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Objective: This study investigated the impact of driving cessation on social isolation in older adults. Method: Data were obtained from Rounds 1 through 6 of the National Health and Aging Trends Study. The study sample consisted of 6,916 Medicare beneficiaries aged 65 or above who were eligible drivers at baseline. Mixed-effects ordered logistic regression and piecewise regression were used to examine the impact of driving cessation on social isolation. Results: In multivariable mixed-effects ordered logistic regression, past-year nondrivers had a twofold increase in the odds of being in a higher social isolation category (odds ratio [OR] = 2.1, p <.001). Piecewise regression analysis showed that social isolation scores increased by 0.08 points (p =.024) following an incident of driving cessation. Discussion: Driving cessation is associated with a higher risk of social isolation in older adults. Interventions to reduce social isolation among older adults may improve public health by targeting older adults who have recently stopped driving. [ABSTRACT FROM AUTHOR]

Objective: The objective of this review is to outline a comprehensive set of possible design interventions focusing on spatial and environmental design factors influencing positive social interaction, which is one of the key aspects of quality of life (QoL) in long-term care facilities (LTCFs). Methods : This systematic literature review synthesized research evidence from seven databases (after the year 2000) spanning medical and health literature, environmental psychology, architecture, interior design, and evidence-based design literature. Results : The key spatial design characteristics of the facilities shown to affect positive social interaction were as follows: (a) The Physical Environment and Setting; (b) Accessibility, Legibility, and Layout; (c) Social Environment and Network; and (d) Staff–Resident Ratio and Care Philosophy. Conclusion : Several critical spatial design features of the facilities were identified. Spatial design interventions could influence the design decisions for future care facilities and provide designers the guidelines that are generalizable regardless of geographic location of the LTCF. [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: This study evaluated the effect of a community-wide walking intervention (involving walking maps and events) on older residents' walking and environmental perceptions. Method: In this nonrandomized quasi-panel study, older adults living in an intervention and control site were recruited at baseline and follow-up. All households in the intervention site received maps and were invited to participate in a walking event monthly. The intervention lasted for 21 months. The outcomes were walking frequency, duration, and perceptions of local environments. Results: We did not find a significant improvement in walking frequency or duration in the intervention site relative to the control site. However, there was a significant increase in the awareness of others being active and a marginal increase in the perception of aesthetics in the intervention site. Discussion: The increased awareness of others being active may be a positive step in the stages of change toward engagement in physical activity. [ABSTRACT FROM AUTHOR]

Objectives: As the homeless population ages, it is imperative to improve access to advance care planning (ACP) and document preferences in case medical decision-making capacity is lost. Methods: We implemented an ACP Project to discuss and document advance care plans with all patients aged 45 and older who received primary care at our adult Homeless Program clinics. Results: Over 14 months, ACP was discussed with 48% (n = 138) of the population and health care proxy (HCP) appointment with 91% (n = 125) of these patients. Most (62%; n = 77) appointed a HCP from personal relationships, though a significant minority (38%; n = 48) could not and were considered "surrogateless." End-of-life preferences varied. Approximately 20% of patients wanted to defer to a surrogate for each decision. Discussion: ACP is feasible in primary care for adults who have experienced homelessness and should be incorporated into routine care. [ABSTRACT FROM AUTHOR]

Objective: This research investigates the associations between smoking frequency and body mass index (BMI) among older adults in China with and without the inclusion of food consumption behaviors. Method: Applying three waves of the Chinese Longitudinal Healthy Longevity Survey (2009, 2012, and 2014), with 12,312 observations from 4,104 participants, gender-stratified panel ordered logistic regressions were performed. Food consumption included intake frequency and types of fruits, vegetables, staple food, cooking oil, and meat. Results: Among male older adults, more frequent smoking behavior was associated with lower BMI with the inclusion of food consumption behaviors. However, more frequent smoking behavior was not associated with BMI among female participants with the inclusion of food consumption behaviors. Former smoking status was not associated with BMI in all models. Discussion: The findings suggest the need of food consumption behaviors when researchers study the associations between smoking frequency and obesity. Gender gaps also should be considered. [ABSTRACT FROM AUTHOR]

Objective: To assess whether unhealthy behaviors moderated the relationship between allostatic load (AL) and future significant depressive symptoms (SDSs) among 1,789 older Latinos. Method: Longitudinal data included baseline AL, three unhealthy behaviors (UBs), and 2-year follow-up SDS. Multivariable logistic regression analyses, stratified by birthplace (U.S. vs. foreign born), modeled the effects of AL, UB count (range = 0-3), and their interaction on follow-up SDS. Results: Compared with U.S.-born, foreign-born participants engaged in fewer UBs (0.52 vs. 0.60 behaviors, p =.01) and had higher baseline SDS (31% vs. 20%, p <.001). Among foreign-born participants, the effect of AL on future SDS (adjusted odds ratios [aORs]; 95% confidence interval [CI]) significantly increased across UB counts of 0 to 3: 1.06 [0.83, 1.35], 1.46 [1.14, 1.87], 2.00 [1.18, 3.41], and 2.75 [1.18, 6.44], respectively. Discussion: Among foreign-born Latinos, these results were most pronounced for women and adults above age 80, which may represent higher risk groups requiring more intensive screening for depression. [ABSTRACT FROM AUTHOR]

Objective: To examine how neighborhood-based cognitive and structural social capital are associated with individual quality of life among a sample of community-dwelling older adults in Singapore. Method: Using survey data from 981 older adults (aged 55 years and above) in nine residential neighborhoods, multilevel models simultaneously estimated the effects of independent variables at the individual and neighborhood levels on quality of life (CASP-12). Results: Social cohesion (β = 1.39, p <.01) and associational membership (β = 19.16, p <.01) were associated with higher quality of life in models adjusted for neighborhood facilities and individual sociodemographics, social networks, functional limitations, global cognitive status, and medical conditions. Discussion: The results suggest that place-based or neighborhood social capital may be important for older person's well-being. It identifies the contribution of structural (associational membership) and cognitive (social cohesion) social capital to the well-being of community-dwelling older adults in Singapore. [ABSTRACT FROM AUTHOR]

Objective: The objectives of this study were (a) to assess the nature and extent of racial disparities in cognitive functioning among older adults in Canada, and (b) to assess the role of socioeconomic factors and patterned health behaviors as social determinants of racial disparities in cognitive functioning. Method: Data were drawn from the 2009-2010 Canadian Community Health Survey. The study sample included 20,646 people aged 60 years or older. Ordered logistic regression analyses were carried out to test hypotheses linking race, socioeconomic factors, and patterned health behaviors, and cognitive functioning. Results: Our findings revealed a racial gap in cognitive functioning among older adults in Canada. This gap was, in part, mediated by socioeconomic inequalities (in income and food security) and socially patterned behaviors (i.e., drinking, physical activity levels). However, socioeconomic status (SES) and behavioral factors appeared to operate independently of one another. Discussion: The findings suggest a need to focus on the direct effects of race as well as its indirect effects, through socioeconomic factors and patterned health behaviors, for an understanding of racial disparities in cognitive functioning. [ABSTRACT FROM AUTHOR]

Objective: This study examined the trajectories of depressive symptoms and associated factors in older adults using an enhanced group-based trajectory modeling. Method: The study sample consisted of 7,573 adults aged ≥65 years from the National Health and Aging Trends Study (Rounds 1-7). Depressive trajectories were estimated using a group-based trajectory modeling accounting for nonrandom attrition. Results: A four-trajectory model including "persistently low" (77.7%), "increasing" (7.9%), "declining," (5.5%), and "persistently high" (8.9%) was the best fit using methods accounting for nonrandom attrition. In comparison, methods not accounting for attrition estimated that only 3.2% of older adults were on the "persistently high" trajectory. There were significant differences in depressive trajectories by age, race/ethnicity, sex, physical, and cognitive functioning, and social connections. Discussion: Persistently high depressive symptoms affected a larger proportion of older adults than previously estimated. Depression had a more long-term and increasing course in the oldest-old. [ABSTRACT FROM AUTHOR]

Objective: Hospital use increases in the last 3 months of life. We aimed to examine its association with where people live and its variation across a large health jurisdiction. Methods: We studied a number of emergency department presentations and days spent in hospital, and in-hospital deaths among decedents who were hospitalized within 30 days of death across 153 areas in New South Wales (NSW), Australia, during 2010-2015. Results: Decedents' demographics and health status were associated with hospital use. Primary care and aged care supply had no or minimal influence, as opposed to the varying effects of areal factors—socioeconomic status, remoteness, and distance to hospital last admitted. Overall, there was an approximate 20% difference in hospital use by decedents across areas. In all, 18% to 57% of areas had hospital use that differed from the average. Discussion: The observed disparity can inform targeted local efforts to strengthen the use of community care services and reduce the burden of end-of-life care on hospitals. [ABSTRACT FROM AUTHOR]

Objective: We estimate depressive symptoms in a sample of older Hmong refugees in the United States, and investigate factors shaping risk of depression in this population. Method: Data were collected in California and Minnesota (N = 127). The study sample included Hmong immigrants aged 55 and over. The measure of depression used is the Hopkins Symptom Checklist–10 (HSCL-10) inventory. Linear regression models were used to identify significant correlates of depressive symptoms. Results: More than 72% of the participants indicated being symptomatic of depression, as reflected by having a HSCL-10 score of 1.85 or higher. Self-reported health was a risk factor for depression. Protective factors from depression were larger household size and older age of arrival into the United States. Discussion: This study updated knowledge about the mental health status of Hmong refugees, who are now at later life. Our findings suggest that depression may be a lifelong experience in this high risk population. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to assess the cross-sectional associations between sensory impairments (vision, hearing, and/or olfactory loss) and handgrip strength. Method: In the Blue Mountains Eye Study, 947 participants aged 65+ years had handgrip strength measured using a dynamometer. Visual impairment was defined as visual acuity <20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold >25 dBHL (500-4,000 Hz). Olfaction was measured using the San Diego Odor Identification Test. Results: Marginally significant associations between sensory impairment and handgrip strength were observed after multivariable adjustment. For example, women with two or three sensory impairments had lower adjusted mean handgrip strength (17.47 ± 0.5 kg) versus women who had no sensory loss (18.59 ± 0.3 kg; p =.06) or only one sensory impairment (18.58 ± 0.3 kg; p =.05), respectively. No significant associations were observed in men. Discussion: Women who had multiple sensory impairments had reduced muscle strength as indicated by ~1.1 kg lower mean handgrip strength. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to adapt and validate the Vietnamese version of Active Aging Index (AAI). Method: We conducted an expert panel, focus groups, test–retest and examination of internal consistency, and construct and concurrent validity among 804 older Vietnamese adults. Results: Scale content validity index (CVI) was 0.98. Test–retest coefficients ranged from 0.70 to 1.00. The Cronbach's alphas of well-being, voluntary, affordability, and politics were 0.94, 0.70, 0.65, and 0.16, respectively. Voluntary and well-being had good construct validity. Regarding politics, only one of four items had good test–retest reliability (Kappa 0.84), while other three had low variance in both test–retest and field study. In exploratory factor analysis, items assessing affordability loaded on three components. AAI was positively associated with perceived health, life satisfaction, and quality of life; it was negatively associated with falls, loneliness, and frailty. Discussion: In adapting AAI, researchers should consider cultural sensitivity. Key modifications, findings, explanations, and suggestions are presented here. [ABSTRACT FROM AUTHOR]

Objective: To estimate the short-run (6-9 months) impact and mediating mechanisms of an intervention providing supplemental income to individuals 70 years and above from the Mexican state of Yucatan on markers of cognitive functioning (immediate and delayed word recall). Method: Regression-adjusted difference-in-differences (DID) analysis using baseline and follow-up data collected at treatment and control sites from an experiment. Results: The intervention improved immediate and delayed recall scores for men and women. We found no effects on diagnoses of dementia risk factors, depression, and activities of daily living (ADLs). The intervention increased health care use and decreased anemia for men and women, and improved food availability for men. The effects on cognitive outcomes were mediated by health care use for both men and women, and food availability for men. Discussion: In low- and middle-income countries, supplemental income for elderly may be an effective strategy to improve cognitive function by increasing food security and health care utilization. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to examine the relationship between loneliness and work disability and whether depression mediates the hypothesized relationship. Method: We draw on data from the 2013 and 2015 waves of the Survey of Health, Aging, and Retirement in Europe. We limited the sample to adults between the ages of 50 and 65 who were working and without work limitations in 2013, which consisted of 10,154 adults from 14 countries. We apply multivariate logistic regression and a binary mediation analysis with logistic regression to examine predictors of the onset of work disability in 2015. Results: Loneliness was predictive of future work disability onset when adjusting for other factors in the disablement process. Depression partly mediated the longitudinal relationship between loneliness and work disability. Discussion: The results indicate that addressing loneliness could mitigate the risk of depression and, in turn, work disability onset. [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: This study examines how the patterns of life partner concordance on preventive health service uptake vary by a partner's previous behavioral history and between genders. Method: This study uses 2008 and 2012 waves of Health and Retirement Study (HRS), a nationally representative sample of U.S. aging population, to examine one's decision to receive a preventive service as a function of the partner's decision changes over time (N = 2,680). Results: Life partner concordance on preventive service use is different by the partner's previous use history and gender. Positive partner preventive engagement showed greater association than negative ones. Women are more responsive to the positive health behaviors (of their partners), and men are more sensitive to the negative partner health behaviors. Conclusion: The asymmetric partner concordance by gender and the partner's previous usage experience provide implications to develop efficient and culturally acceptable interventions to increase the uptake of preventive health services. [ABSTRACT FROM AUTHOR]

Objective: Timing and accumulation of work-related exposures may influence later life health. This study evaluates the association between women's work patterns and physical functioning. Method: Work history and physical functioning information was collected at baseline for U.S. women ages 50 to 79 years in the Women's Health Initiative Observational Study (N = 75,507). We estimated life course workforce participation patterns using latent class analysis. Associations between work patterns and physical limitations were explored using modified Poisson regression. Results: Compared with working continuously, women who left the workforce early had 8% increased risk and women who worked intermittently had 5% reduced risk of physical limitations later in life. The negative association with intermittent workforce participation was stronger for women with substantively complex work (9% reduced risk) than for women with nonsubstantively complex work (2% reduced risk). Discussion : Life course work patterns and characteristics may contribute to physical functioning later in life among women. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to estimate healthy life expectancies in eight low- and middle-income countries (LMICs), using two indicators: disability-free life expectancy (DFLE) and dependence-free life expectancy (DepFLE). Method: Using the Sullivan method, healthy life expectancy was calculated based on the prevalence of dependence and disability from the 10/66 cohort study, which included 16,990 people aged 65 or above in China, Cuba, Dominican Republic, India, Mexico, Peru, Puerto Rico, and Venezuela, and country-specific life tables from the World Population Prospects 2017. Results: DFLE and DepFLE declined with older age across all sites and were higher in women than men. Mexico reported the highest DFLE at age 65 for men (15.4, SE = 0.5) and women (16.5, SE = 0.4), whereas India had the lowest with (11.5, SE = 0.3) in men and women (11.7, SE = 0.4). Discussion: Healthy life expectancy based on disability and dependency can be a critical indicator for aging research and policy planning in LMICs. [ABSTRACT FROM AUTHOR]

Objective: We use the panel structure of the Survey of Health, Ageing and Retirement in Europe (SHARE) data for 14 countries to examine the implications of material and social deprivation for health deterioration in old age and mortality. Method: To minimize the potential endogeneity bias, we examine the relationship between deprivation and changes in health rather than levels of health. We include a substantial set of fixed "initial conditions," and extend the controls with health measures, as observed at the initial period. Results: The results of the probit regression suggest a strong and statistically significant relationship between measures of material and social deprivation and changes in physical and mental health. Mortality is only affected by the social dimension of deprivation. Discussion: Treating material and social deprivation separately rather than as a single social exclusion indicator allows for more specific identification of the role of the two dimensions, which might be important for policy decisions. [ABSTRACT FROM AUTHOR]

Objective: To examine cross-sectional and longitudinal associations between (a) activity-limiting fall worry (ALW) and (b) self-reported health-related restrictions and social engagement among older adults. Method : The National Health and Aging Trends Study Waves 5 (T1) and 6 (T2) provided data (n = 6,279). Binary and multinomial logistic regression models were used to examine association of T2 social engagement restrictions with T2 fall worry and association of T1–T2 changes in social engagement restrictions with T1–T2 changes in fall worry. Results : ALW was significantly associated with both informal and formal social engagement restriction at T2. Onset of ALW and continued ALW between T1 and T2 were also significantly associated with newly reported restrictions in both informal and formal social engagement at T2 even controlling for falls incidents and changes in health status and other covariates. Discussion : The findings underscore the importance of reducing fall worry and preventing social disengagement in late life. [ABSTRACT FROM AUTHOR]

Objective: We compare population aging in Europe and Asia using a measure that is both consistent over time and appropriate for cross-country comparison. Method: Sanderson and Scherbov proposed to estimate the old-age threshold by the age at which the remaining life expectancy (RLE) equals 15 years. We propose an adjustment of this measure, taking into account cross-national differences in the exceptionality of reaching that age. Results: Our old-age threshold was lower than 65 years in 2012 in Central Asia, Southern Asia, Southeastern Asia, and many Eastern European countries. These populations also experienced a higher share of elderly compared with the RLE15 method. Our method revealed more geographical diversity in the shares of elderly. Both methods exhibited similar time trends for the old-age thresholds and the shares of elderly. Discussion: Our prospective and comparative measure reveals higher population aging estimates in most Asian and Eastern European countries and more diversity in aging. [ABSTRACT FROM AUTHOR]

Objective: Given that one in four older adults suffer potentially preventable falls annually, we aimed to identify areas with (a) delivery gaps of evidence-based programs (EBPs) targeting fall prevention among older adults, namely A Matter of Balance (AMOB), and (b) high rates of fall-related hospitalizations—hotspots. Method: Analyses included multiple geospatially linked datasets. Results: EBPs were delivered ≥1 time in 84 counties in 2012 and 90 counties in 2014. Factors associated with EPB delivery gaps (absence; p <.05) included high-density older adult areas, non-fall-related hospitalization hotspots, lower population density, nonmetropolitan areas, high-density Hispanic adult areas, and areas with limited access to home health care agencies. Hotspots for fall-related hospitalization numbered 64 in 2012 and 62 in 2014. Factors associated with hotspots included low-density older adult areas, having AMOB delivered ≥1 time annually, high population density, and high-density Hispanic adult areas. Discussion: In resource-finite settings (e.g., the aging services sector), identifying high priority areas allows for precise allocation of limited resources. [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: The present study aimed to examine predictors of improvement in subjective everyday memory ability 5 years following participation in a group cognitive-behavioral memory intervention for community-living older adults, the La Trobe and Caulfield Hospital (LaTCH) Memory Group program. Method: Participants were 61 healthy older adults and data were analyzed using one-way repeated measures analysis of variance (ANOVA), hierarchical regression, and moderator analyses. Results: Although the group as a whole did not show significant gains in subjective memory ability following the intervention, greater gains in subjective memory ability were associated with poorer baseline associative memory, better baseline cognitive flexibility, and more subjective memory concerns prior to intervention. There was no interaction between the cognitive predictors and subjective memory concerns in predicting gains in subjective memory ability. Discussion: Differential benefits for more cognitively flexible individuals may derive from a greater capacity to engage skillfully in the expectancy modification aspects of the program. [ABSTRACT FROM AUTHOR]

Objective: A total of 34 years of FBI Supplementary Homicide Reports were examined using statistical graphics to illustrate patterns across ages, by sex, and victim/offender relationships (intimate partner [IP], other family, acquaintance, or stranger). Method: An innovative fourfold display and victim/sex-specific scatterplots with overlaid deviation ellipses determine the age/sex patterns for each relationship. Results: We illustrate numerous acquaintance killings among young men and improve our understanding of predictors by sex, relationship, and circumstances in mid/later life. Male victims of strangers are either older with young male offenders or vice versa. Female acquaintance and stranger homicides are rare. Within families, older male parents are killed by adult offspring, but rarely by IP. The majority of elder femicide is perpetrated by IP or other family. Discussion: U.S. murder rates are rising, and we found children from 6 to 12 years were least likely to die by homicide. Elder femicide risk from IP and other kin indicated danger from within the home. [ABSTRACT FROM AUTHOR]

Objective: We adopt a novel approach to mediation analysis to account for interrelated life course social processes that constitute later life health disparities. We examine gender-specific direct effect of parental education on functional limitations in later life. Method: Based on the first wave (2007-2010; n = 7,150) of the Study on Global Ageing and Adult Health (SAGE), we estimate both (natural) direct and indirect effects of parental education on functional limitations in later life. Results: We observed a significant indirect and positive effect of parental education on functional health. Contrary to prior literature, we documented adverse direct effect of parental education on later life functional health. The direct effect is statistically significant only for father's education, and is greater, though not statistically significantly so, for women than men. Discussion: The intersection of gender status and interrelated social stratification documented by this study highlights the need for gender-sensitive life course research. Such research can enhance our understanding of the ways patriarchal social systems produce heterogeneous effects of interrelated structural factors on later life health for men and women. [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: Limited knowledge exists about whether childhood health and socioeconomic status (SES) conditions influence health among older adults in Indonesia. Method: Data from Wave 5 (2014/2015) of the Indonesian Family Life Survey (N = 6,530) was used to examine associations between childhood health and SES and hypertension, lung conditions, diabetes, lower body functional limitations (LBFL), and instrumental activities of daily living limitations (IADL). Results: Poor childhood health was associated with 34% higher odds of hypertension (odds ratio [OR] = 1.34, p <.05), 37% higher odds of diabetes (OR = 1.37, p <.05), and 32% higher odds of lung conditions (OR = 1.32, p <.05). Household overcrowding was associated with 22% higher odds of a LBFL (OR = 1.22, p <.05) and 24% higher odds of an IADL (OR = 1.24, p <.01). Lacking a household toilet was associated with 18% higher odds of a LBFL (OR = 1.18, p <.05). Adjusting for adult SES and current health did not account for these relationships. Discussion: Childhood conditions appear to shape older adult health in Indonesia. [ABSTRACT FROM AUTHOR]

Objectives: We examine survey reporting of Medicare coverage of the older population by evaluating discordance between survey responses and administrative records. Method: We link data from the 2014 Current Population Survey Annual Social and Economic Supplement (CPS ASEC) and 2014 Medicare Enrollment Database to evaluate the extent to which individuals misreport Medicare coverage in the CPS ASEC. Using regression analyses, we assess factors associated with misreporting. Results: We find the CPS ASEC undercounts the population aged 65 years and older with Medicare by 4.5%. Misreporting of Medicare coverage is associated with citizenship status, immigration year of entry, employment, coverage of other household members, and imputation of Medicare responses. Adjusting for misreporting, Medicare coverage among older individuals increases from 93.4% to 95.6%. Discussion: The CPS ASEC underestimates Medicare coverage for the older population. Administrative records may be useful to evaluate and improve survey imputation of Medicare coverage when missing. [ABSTRACT FROM AUTHOR]

Objectives: We hypothesized that the number and length of hospital admissions in people with Parkinson's disease (PD) would increase immediately prior to admission to a care home relative to those who were able to continue living at home or who died. Method: PD patients at Hoehn and Yahr Stages III to V were followed-up over two and a half years with deaths and care home placements recorded. Hospital admissions data were collected over this period. Results: Of 286 patients included in the study, 7.3% entered a care home and 28.3% died. In the final 120 days prior to the study exit point (care home placement, death, or continued living at home), longer hospital stay was significantly associated with care home placement, after adjusting for the competing risk of death. Conclusion: Our data provide evidence that, for many people with PD, a period of crisis is reached immediately prior to care home placement. [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: The objective of the study is to examine the association of auditory, vision, and dual sensory impairment with late-life depressive and anxiety symptoms. Method: Our study included 7,507 older adults from the National Health & Aging Trends Study, a nationally representative sample of U.S. Medicare beneficiaries. Auditory and vision impairment were determined by self-report, and depressive and anxiety symptoms were evaluated by the two-item Patient Health Questionnaire (PHQ-2) and two-item Generalized Anxiety Disorder Scale (GAD-2), respectively. Results: Auditory, vision, and dual impairment were associated with an increased risk of depressive and anxiety symptoms in multivariable analyses accounting for sociodemographics, medical comorbidity, and functional impairment. Auditory, vision, and dual impairment were also associated with an increased risk for depressive and anxiety symptoms that persist or were of new onset after 1 year. Discussion: Screening older adults with sensory impairments for depression and anxiety, and screening those with late-life depression and anxiety for sensory impairments, may identify treatment opportunities to optimize health and well-being. [ABSTRACT FROM AUTHOR]

Objectives: Our study aimed to explore patterns and predictors of hospital utilization among Chinese older adults in the context of a rapidly aging population and increasing health care costs in contemporary China. Methods: This study used a national representative sample aged 60 years or older (N = 11,511) from the China Longitudinal Aging Social Survey in 2014. We applied Andersen's social behavioral model and stepwise logistic regression to identify predictors of hospital utilization. Results: About 25% of the respondents were hospitalized in the previous year. Level of literacy, rural residence, social support, intergenerational relationships, and negative perceptions of aging were significant factors predicting hospital utilization. However, major variations existed across provinces in the use of hospitals. Discussion: Conclusions regarding how to integrate the complex range of hospital services more effectively and evenly are described. Social services should be developed in response to the hospital services utilization needs of older people. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the variability in activities of daily living (ADL) trajectories among 6,155 nursing home residents using unique and rich observational data. Method: The impairment in ADL performance was considered as a dynamic process in a multi-state framework. Using an innovative mixture model, such states were not defined a priori but inferred from the data. Results: The process of change in functional health differed among residents. We identified four latent regimes: stability or slight deterioration, relevant change, variability, and recovery. Impaired body functions and poor physical performance were main risk factors associated with degradation in functional health. Discussion: The evolution of disability in later life is not completely gradual or homogeneous. Steep deterioration in functional health can be followed by periods of stability or even recovery. The current condition can be used to successfully predict the evolution of ADL allowing to set and target different care priorities and practices. [ABSTRACT FROM AUTHOR]

Objective: Retirement is a salient later-life transition that may influence cognition. Leisure activities can help individuals better adjust to life after significant life transitions. This study examined the role of leisure activity engagement in the relationship between retirement and cognition. Method: A path analysis (N = 2,827) was conducted using three waves of the Health and Retirement Study (2004, 2006, 2008) and its supplementary Consumption and Activities Mail Survey, to test the association between retirement (categorized as remained working, transitioned to retirement, remained retired) and cognition (memory, working memory, attention, and processing speed) via leisure (mental, physical, social, household) activity engagement. Results: Older adults who remained retired showed significantly lower cognition than those who remained working. Moreover, this negative association between retirement and cognition was attenuated by greater engagement mental activities. Discussion: Interventions that encourage mental activities among retired individuals are strongly suggested to help maintain cognitive function. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to evaluate the relationship of leading causes of death with gradients of cognitive impairment and multimorbidity. Method: This is a population-based study using data from the linked 1992-2010 Health and Retirement Study and National Death Index (n = 9,691). Multimorbidity is defined as a combination of chronic conditions, functional limitations, and geriatric syndromes. Regression trees and Random Forest identified which combinations of multimorbidity associated with causes of death. Results: Multimorbidity is common in the study population. Heart disease is the leading cause in all groups, but with a larger percentage of deaths in the mild and moderate/severe cognitively impaired groups than among the noncognitively impaired. The different "paths" down the regression trees show that the distribution of causes of death changes with different combinations of multimorbidity. Discussion: Understanding the considerable heterogeneity in chronic conditions, functional limitations, geriatric syndromes, and causes of death among people with cognitive impairment can target care management and resource allocation. [ABSTRACT FROM AUTHOR]

Objectives: To compare the risk of insomnia symptoms among community-dwelling older adults who participated and did not participate in organized social activity and physical exercise. Design: Secondary data analysis of a prospective cohort study. Material and Methods: Community-dwelling older adults ≥65 years of age with no insomnia symptoms at baseline were included in the study. Participants were followed up yearly for 3 years. Insomnia symptoms, social activity, and physical exercise status of study participants were assessed at baseline and during follow-up. Results: Study participants who reported engaging in organized social activity and low-intensity physical exercise and organized social activity and high-intensity physical exercise were less likely to report insomnia symptoms during follow-up compared with those who did not engage in any activity. Conclusion: These results suggest beneficial effect of organized social activity and physical exercise in maintaining sleep quality in old age. [ABSTRACT FROM AUTHOR]

Objective: This study aims to examine the relationship between different levels of cognitive impairment (CI) and the frequency of hospital admission (HA). Method: Data from the National Health and Aging Trend Study, Round 1 (2011), with 8,245 respondents from Medicare beneficiaries were used. The data account for the number of hospital admissions for one year before the data collection. Clock Drawing Test and delayed word recall were employed to measure CI. Results: The severity of CI is one of the factors significantly associated with HA. Controlling for the level of function, the likelihood of HA increased among respondents with moderate, mild-to-moderate, and mild CI. Counterintuitively, HA was reduced when CI is severe. Discussion: People with CI are at more risk of frequent HA and the severity of impairment can increase this risk subsequently. Screening for CI at admission can open up the possibility of interventions, hence reducing complications during and after hospitalization. [ABSTRACT FROM AUTHOR]

Objective: Investigate direct and indirect associations between markers of socioeconomic position (SEP) across the life course and midlife cognitive ability while addressing methodological limitations in prior work. Method: Longitudinal data from the Danish Metropolit cohort of men born in 1953 (N = 2,479) who completed ability tests at age 12, 18, and 56-58 linked to register-based information on paternal occupational class, educational attainment, and occupational level. Associations were assessed using structural equation models, and different models were estimated to examine the importance of accounting for childhood ability and measurement error. Results: Associations between adult SEP measures and midlife ability decreased significantly when adjusting for childhood ability and measurement error. The association between childhood and midlife ability was by far the strongest. Discussion: The impact of adult SEP on later life ability may be exaggerated when not accounting for the stability of individual differences in cognitive ability and measurement error in test scores. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to explore the association between mental work demands (MWDs) and late-life cognition among Chinese older adults. Method: Data were drawn from the baseline of the Shanghai Aging Study. Results: Among 3,546 participants, the mean MWDs index of participants with dementia, mild cognitive impairment (MCI), and cognitive normal were 2.8 (SD = 0.5), 2.8 (SD = 0.5), and 2.9 (SD = 0.4), respectively. Mini Mental State Examination (MMSE) scores in group with low MWDs level decreased more dramatically by increasing age than that in groups with middle and high MWDs level (p <.001). In a subgroup of participants with education ≥6 years, we found a positive correlation between MWDs index and MMSE score after adjusting for gender, age, body mass index, income, living alone, smoking, drinking, anxiety, depression, heart disease, hypertension, diabetes, and APOE-ε4 (apolipoprotein), by generalized linear model analysis (p <.001). Discussion: Our results suggest that long-time mental work stimulation during adulthood would have potential benefits to late-life cognition. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to describe behavioral change trajectories for healthful eating and exercise in a group of community-dwelling older adults. A secondary aim was to determine predictors of maintenance and resilience. Method: Subjects were participants in the Study of Exercise and Nutrition in Older Rhode Islanders (SENIOR) I study who had achieved postaction stage of change for at least one behavior by its end. They were recruited for SENIOR II, a 48-month study with annual assessments on demographic, anthropometric, cognitive, psychosocial, and behavioral variables. Results: Maintainers generally had higher levels of healthy behaviors and better cognitive function. Resilient older adults were similar to maintainers but were older and had greater functional limitations. Discussion: Findings suggest that both physical health and psychological capital provide important resources upon which to draw as older adults grow even older. The trajectory model can provide useful information for developing resilience interventions for older adults. [ABSTRACT FROM AUTHOR]

Objective: We offer a strategy for quantifying the impact of mortality and attrition on inferences from later-life health trajectory models. Method: Using latent class growth analysis (LCGA), we identify functional limitation trajectory classes in the Health and Retirement Study. We compare results from complete case and full information maximum likelihood (FIML) analyses, and demonstrate a method for producing upper- and lower-bound estimates of the impact of attrition on results. Results: LCGA inferences vary substantially depending on the handling of missing data. For older adults who die during the follow-up period, the widely used FIML approach may underestimate functional limitations by up to 20%. Discussion: The most commonly used approaches to handling missing data likely underestimate the extent of poor health in aging populations. Although there is no single solution for nonrandom missingness, we show that bounding estimates can help analysts to better characterize patterns of health in later life. [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]

Objectives: Multimorbidity in centenarians is common; although investigations of the prevalence of morbidity in centenarians are accumulating, research on profiles of co-occurrence of morbidities is still sparse. Our aim was to explore profiles of comorbidities in centenarians. Method: Health insurance data from 1,121 centenarians comprising inpatient and outpatient diagnoses from the past 5 years (2009-2013) were analyzed using latent class analysis with adjustments for sex, age, hospitalization, and long-term care. Results: Four distinct comorbidity profiles emerged from the data: 36% of centenarians were categorized as "age-associated"; 18% had a variety of comorbidities but were not diabetic were labeled "multimorbid without diabetes"; 9% were labeled "multimorbid with diabetes"; and 36% "low morbidity." Conclusion: Patterns of comorbidities describe the complexity of geriatric multimorbidity more appropriately than an approach focused on a single disease. The profiles described by this specific research may inform clinicians and health care planners for the oldest old. [ABSTRACT FROM AUTHOR]

Objective: To determine whether emotional support, and proportion of emotional support provided by specific sources (e.g., family, other prisoners, clinicians), is associated with health-related self-efficacy among older prisoners. Method: Cross-sectional study of 140 older prisoners age ≥50 with chronic medical illness who completed face-to-face interviews. Logistic regression, controlling for demographic, incarceration, and clinical/behavioral factors evaluated the association between emotional support, operationalized as a score and as a proportion of total emotional support from specific sources, and health-related self-efficacy. Results: Higher emotional support scores, and greater proportion of support from clinicians, were associated with lower likelihood of poor health-related self-efficacy. Those with >50% of their emotional support coming from other prisoners had higher likelihood of poor self-efficacy. Discussion: Among older prisoners with chronic illness, higher emotional support, particularly from clinicians, is associated with lower likelihood of poor self-efficacy; relying on other prisoners for emotional support is associated with poor health-related self-efficacy. [ABSTRACT FROM AUTHOR]