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The article presents a framework of issues to consider when modifying measures of healthcare disparities for diverse populations including ethnic minorities, racially diverse and older populations. The study concluded that by calling attention to the importance of providing details, the hope is to promote better reporting in publications that use modified measures. The value of modifications in the ongoing evolution of concepts and measures in studies of minority aging is highlighted.

Objectives: Mexican Americans live longer on average than other ethnic groups, but often with protracted cognitive and physical disability. Little is known, however, about the role of cognitive decline for transitions in instrumental activities of daily living (IADL) disability and tertiary outcomes of the IADL disablement for the oldest old (after 80 years old). Methods We employ the Hispanic Established Populations for the Epidemiologic Study of the Elderly (2010–2011, 2012–2013, and 2016, N = 1,078) to investigate the longitudinal patterns of IADL decline using latent transition analysis. Results Three IADL groups were identified: independent (developing mobility limitations), emerging dependence (limited mobility and community activities), and dependent (limited mobility and household and community activities). Declines in cognitive function were a consistent predictor of greater IADL disablement, and loneliness was a particularly salient distal outcome for emerging dependence. Discussion These results highlight the social consequences of cognitive decline and dependency as well as underscore important areas of intervention at each stage of the disablement process. [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]

Objective: To characterize frailty phenotype in a representative cohort of older Americans and examine determinants of health factors. Methods: Retrospective analysis of data from 5,553 adults ≥60 years old in the 2011–2016 cross-sectional National Health and Nutrition Examination Survey (NHANES). World Health Organization " Determinants of Health " conceptual model was used to prioritize variables for multinomial logistic regression for the outcome of modified Fried frailty phenotype. Results: 482 participants (9%) were frail and 2432 (44%) prefrail. Four factors were highly associated with frailty: difficulty with ≥1 activity of daily living (77%; OR 24.81 p < 0.01), ≥2 hospitalizations in the previous year (17%, OR 3.94 p < 0.01), having >2 comorbidities (27%; OR 3.33 p < 0.01), and polypharmacy (66%; OR 2.38 p < 0.01). Discussion: A modified Fried frailty assessment incorporating five self-reported criteria may be useful as a rapid nursing screen in low-resource settings. These assessments can streamline nursing care coordination and case management activities, thereby facilitating targeted frailty interventions to support healthy aging in vulnerable populations. [ABSTRACT FROM AUTHOR]

Objectives: The prevalence of dementia has declined in the United States; how this parallels to changes in incidence and mortality, and how improvements in educational attainment may have influences these trends, is not known. Methods: Using the Health and Retirement Study (2000–2016), we estimated logistic regression models to examine trends in dementia prevalence and incidence, and mortality for those with and without dementia. Results: The relative decline was about 2.4% per year for dementia prevalence and 1.9% for dementia incidence. Mortality declined similarly for those with and without dementia. Improved educational attainment accounted for decline in incidence, some of the decline in prevalence, and had a negligible role in mortality. Discussion: The declines in dementia incidence provide evidence that dementia prevalence should continue to decline in the near future. These declines are most likely largely driven by continued improvements in older adult education. [ABSTRACT FROM AUTHOR]

Objectives: We investigate whether obesity accounts for widening socioeconomic disparities in pain. Methods: Based on nationally representative samples of Americans aged 25–74 in 1995–1996 and 2011–2014, we use logistic regression to model period change in headaches, backaches, and joint aches as well as physical limitations and to determine whether those changes vary by a multidimensional measure of socioeconomic status. Results: Prevalence of backaches, joint aches, physical limitations, and obesity increased between the mid-1990s and the early 2010s, particularly among more disadvantaged Americans. Socioeconomic disparities in frequent backaches, frequent joint pain, and physical limitations more than doubled over this period. We estimate that obesity and health conditions may account for nearly a quarter of the widening disparity in frequent backaches and about half of the widening disparity in frequent joint pain and physical limitations. Discussion: Widening disparities in backaches, joint pain, and physical limitations have coincided with growing obesity. [ABSTRACT FROM AUTHOR]

Objectives: To examine the association between education and mortality by age and gender in Chile. Methods: We drew data from 10,147 adults aged 40 years and over from the Chilean Social Protection Survey linked to the national death records. We specify five Cox regression models to estimate the main and interaction effects for education levels, age, sex, and mortality. Results: The hazard ratios reduce with increasing education. Secondary and tertiary education levels are associated, respectively, with 34% and 41% lower hazard rates than 0–4 years of schooling. Also, the educational gradient in mortality is significantly weaker at older ages, and it does not differ by gender. Discussion: Our findings endorse the negative association of formal education with adult mortality, uncovering Chile's structural problems despite the economic improvements underway. It also corroborates the importance of novel longitudinal data for mortality analyses in Latin America. [ABSTRACT FROM AUTHOR]

Objectives: We profiled the health and health services needs of a sample of older adult women (age 50+) with criminal–legal system (CLS) involvement and compared them with younger women (age 18–49), also CLS-involved. Methods : Using survey data collected from January to June 2020 from adult women with CLS involvement in three US cities, we profiled and compared the older adult women with younger women on behavioral and structural risk factors, health conditions, and health services access and use. Results: One-third (157/510) were age 50+. We found significant differences (p <.05) in health conditions and health services use: older women had more chronic conditions (e.g., hypertension and stroke) and more multimorbidity and reported more use of personalized care (e.g., private doctor, medical home, and health insurance). Discussion: Although older women with CLS involvement reported good access to health services compared with younger women, their chronic health conditions, multimorbidity, and functional declines merit attention. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether the association between non-spousal support and mortality risk differs by marital status. Methods: Using data from the National Social Life, Health, and Aging Project (N = 2460), we estimate a series of logistic regression models to assess how non-spousal support moderates the relationship between marital status and mortality across a 5-year period. Results: Never married respondents who had minimal perceived access to non-spousal support had a greater probability of death compared to married respondents with similar levels of non-spousal support. The disparity in mortality risk between these two groups disappeared when non-spousal support was high. Discussion: Although family and friends play an important role in mortality risk in later life, these findings suggest that never married older adults exhibit a heightened dependence on support from non-spousal sources. Future research and policies should explore ways in which never married older adults can be integrated into a supportive social environment. [ABSTRACT FROM AUTHOR]

Objective: As HIV shifts from "death sentence" to "chronic condition," disclosure of HIV status to intimate partners and family is a significant component of both prevention and treatment adherence. While disclosure is closely considered in many studies, few examine middle-aged and older persons' (age 40+) perspectives or practices. We trace older rural South Africans' views on HIV disclosure to their partners and family members in a high prevalence community over a period of extensive antiretroviral treatment (ART) rollout. Methods: Community focus group discussions (FGD) conducted in 2013 and 2018 show shifts in older persons' thinking about HIV disclosure. Findings: Our FGD participants saw fewer negative consequences of disclosure in 2018 than in 2013, and highlighted positive outcomes including building trust (partners) as well as greater support for medication collection and adherence (family). Discussion: Particularly as the epidemic ages in South Africa and globally, tracing changes in older persons' views on disclosure is an important step in developing messaging that could enhance treatment as prevention and ART adherence. [ABSTRACT FROM AUTHOR]

Objectives: This study longitudinally examined how older adult cancer survivors perceive disability in activities of daily living over time compared to older adults who have not had cancer. Methods: This was a secondary analysis of the National Health and Aging Trends Study examining participants with a new cancer diagnosis and age-, gender-, and comorbidity-matched comparison participants without a history of cancer. Generalized linear mixed models examined time and group interaction and main effects in disability. Results: There was a significant main effect of time (F 4,771 = 12.81; p <.0001) demonstrating increasing disability levels for both groups. There were significant group differences, with higher disability in the cancer group than the comparison group (β = 0.628, SE = 0.263; t = 2.39, p = 0.017). Discussion: Although perceived disability was greater immediately following cancer diagnosis, older adult cancer survivors and comparison participants appear to have similar perceived disability over time. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated special education as an indicator of childhood disability and used that indicator to estimate lifetime dependency and life expectancy. Methods: Data: Panel Study of Income Dynamics and Health and Retirement Study (n = 20,563). Dependency: Nursing home care or equivalent. Analysis: We first analyzed special education as an indicator of childhood disability; multinomial logistic Markov models and microsimulation then compared populations with and without childhood disability. Results: Special education history was a valid indicator of childhood disability. For example, with parents who did not complete high school, 3.8% with no special education history were dependent at least 5 years of adult life; that result with special education was 15.2%. Life expectancy from age 20 was 58.3 years without special education, 46.0 years with special education (both p <.05). Discussion: Special education history can indicate childhood disability. People with that history had significantly a more dependency than others and significantly shorter lives. [ABSTRACT FROM AUTHOR]

Objectives: This study explores the effects of the Active Plus intervention aiming to decrease loneliness among older adults (>65 years) with chronic diseases. Methods: A randomized controlled trial (RCT) was performed (N = 585; age: M = 74.5 years, SD = 6.4), assessing loneliness at baseline, 6 months and 12 months. Outcome measures in the multilevel linear regression analyses were total, social and emotional loneliness. Results: At 12 months, significant decreases in total (B = −.37, p =.01) and social loneliness (B = −.24, p =.02) were found. Age was a significant moderator for total and social loneliness; however, the intervention was effective only for participants aged 80 years and older. Discussion: The Active Plus intervention showed a significant decrease in total and social loneliness and was especially beneficial for the vulnerable age group of 80 years and older. A more comprehensive tool for measuring social activity and mobility impairments, and using a longer time frame to detect loneliness changes, may form interesting future research. [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: We investigated the risk factors associated with toileting disability among older adults in China, focusing on environmental factors (physical, social, and external supports). Methods: Data were drawn from the WHO's SAGE wave 1. We proposed a conceptual framework to guide the selection of risk factors, and implemented logistic regressions separately for urban and rural subpopulations. Results: In both subsamples, older adults who relied on assistive devices were about three times more likely to be toileting-disabled. Rural residents using non-flush toilets were 1.94 more likely to have difficulty toileting than those using flush system toilets. Sharing toilets and did not feel safe in homes were also positively associated with toileting disability. For urban residents, low neighborhood trust was weakly predictive of higher odds of toileting disability. Discussion: This study highlights the importance of environmental factors in explaining toileting disability, and the potential for related policy interventions in developing countries. [ABSTRACT FROM AUTHOR]

Objectives: Sensory loss may be a barrier to accessing healthcare services, and this study seeks to examine the association of sensory loss with whether older adults report having a usual source of health care. Methods: Our study included 7548 older adults who participated in the National Health and Aging Trends Study in 2015. Having a self-reported usual source of health care was our outcome, and hearing and vision loss were our primary independent variables. Results: In multivariate analysis accounting for demographics, socioeconomic, health status, and environmental covariates, near vision loss but not distance vision or hearing loss was associated with decreased odds of having a usual source of health care. Discussion: That older adults with near vision loss were less likely to report having a usual source of health care is concerning. Examining barriers to care is needed to identify sensory loss-relevant processes to optimize and intervene upon. [ABSTRACT FROM AUTHOR]

Objective: Hearing loss is associated with higher health expenditures and poor healthcare utilization. This study aims to build on these findings by characterizing the association between hearing status and healthcare-seeking behaviors among Medicare beneficiaries. Methods: Cross-sectional log-binominal regression was used to assess the association between self-report hearing and healthcare-seeking behaviors (avoidance or delay of care, personal health concerns, and sharing health status) using the 2016 Medicare Current Beneficiary Survey (N = 12,140). Results: Beneficiaries with trouble hearing had significantly higher risks of avoiding and delaying health care compared to those without trouble hearing. Conversely, trouble hearing was not associated with concern for health status or sharing health status. Discussion: These findings may help explain higher costs associated with hearing loss as avoidance of care can exacerbate health problems. Further work is needed to understand underlying causes and whether addressing hearing loss modifies the observed association. [ABSTRACT FROM AUTHOR]

Objective: The current study examined the association between role stress and using food to cope with stress in midlife women and examined sense of control as a potential underlying mechanism. Methods : An archival analysis was performed using data from 638 midlife women from the Midlife in the United States II study. Results: Hierarchical linear regression analyses demonstrated that work stress (β =.180, p <.001) and family stress (β =.138, p <.05) significantly predicted using food to cope with stress. Sense of control was a significant mediator between work stress and using food to cope with stress (b = 0.02, 95% CI [.0014,.0314]). Discussion: Midlife women with higher role stress related to work and family are more likely to use food to cope with stress, and sense of control seems to be the link between work stress and using food to cope. [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: Socialization predicts cognitive aging outcomes. Neighborhoods may facilitate socially engaged aging and thus shape cognition. We investigated places where older adults socialized and whether availability of these sites was associated with cognitive outcomes. Methods: Qualitative analysis of interviews and ethnography with 125 older adults (mean age 71 years) in Minneapolis identified where participants socialized outside of home. This informed quantitative analysis of a national sample of 21,151 older Americans (mean age at baseline 67 years) from the Reasons for Geographic and Racial Differences in Stroke study. Multilevel generalized additive models described associations between access to key social places and cognitive function and decline. Results: Qualitative analysis identified eateries, senior centers, and civic groups as key places to socialize. We identified significant positive associations between kernel density of senior centers, civic/social organizations, and cognitive function. Discussion: Specific neighborhood social infrastructures may support cognitive health among older adults aging in place. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "When older adults experience more limitations than would be expected based on performance tests, the literature typically refers to this as "overestimation," whereas the opposite is referred to as "underestimation" which appeared in the previous issue.

Objectives: Commentaries have suggested that initial emphasis on the higher susceptibility and mortality rates of older adults to COVID-19 has instigated ageism within the public discourse and policy decisions. Using the health belief model, the current study examined ageism in interaction with other factors influencing intention to social distance. Methods: Threat of contracting COVID-19, benefits and barriers to social distancing, benevolent and hostile ageism, and intention to social distance were examined in 960 adults (M = 37.81 years, SD = 11.65). Results: Benevolent and hostile ageism were significant moderators for both perceived threat and barriers on intent to social distance; hostile ageism also moderated benefits on intent to social distance. Discussion: The current study demonstrates how ageism influences behavior during a pandemic. With initial reports of COVID-19 presenting older adults as a homogenous group, ageism negatively interacted with intention to social distance and may place older adults at greater risk. [ABSTRACT FROM AUTHOR]

Objectives: Framed within a life course perspective and cognitive reserve theory, this study examined the mediating role of educational attainment for the association between child–parent relationships during childhood and cognitive function among older adults in rural China. Methods: Data were obtained from three waves of the China Health and Retirement Longitudinal Study (N = 9809). We employed latent growth curve modeling to test the association among early child–parent relationship quality, educational attainment, and cognitive function in later life. Results: Early child–mother relationship quality was associated with the level and change in cognitive function. Early child–father relationship quality was only related to baseline cognitive function. Educational attainment mediated the relationship between early child–parent relationship quality with mothers and fathers and cognitive function. Discussion: Parental relationship experience in childhood was one distal factor related to cognitive function among older adults. The findings supported the long-term impacts of childhood conditions for later life health consequences. [ABSTRACT FROM AUTHOR]

Objectives: A wealth of literature has established risk factors for social isolation among older people; however, much of this research has focused on community-dwelling populations. Relatively little is known about how risk of social isolation is experienced among those living in long-term care (LTC) homes. We conducted a scoping review to identify possible risk factors for social isolation among older adults living in LTC homes. Methods: A systematic search of five online databases retrieved 1535 unique articles. Eight studies met the inclusion criteria. Results: Thematic analyses revealed that possible risk factors exist at three levels: individual (e.g., communication barriers), systems (e.g., location of LTC facility), and structural factors (e.g., discrimination). Discussion: Our review identified several risk factors for social isolation that have been previously documented in literature, in addition to several risks that may be unique to those living in LTC homes. Results highlight several scholarly and practical implications. [ABSTRACT FROM AUTHOR]

Objectives: This study compares the associations of two subjective lifetime perspectives, subjective age (SA) and subjective life expectancy (SLE), with physical performance, self-rated health, and depressive symptoms. Methods: 64 91-year-old participants were selected from three waves of the Longitudinal Aging Study Amsterdam (2008/09, 2011/12, 2015/16; n = 1822 participants, n = 3500 observations) that included graphical and numerical measures of SA and SLE. We used generalized estimating equations to examine their associations with health. Results: Associations of SA/SLE with health were weaker for physical performance than for self-rated health and depressive symptoms. The associations of SA and SLE with physical performance were of similar magnitude but with self-rated health depended on the type of measure. Depressive symptoms, instead, showed a stronger association with SA than with SLE. Graphical measures showed weaker associations than numerical measures. Discussion: The way in which subjective lifetime perspectives and health are conceptualized and measured influences the strength of their associations. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has exerted a disproportionate effect on older European populations living in nursing homes. This article discusses the 'fatal underfunding hypothesis', and reports an exploratory empirical analysis of the regional variation in nursing home fatalities during the first wave of the COVID-19 pandemic in Spain, one of the European countries with the highest number of nursing home fatalities. We draw on descriptive and multivariate regression analysis to examine the association between fatalities and measures of nursing home organisation, capacity and coordination plans alongside other characteristics. We document a correlation between regional nursing home fatalities (as a share of excess deaths) and a number of proxies for underfunding including nursing home size, occupancy rate and lower staff to a resident ratio (proxying understaffing). Our preliminary estimates reveal a 0.44 percentual point reduction in the share of nursing home fatalities for each additional staff per place in a nursing home consistent with a fatal underfunding hypothesis. [ABSTRACT FROM AUTHOR]

Objective: To examine whether the effect of population aging on healthcare expenditures as a share of Gross Domestic Product (GDP) is attenuated in more educated countries. Method: The analysis is based on a dataset of 22 Latin American countries between 1995 and 2013. We estimate panel data models with country and time fixed effects, and control for potential nonlinear effects of population aging on health expenditure. Results: We find population aging increases health expenditure as a share of GDP in economies characterized by low levels of education, but this effect is mitigated in economies with higher levels of education. Results are driven by private health expenditures. Discussion: Results suggest population aging and education have a stronger influence on healthcare expenditures in less developed countries. This finding is important in a context in which the rapid growth of the aging population is likely to lead to significant costs in terms of health expenditures, but less so in more educated societies. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated the predictors of risk perception and its effect on older adults' preventive behavior and/or medical care avoidance during the COVID-19 pandemic. Methods: Older respondents (age >50 years) from the MIT COVID-19 Preventive Health Survey reported their social distancing, hand washing, mask wearing, and medical care avoidance between July and October 2020 (n = 4395). Structural equation models were used. Results: Significant predictors of higher risk perception were female gender, older age, poorer health, city residency, personally knowing someone who had COVID-19, and correct knowledge of vaccine/treatment. Higher risk perception was subsequently associated with higher frequency/probability of practicing preventive behavior and/or avoiding medical care. Knowledge had the strongest path coefficient with risk perception. Discussion: Disseminating correct information to older adults could help them evaluate infection risk accurately. Educational programs on the precautions implemented at clinical settings to ensure patient safety may encourage older adults to seek timely medical care. [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: Volunteering is associated with positive well-being among older people, providing opportunities to stay active and socially connected. This may be especially relevant for older lesbian and gay people, who are less likely than heterosexual people to have a partner, children or support from their family of origin. Methods: Patterns of volunteering and mental, physical and social well-being were examined in a sample of 754 lesbian and gay adults in Australia aged 60 years and older who completed a nationwide survey. Results: Volunteers reported greater positive mental health than non-volunteers. Among the gay men, volunteers additionally reported higher self-rated health and social support and lower psychological distress. Both the lesbian women and gay men who volunteered for lesbian, gay, bisexual, transgender or intersex (LGBTI) organisations also reported greater LGBTI community connectedness than volunteers for non-LGBTI organisations. Discussion: These findings provide further insight into potential factors associated with the well-being of older lesbian and gay adults. [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]

Objectives: To examine racial differences in respite utilization among a nationally representative sample of caregivers for persons living with dementia (PLwD). A secondary aim identified factors associated with respite utilization. Methods: Using data from the 2015 National Health and Aging Trends Study and National Study of Caregiving, we conducted binary logistic regression to examine racial difference in respite use among Black and white caregivers (n = 750). Results: 22% of the sample used respite for PLwD. Black dementia caregivers were 69% less likely (odds ratio: .31, p = .001) to use respite compared to white caregivers. Other factors associated with utilization included education, receiving help with caregiving, and providing care for more self-care/mobility tasks or to a Medicaid-enrollee.Discussion: Findings suggest that Black dementia caregivers may be at risk for less frequent use of respite and highlight the need to identify factors that promote respite use. [ABSTRACT FROM AUTHOR]

Objective: To examine whether we live healthier as we live longer in Hong Kong, which has one of the highest life expectancies in the world. Methods: Sullivan's method was used to evaluate the chronic disease--free life expectancy (CDFLE), life expectancy in good self-perceived health (GPHLE), and impairment-free life expectancy (IFLE) among population aged 50 years and older in Hong Kong in 2007--2016. Results: In spite of the marked improvement in life expectancy in Hong Kong, the increase in GPHLE was much smaller, while CDFLE and IFLE even declined for both genders. The situation was more severe among older population. Discussion: People in Hong Kong live longer but with worsening health. The expansion of chronic diseases, self-perceived poor health, and impairments among older adults calls for more fiscal investments, government attention, and public health policies. [ABSTRACT FROM AUTHOR]

Objectives: To describe the prevalence of bathroom modifications, clutter, and tripping hazards in the homes of US older adults and to examine changes after an incident fall. Methods: We used data from the 2015--2017 National Health and Aging Trends Study (n = 7499). Outcomes were the prevalence of bathroom modifications, clutter, and tripping hazards and changes after incident fall. Results: In 2015, 26.5% of community-dwelling older adults had clutter or tripping hazards in the home, and 69.3% had at least one bathroom modification. Compared to nonfallers, older adults with multiple falls were significantly more likely to modify the bathroom. The magnitude of hazard reduction was similar after multiple falls but was not statistically significant. Discussion: Bathroom modifications are common and increase after multiple falls. A single incident fall does not appear to lead to home environment changes to reduce fall risk. Targeting home hazards may be an opportunity to reduce fall risk. [ABSTRACT FROM AUTHOR]

Objectives: We examined functional, social, and health needs and service delivery gaps among a geographically expansive and economically diverse population of older adults to identify service priorities. Methods: We conducted analyses based on 1280 respondents aged 60 years and older surveyed for an 8-county needs assessment. Results: We identified three distinct risk profiles using two-step cluster analysis. ANOVA and chi-square analyses revealed significant differences between risk profiles on a range of health and social service needs. Discussion: Identifying high-risk residents can support community providers' efforts to help older adults age in place. Community-based organizations are well-positioned to respond early to social determinants of health needs. Targeting services and supports that reduce risk, extend independence, and prevent avoidable adverse healthcare situations to improve health and achieve health equity among historically underserved and hard-to-reach populations and prioritizing low-cost community interventions can reduce the need for high-cost interventions (e.g., emergency care and hospitalizations). [ABSTRACT FROM AUTHOR]

Objectives: Alcohol consumption and harms among older people are increasing. We examined different demographic characteristics and drinking patterns among an older population. Methods: Secondary analyses of nationally representative Australian data; subjects aged 50+ years (N = 10,856). Two-step cluster analysis was performed to identify demographic groups and alcohol consumption behaviours. Results: Three groups were identified: Group 1 (older, unmarried, and lived alone): >65 years, moderate drinkers, poorest health, psychological distress, social disadvantage, smokers, illicit drug users, and more frequent previous alcohol treatment. Group 3 (older married): >65 years, good health, low psychological distress, less likely to drink at risky levels, and one in five drank daily. Group 2 (younger married): 50--64 years, mostly employed, highest proportion of risky drinkers and of 5+ standard drinks per session, and liberal drinking attitudes with most concern from others about their drinking. Discussion: These demographic typologies can inform targeted prevention efforts for an estimated 1.3 million adults older than 50 years drinking at risky levels. [ABSTRACT FROM AUTHOR]

Objectives: By 2050, individuals aged 65 years and older will comprise over 20% of the American population. A portion is at risk for becoming elder orphans: older adults living in the community who lack caregivers or surrogates. Methods: Using the first wave of the National Health and Aging Trends Survey, we estimated the prevalence of older adults who reside in the community, who are socially or physically isolated, and who lack caregivers. Individuals who are "at risk" meet all of these criteria, with the exception that they live with and receive caregiving from their spouse. Results: We estimated the elder orphan prevalence for this population to be 2.62% (2.24--3.00), with an additional 21.29% determined to be at risk. Discussion: As the population of the United States ages, an understanding of the prevalence and demographics of elder orphans will be useful to guide policies and services to assist this population. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between functional status and post-acute care (PAC) transition(s). Methods: Secondary analysis of 2013-2014 Medicare data for individuals aged ≥66 years with stroke, lower extremity joint replacements, and hip/femur fracture discharged to one of three PAC settings (inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies). Functional scores were co-calibrated into a 0--100 scale across settings. Multilevel logistic regression was used to test the partition of variance (%) and the probability of PAC transition attributed to the functional score in the initial PAC setting. Results: Patients discharged to inpatient rehabilitation facilities with higher function were less likely to use additional PAC. Function level in an inpatient rehabilitation facility explained more of the variance in PAC transitions than function level while in a skilled nursing facility. Discussion: The function level affected PAC transitions more for those discharged to an inpatient rehabilitation facility than to a skilled nursing facility. [ABSTRACT FROM AUTHOR]

Objectives: Many medications have cognitive impairment, memory loss, amnesia, or dementia as side effects ("cognitive side effects" hereafter), but little is known about trends in the prevalence of these medications or their implications for population-level cognitive impairment. Method: We use data from the National Health and Nutrition Examination Survey (1999–2016) to describe trends in the use of medications with cognitive side effects among adults aged 60+ (N = 16,937) and their implications for cognitive functioning (measured using word learning and recall, animal fluency, and digit symbol substitution assessments). Results: Between 1999 to 2000 and 2015 to 2016, the prevalence of older adults taking one, two, and at least three medications with cognitive side effects increased by 10.2%, 57.3%, and 298.7%, respectively. Compared to non-users, respondents who simultaneously used three or more medications with cognitive side effects scored 0.22 to 0.27 standard deviations lower in word learning and recall (p =.02), digit symbol substitution (p <.01), and the average standardized score of the three assessments (p <.001). Limitation: Dosage of medications associated with cognitive side effects was not measured. Discussion: Concurrent use of medications with cognitive side effects among older adults has increased dramatically over the past two decades. The use of such medications is associated with cognitive impairment and may explain for disparities in cognitive function across subgroups. These findings highlight the need for cognitive screenings among patients who consume medications with cognitive side effects. They also highlight the synergic effects of polypharmacy and potential drug-drug interactions that result in cognitive deficits. [ABSTRACT FROM AUTHOR]

Objectives: To examine the association between informal caregiving and caregiver work performance. Method: A systematized review of the literature. Results: We found that caregiving has an adverse impact on work performance: caregivers experience substantial work disruptions and negative work performance outcomes, and these findings were consistent across measures. Our synthesis suggests that caregivers miss a significant amount of work and have reductions in productivity due to their caregiving responsibilities. However, significant methodological limitations with the reviewed studies make systematic interpretations and causal determinations challenging. Discussion: Examining the effect of caregiving on work performance is critical to better understand the full impact of caregiving, especially as demand for caregivers increases as the population ages. This comprehensive review suggests that caregiving has a significant negative impact on work performance, although methodological challenges remain in this area of science. These findings should inform both public policy development and workplace benefits design. [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 model the relationship between loneliness and sleep disturbance over time. Method : Data came from the Health and Retirement Study (2006, 2010, 2014 waves; age ≥ 65 years; n = 5,067). Loneliness was measured via the Hughes Loneliness Scale and sleep disturbance via a four-item scale assessing sleep and restedness. Cross-lagged panel modeling (path analysis) was used to jointly examine reciprocal effects between loneliness and sleep disturbance. Results : Higher loneliness correlated with higher sleep disturbance at baseline. There was evidence of reciprocal effects between loneliness and sleep across timepoints. These associations overall remained when accounting for demographics, objective isolation, and depression. Discussion : Although causality cannot be established, the findings indicate that the relationship between loneliness and sleep disturbance is bidirectional. This requires revision to the current theory on sleep disturbance as a mechanism for the relationship between loneliness and health and indicates that effective treatment of sleep disturbance may reduce loneliness. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the link between neighborhood social cohesion, disorder, and physical function in older adults, and identified potential racial/ethnic differences in these associations. Method: Data come from the National Health and Aging Trends Study (NHATS; N = 5,619). A series of linear regression models were used to predict physical function. Subgroup analyses and neighborhood/race interactions were used to examine differences. Results: Neighborhood disorder was associated with poorer physical function (p <.05), while neighborhood cohesion was not (p =.06). Although tests of interactions were not significant, subgroup analyses showed that neighborhood disorder, and not social cohesion, was associated with poorer physical function only in Whites. Discussion: Disadvantaged neighborhood social environment may contribute to differences in physical function among older adults. Racial and ethnic differences warrant closer investigation in studies of neighborhoods and functional health. [ABSTRACT FROM AUTHOR]

Objective: We sought to determine whether daily protein intake and protein distribution across eating occasions were associated with functional disability in a national sample of older Americans. Methods : Data from 8,070 adults aged ≥60 years from the 2007-2016 waves of the National Health and Nutrition Examination Survey were included. Protein intake and functional capacity was self-reported. A daily protein recommendation of ≥1.0 g/kg/day was utilized. The daily protein recommendation was then spread-out across four meals, whereby a ≥0.25 g/kg/meal threshold was used. Results : Those meeting the daily protein recommendation had 0.78 (95% confidence interval [CI] = [0.65, 0.93]) decreased odds for functional disability. Persons meeting the protein intake threshold per eating occasion for one, two, three, and four occasions had 0.60 (CI = [0.38, 0.95]), 0.48 (CI = [0.30, 0.77]), 0.47 (CI = [0.29, 0.77]), and 0.39 (CI = [0.20, 0.75]) decreased odds for functional disability, respectively. Discussion : Protein consumption seems to be important for preserving function in older Americans. [ABSTRACT FROM AUTHOR]

Objective: Geriatricians are skilled in the recognition of asymptomatic and atypical presentations that occur in the elderly and provide comprehensive medication management including recognizing adverse drug events, reducing polypharmacy, and de-prescribing. However, despite the increasing average age of the U.S. population, with the number of individuals above 65 years old predicted to increase 55% by 2030, the geriatric workforce capacity in the United States has actually decreased from 10,270 in 2000 to 8,502 in 2010. Method: We describe physiologic changes in older adults, historical trends in geriatric training, and propose solutions for this looming crisis. Results: Many factors are responsible for the shortage of skilled geriatric providers. Discussion: We discuss the historical context of the lack of geriatricians including changes to the training system, describe the impact of expert geriatric care on patient care and health system outcomes, and propose methods to improve recruitment and retention for geriatric medicine. [ABSTRACT FROM AUTHOR]

Objectives: While online health information (OHI) has become ubiquitous, little is known about its use by middle-aged and older adults. This contribution examines the role of OHI and its influence on the patient–physician relationship. Method: This qualitative study reports the thematic analysis of 40 semistructured, in-depth interviews with Flemish middle-aged and older adults between the ages of 50 and 80 years. Results: Middle-aged and older adults obtain OHI pre- and post-consultation, albeit with different motivations and in search of different types of information. Patients strategically and carefully introduce OHI in the clinical encounter. "Doctor Google" expands the traditional patient–physician dyad into an information triangle. Discussion: The findings have implications for policy guidance and clinical practice. Public campaigns against "Googling" for health information might have to be amended to be successful. Importantly, physicians are increasingly expected to refer to and appraise OHI and put it into the individual patient context. [ABSTRACT FROM AUTHOR]

Objective: Our article aims to investigate changes in the rate of informal care provision, which occurred in Israel and Italy in the last decade. In addition, we analyze typology and magnitude of the main factors contributing to explain the probability of providing informal care. Method: We used data from the Survey of Health, Ageing and Retirement in Europe (SHARE) at two selected time points (2006/2007 and 2015). Results: The probability of offering social support to elder family members who live outside the household has been trending down substantially over the years. The likelihood of providing unpaid care is significantly higher when one performs volunteer or charitable work and/or engages in leisure activities, and the importance of these two variables has been growing over the years. Discussion: Israel and Italy have experienced over the years a remarkable decline in the share of older adults providing informal care. The article helps to identify which factors have been associated with this phenomenon. [ABSTRACT FROM AUTHOR]