU among older adults in India was 44.6%, and SHS exposure at home and public places were 20.0% and 30.0%, respectively. Men, younger age-group, rural, lower education, lower wealth index, and lower knowledge were independently associated with CTU. Men, rural, lower education, lower wealth index, CTU, and lower knowledge were independently associated with SHS exposure at home. Men, younger age, and rural residence were associated with SHS exposure in public places. Conclusion: CTU and SHS exposure among older adults in India suggest targeted interventions to address associated social and demographic factors. [ABSTRACT FROM AUTHOR]

Objectives: To identify the interrelations between the trajectories of social isolation and dementia in older adults. Methods: Data came from the National Health and Aging Trends Study 2011–2018 surveys. Group-based dual trajectory modeling was used to examine trajectories and their interrelations. Results: Four trajectories of social isolation—rarely isolated (62.2%), steady increase (13.5%), steady decrease (7.4%), and persistently isolated (16.9%) and dementia risk—persistently low risk (80.4%), increasing with early onset (3.9%), increasing with late onset (4.5%), and persistently high risk (11.2%) emerged. Two-thirds of the low-risk dementia group were in the rarely isolated group. The high-risk dementia group had the most overlap with the decreasing social isolation group (47%), followed by the persistently isolated group (28%). Conclusions: Social isolation and dementia mostly evolved in the same direction. However, the pattern of associations between these trajectories is intricate and may be reversed among long-term dementia survivors. [ABSTRACT FROM AUTHOR]

Objective: This study investigates the impact of informal care and work stress on women's health and further disentangles this effect through intensity and channel analysis. Method: This research uses the 2000–2015 China Health and Nutrition Survey and employs the propensity score matching model with fixed effects. Results: The care and work burden significantly increases the probability of women suffering from chronic diseases, being underweight or overweight, and self-reporting poor health by 0.63%, 1.69%, and 2.35%, respectively. This double-burden effect is exacerbated as the care and work hours increase. Women who care for more than 20 hr and work for more than 50 hr per week experience the most serious health decline. We further find that the double burden leads to health deterioration through channels of reduced exercise and increased psychological stress. Discussion: This study provides a reliable decision-making basis for policy makers to formulate strategies for informal caregivers in China. [ABSTRACT FROM AUTHOR]

Objectives: To assess two models for the prediction of health utilization and functions using standardized in-person assessments of frailty and administrative claims-based geriatric risk measures among Medicare fee-for-service beneficiaries aged 65 years and above. Methods: Outcomes of hospitalizations, death, and functional help were investigated for participants in the 2011 National Health and Aging Trends Study. For each outcome, multivariable logistic regression model was used to investigate claims-based geriatric risk and survey-based frailty. Results: Both claims-based and survey-based models showed moderate discrimination. The c-statistic of the standardized frailty models ranged from 0.67 (for any hospitalization) to 0.84 (for any IADL [instrumental activities of daily living] help). Models using administrative data ranged from 0.71 (for any hospitalization) to 0.81 (for any IADL help). Discussion: Models based on existing administrative data appear to be as discriminate as survey-based models. Health care providers and insurance plans can effectively apply existing data resources to help identify high-risk individuals for potential care management interventions. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether social capital benefits older adults' self-rated health and well-being and whether physical activity mediates this relation. Methods: A survey study was conducted among members of a sociocultural organization (age ≥55 years), both cross-sectionally (baseline Time 1; N = 959) and longitudinally (3-year follow-up Time 2; N = 409). Results: Specific indicators of social capital were positively, though modestly, related to health and well-being at Time 1 and Time 2. Experienced connectedness with age peers emerged as the strongest predictor. Physical activity only mediated the relation with experienced safety in society. Discussion: The relative importance of older adults' experienced connectedness with their age peers underlines the importance of internalized group membership as a determinant of their health and well-being. Physical activity seems to play only a minor mediating role. [ABSTRACT FROM AUTHOR]

Objective: We investigate how (a) attendance at sport games and (b) identification with a sport team as fans (i.e., team identification) influence older adults' perceptions of emotional support, belonging, and subjective well-being (SWB). Method: An experimental pilot study was conducted with 50 older adults, followed by a main survey study administered to 534 older adults from various communities across the United States. Results: Pilot study results indicated that game attendance and team identification had a positive and significant influence on older adults' perceptions of emotional support from fellow team fans. These results were replicated in the main study, which also showed that older adults' perceived emotional support from fellow fans was positively associated with their sense of belonging which predicted their SWB. Discussion: The findings provide insights into how older adults may be engaged in meaningful forms of social life to help them maintain and enhance mental health. [ABSTRACT FROM AUTHOR]

Objective: To examine the potentially bidirectional relationship between anxiety symptoms and unmet needs for assistance with daily activities among older adults. Method: Data came from the National Health and Aging Trends Study, 2011 through 2016 surveys. The study sample consisted of 3,936 Medicare beneficiaries with activity limitations at baseline, aged 65 or older. Cox proportional hazards regression was used to test the proposed relationship between anxiety symptoms and unmet needs for assistance with daily activities. Result: Having unmet needs increased the risk of the onset of anxiety symptoms, and elevated anxiety symptoms increased the risk of incident unmet needs for assistance with daily activities. Conclusion : Anxiety symptoms and unmet needs form a bidirectional relationship. Integrated mental health and community-based long-term care services may help reduce the burden of late-life anxiety disorders and stressful life incidents contributing to disability. [ABSTRACT FROM AUTHOR]

Objectives: The article addresses whether specific combinations of employment and domestic duties over the life course are associated with variations in women's health at the time of retirement. It also explores the differences of this relationship in four European welfare states. Method: Women from three waves of SHARE (Survey of Health, Aging and Retirement in Europe) are grouped using sequence analysis. Using logistic regression models, group differences in later life depression and self-reported health are tested. Predicted probabilities are applied to analyze welfares' differences. Results: The findings confirm that a combination of employment and domestic duties across the life course has a positive association with later life health. Being outside the labor market is detrimental for women's health. Well-being across the life course is framed by the welfare context in which women live. Discussion: We suggest that further research is needed to explore the mechanisms linking work and care trajectories to poor health and enable appropriate interventions. [ABSTRACT FROM AUTHOR]

Objective: This study describes trends in self-reported dental care utilization and services needed among American Indian/Alaska Native/Native Hawaiian (AI/AN/NH) elders 2008 to 2017, including demographic and socioeconomic variability. Method: Researchers utilized data from the Survey of Elders administered by the National Resource Center on Native American Aging, representing all regions of the United States and 262 tribes. Data were analyzed comparing means over time and between/within groups. Results: Between April 2008 and March 2017, there was a statistically significant (p <.001) increase in the proportion of older adults who visited a dentist and an increase in need for treatment. A smaller proportion of older adults reported need for treatment among those who were privately insured, high income, had no tobacco use, were employed, and had visited a dental professional in the last year. Discussion: These findings highlight current dental needs among tribal elders while also identifying elders at greater risk of poor oral health. [ABSTRACT FROM AUTHOR]

Objective: To describe, for a national sample of midlife and older adults, the types of complementary and alternative medicine (CAM) used for health and wellness and the perceived benefits of CAM use by race/ethnicity. Method: Using data from the 2012 National Health Interview Survey, we ran multiple logistic regression models to estimate the odds of each perceived benefit among adults ages 50 and older. Results: More than 38% of midlife and older adults used CAM in the past year. For six of seven perceived benefits examined, we found significant differences by race/ethnicity, with each group having higher odds of two or more perceived benefits compared with non-Hispanic Whites. Discussion: Although racial/ethnic minority groups are less likely to use CAM compared with non-Hispanic Whites, those who use CAM perceive great benefit. Future research should examine the potential contribution of evidence-based CAM to promoting health and well-being in a diverse aging population. [ABSTRACT FROM AUTHOR]

Objective: We examine the importance of early life displacement and nutrition on hypertension (HTN) and diabetes in older Colombian adults (60+ years) exposed to rapid demographic, epidemiological, and nutritional transitions, and armed conflict. We compare early life nutritional status and adult health in other middle- and high-income countries. Method: In Colombia (Survey of Health, Wellbeing and Aging [SABE]-Bogotá), we estimate the effects of early life conditions (displacement due to armed conflict and violence, hunger, low height, and not born in the capital city) and obesity on adult health; we compare the effects of low height on adult health in Mexico, South Africa (Study on Global Ageing and Adult Health [SAGE]), the United States, and England (Health and Retirement Study [HRS], English Longitudinal Study of Ageing [ELSA]). Results: Early life displacement, early poor nutrition, and adult obesity increase the risk of HTN and diabetes in Colombia. Being short is most detrimental for HTN in Colombian males. Discussion: Colombian data provide new evidence into how early life conditions and adult obesity contribute to older adult health. [ABSTRACT FROM AUTHOR]

Objective: This research examines health information (HI) seeking and use among middle-aged and older adults with chronic health conditions. Method: We used logistic regression models to analyze HI seeking (N = 7,822) and use (N = 4,541-4,547) among participants (aged 45+ years) with chronic conditions from the nationally-representative Health Tracking Household Survey. Results: Adults aged 45+ years with chronic conditions were significantly more likely to seek and use HI; however, these results varied based on the age and education. Compared with Whites, Latinos were less likely to seek HI but more likely to use HI to treat illness, and African Americans were more likely to use HI to maintain health. Conclusion: Middle-aged and older adults with chronic conditions are prominent HI seekers and users. Proficient HI seeking and use may have the potential to enhance control over one's own health, maintain independence in the community, and reduce the impact of negative health consequences on the health care system. [ABSTRACT FROM AUTHOR]

Objective: We assessed whether education inequalities in health among older people can be partially explained by different levels of active aging among educational groups. Method: We applied logistic regression and the Karlson, Holm, & Breen (KHB) decomposition method using the 2010 and 2012 waves of the Survey of Health, Ageing and Retirement in Europe on individuals aged 50+ years (N = 27,579). Active aging included social participation, paid work, and provision of grandchild care. Health was measured by good self-perceived health, low number of depressive symptoms, and absence of limitations because of health in activities people usually do. Results: We found a positive educational gradient for each of the three health measures. Up to a third of the health gaps between high and low educated were associated with differences in engagement in active aging activities. Discussion: Policies devoted at stimulating an active participation in society among older people should be particularly focused on lower educated groups. [ABSTRACT FROM AUTHOR]

Objective: To estimate proportions of married couples aged 30 to 59 years who face simultaneous demands from elderly parents and children in China, Japan, Korea, and Taiwan, and the effects on couples’ life and marital satisfaction. Method: Using data from the 2006 East Asian Social Survey, proportions of sandwiched couples were estimated using three definitions: co-residence, co-residence or nearby residence, and co-residence or frequent provision of financial/physical assistance. Logistic regression models were used to assess the effects on life and marital satisfaction. Results: Three-generational co-residence is more common in Taiwan and Japan (24.3% and 21.4%), whereas co-residence or provision for both generations is higher in Taiwan and Korea (53.7% and 44.5%). The strain of being sandwiched is associated with lower life and marital satisfaction only among women. Discussion: Intergenerational transfers of care play a major role in elderly support in East Asia but take a toll on the well-being of married women. [ABSTRACT FROM AUTHOR]

Objective: This study examines how older residents’ social support and perceived empowerment are associated with their quality of life (QOL) in long-term care (LTC) facilities in Shanghai, China, controlling for their health-related conditions, facility type, and other socio-demographic characteristics. Method: Using a convenient sampling approach, we selected nine LTC facilities in Shanghai, China. We surveyed 515 older residents from these facilities. Results: Older participants in this study rate their QOL, social support, and perceived empowerment as moderate, and these variables are positively associated with their QOL. Older residents who live in government-owned and private-run LTC facilities are more likely to have a higher level of perceived QOL compared with those living in government-run facilities. Discussion: There is an urgent need to increase staff awareness and capacity to empower older residents, and to engage them in their care plan and delivery. LTC facilities could provide more opportunities for older residents’ social networking within and outside LTC facilities. Improvement of older residents’ QOL is critical in the future development of resident-centered care models in LTC facilities. [ABSTRACT FROM AUTHOR]

Objective: The association between age and sleep problems is considered to be positive, and medication use is a common health care intervention among older individuals. Because daytime consequences are often stated as a reason to seek care, we study to what extent the medicalization of sleep problems is found in an aging European population, with a focus on daily activities. Method: Data from the Survey of Health Ageing and Retirement in Europe are used in three-level, generalized linear mixed models. Medicalization is operationalized as the use of medication for sleep problems at least once per week. Results: Men are more likely than women to use medication for sleep problems, and the process of aging is associated with a decrease in medicalization. Discussion: Sleep problems seem to be medicalized particularly when they prevent aging individuals from engaging in work-related responsibilities, as medication is especially used by employed individuals with sleep problems. [ABSTRACT FROM AUTHOR]

Objectives: Older female smokers are highly vulnerable, yet little is known about their attitudes, beliefs, and behaviors regarding smoking cessation. Methods: Southeast region Women’s Health Initiative participants identified as smokers on at least one prior assessment were surveyed in 2012 regarding current tobacco use. Results: Most of these current and former smokers (N = 409, 63% response) were non-Hispanic White (81.7%) and had some college (80%), with mean age of 75.1 years. Current smoking was confirmed by 56%, and while 61% of these reported a past-year quit attempt, less than half used quit aids. Of current smokers, 57.5% intended to quit within 6 months (26.6% within 30 days), and 68% were interested in joining a cessation study. Conclusions: Older female smokers were highly motivated to quit, yet profoundly underutilized proven quit aids. Results support high acceptability of cessation interventions for this undertreated population. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of objective and subjective social isolation from extended family members and friends on depressive symptoms and psychological distress among a national sample of older adults. Method: Data for older adults (55 years and above) from the National Survey of American Life (N = 1,439) were used to assess level of objective social isolation and subjective social isolation and to test regression models examining their impact on depressive symptoms (Center for Epidemiologic Studies Depression [CES-D] Scale) and psychological distress (Kessler 6 [K6] Scale). Results: The majority of respondents were not socially isolated from family or friends; 5% were objectively isolated from family and friends, and less than 1% were subjectively isolated from family and friends. Regression analyses using both social isolation measures indicated that objective social isolation was unrelated to depressive symptoms and psychological distress. However, subjective social isolation from both family and friends and from friends only was associated with more depressive symptoms, and subjective social isolation from friends only was associated with higher levels of psychological distress. Discussion: Assessments of social isolation among older populations should account for both subjective and objective dimensions, as well as both family and friend social networks. Social isolation from friends is an important, but understudied, issue that has significant consequences for older adult mental health. [ABSTRACT FROM AUTHOR]

Objectives: We explored the links between chronic diseases and cognitive ability using datasets of community-dwelling older adults from Brazil, Chile, Mexico, and Uruguay from the SABE (Health, Well-Being, and Aging) survey. Methods: Ordinary least squares (OLS), Tobit and linear probability models, adjusting for extensive health and socio-demographic factors, were implemented separately for men and women and complemented by a series of robustness checks. Results: We find a negative association between the number of chronic conditions and cognitive decline that has the following characteristics: (a) differs across gender, (b) increases with the number of chronic conditions, (c) is larger among those individuals in the bottom of the cognitive distribution, (d) and is different across types of chronic conditions. Discussion: These results suggest that returns from preventive policies to reduce cognitive decline would increase if they were targeted to seniors with chronic conditions and implemented before the impact from multiple comorbidities makes the cognitive decline too steep to be reversed. [ABSTRACT FROM AUTHOR]

Objective: Disability declined in lower levels of impairment during the late 20th century. However, it is unclear whether ADL disability also declined, or whether it did so across race. In this study, we examine cohorts entering later life between 1984 and 1999, by race, to understand changing ADL disability. Method: We used latent class methods to model trajectories of ADL disability and subsequent mortality in the National Long-Term Care Survey among cohorts entering older adulthood (ages 65-69) between 1984 and 1999. We examined patterns by race, focusing on chronic condition profiles. Results: White cohorts experienced consistent declines in ADL disability but Blacks saw little improvement with some evidence for increased disability. Stroke, diabetes, and heart attack were predominant in predicting disability among Blacks. Discussion: Declining disability trends were only observed consistently among Whites, suggesting previous and future disability trends and their underlying causes should be examined by race. [ABSTRACT FROM AUTHOR]

Objective: This study examined factors associated with the self-reported change in health status as a result of caregiving. Method: Multinomial logistic regression were performed to examine the sociodemographic characteristics, care recipients’ characteristics, and caregiving experiences that affect caregivers’ perceptions of health affected by caregiving using data from 1,087 caregiver respondents in the Caregiving in the U.S. 2015 data set. Data were collected through an online or telephone survey of randomly selected adults in 50 states. Results: Worsened self-reported health with caregiving occurred for caregivers aged 50 to 64, racial/ethnic minorities, those who lived within 20 min of the care recipient’s home, the presence of cognitive deficits, prolonged caregiving, and limited availability of accessible and affordable care services. Importantly, the feeling of choice in taking on care responsibilities was associated with an over fourfold increase in the odds ratio (OR) of better health in response to caregiving (OR = 4.21; confidence interval [CI] = [1.95, 9.08]; p < .001). Discussion: Results suggest that improving accessibility of social service resources to assist caregivers in being better supported and having more choice in caregiving responsibilities may foster a positive change in health status with caregiving. [ABSTRACT FROM AUTHOR]

Objective: When examining the depressive symptoms of left-behind elderly, this article goes beyond a focus on disruption to traditional patterns of living arrangements and investigates the heterogeneities in the patterns of migration distance, as well as the role of community contexts in buffering the loss of migrant children's support. Method: This study uses the first wave of the China Health and Retirement Longitudinal Survey, and employs random effects multi-level modeling. Results: Having migrant children is associated with increased depressive symptoms among older adults, above and beyond living arrangements. Having their migrant children all live outside the province further puts older adults in disadvantaged mental conditions. This disadvantage can be further compounded by residence in impoverished communities. Discussion: In assessing depression among rural older adults in China, examination of living arrangements may be insufficient. It may be necessary to reference to children's migration status as well as community poverty levels. [ABSTRACT FROM AUTHOR]

Objectives: This study extends the field of retirement and health by examining the impacts of daily stressors on morning cortisol levels in 253 retirees between 55 and 75 years of age (M = 66.80, SD = 4.96) and the moderating roles of age and gender. Method: Participants derived from the second wave of the Daily Diary Study portion of the National Survey of Midlife Development in the United States (MIDUS-II). Across eight consecutive evenings, participants completed telephone interviews about their daily experiences and provided saliva samples across 4 days. Results: Findings from the multilevel models showed that in the context of navigating the day-to-day responsibilities, older retirees were at a greater risk for subsequent hypothalamic pituitary adrenal (HPA) dysregulation than younger retirees. Discussion: Together, better identification of the associations between daily stressors and physiological functioning will help contribute to the knowledge on ways to promote greater quality of life in retirement. [ABSTRACT FROM AUTHOR]

Objective: Systemic inflammation is an important risk factor for cardiovascular diseases and inequalities by race/ethnicity, gender, and education have been documented. However, there is incomplete knowledge as to how these disparities present across age, especially in late life. This study assesses whether differences in C-reactive protein (CRP), a marker of inflammation, are contingent on age among older persons. Method: Data are from the 2006/2008 Health and Retirement Study (n = 10,974) biomarker assessment. CRP was regressed on interactions between age and other status characteristics. Results: Racial/ethnic differences in inflammation do not vary significantly by age. However, gender and education differences are greatest at younger ages and then narrow steadily with increasing age. Discussion: There is considerable heterogeneity in how disparities in inflammation present across age and characteristics such as race/ethnicity, gender, and education. Understanding status differences in the influence of age on factors affecting late-life health is useful for health disparities research. [ABSTRACT FROM AUTHOR]

Objectives: While poor health contributes to early work exits, it is less clear how early work exits affect health. This study therefore examines changes in health associated with retirement. Method: Survey data from gainfully employed individuals aged 57 to 66 in 2002 were used to assess changes in health status and behaviors associated with retirement (49%) 5 years later (N = 546). Results: Compared with workers, retirees were more likely to report improvements in mental health (odds ratio [OR] = 1.67), and less likely to report mental health deteriorations (OR = 0.56). Retirees were more likely to both increase (OR = 2.03) and reduce (OR = 1.87) their alcohol intake, and to increase physical activity (OR = 2.01) and lose weight (OR = 1.75). Discussion: As welfare states aim to extend working life to counteract repercussions of population aging, findings on possible health benefits for retirees may warrant more focus on the pros and cons of a prolonged working life. [ABSTRACT FROM AUTHOR]

Objectives: Guided by the acknowledged importance of measures of aging alternative to chronological age, we explored the association between subjective age, on the one hand, and having grandchildren and provision of grandchild care, on the other, by gender and age groups. Method: Data from the Health and Retirement Study (HRS; N = 1,701 men and 2,395 women aged 50-85) and linear regression models were used to test two hypotheses. Results: Grandparents feel older than their grandchildless counterparts at younger ages, but such association is reversed in later life if they look after their grandchildren. A cumulative negative association between subjective age and both having grandchildren and providing grandchild care holds for older women. Discussion: This study extends prior research by examining age and gender differences in factors associated with subjective age. The findings suggest that grandparenthood is central in shaping the personal experience of aging. Future studies should address the causality of the factors analyzed. [ABSTRACT FROM AUTHOR]

Objective: The hostile-world scenario (HWS) denotes a personal belief system regarding threats to one’s physical and mental integrity. We examined whether the HWS predicted health among older adults. Method: The Israeli branch of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel) provided data on 1,286 participants, aged 50+, interviewed in two waves 4 years apart. A special measure assembled items pertinent to the HWS throughout the SHARE survey. Nine outcomes indicated physical health (e.g., activities of daily living, medical conditions) and mental health (e.g., depressive symptoms, satisfaction with life). Results: The HWS at Wave 1 predicted all physical and mental outcomes at Wave 2, except cognitive functioning, beyond effects of sociodemographics and the respective outcome’s baseline at Wave 1. This predictive effect was stronger among older participants. Discussion: The results support the conception of the HWS as a psychological monitor that senses approaching functional declines in later life. [ABSTRACT FROM AUTHOR]