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

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

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

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

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

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

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

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

The article discusses marital dynamics, with a focus on how marital quality affects subjective well-being in later life. Topics include a comparison of husbands' and wives' reports of their marital satisfaction, a comparison of marital and life satisfaction by gender, and the implications for either spouse's marital appraisals.

Context The cost of late-life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To provide a context for framing relevant policy discussions, we investigated activity limitations and assistance, care resources, and unmet need for a national sample of older adults. Methods We analyzed the 2011 National Health and Aging Trends Study, a new national panel study of more than 8,000 Medicare enrollees. Findings Nearly one-half of older adults, or 18 million people, had difficulty or received help in the last month with daily activities. Altogether, 1 in 4 older adults receiving help lived in either a supportive care (15%) or a nursing home (10%) setting. Nearly 3 million received assistance with 3 or more self-care or mobility activities in settings other than nursing homes, and a disproportionate share of persons at this level had low incomes. Nearly all older adults in settings other than nursing homes had at least 1 potential informal care network member (family or household member or close friend), and the average number of network members was 4. Levels of informal assistance, primarily from family caregivers, were substantial for older adults receiving help in the community (164 hours/month) and living in supportive care settings (50 hours/month). Nearly all of those getting help received informal care, and about 3 in 10 received paid care. Of those who had difficulty or received help in settings other than nursing homes, 32% had an adverse consequence in the last month related to an unmet need; for community residents with a paid caregiver, the figure was nearly 60%. Conclusions The older population-especially those with few economic resources-has substantial late-life care needs. Policies to improve long-term services and supports and reduce unmet need could benefit both older adults and those who care for them. [ABSTRACT FROM AUTHOR]

Context: Late-life disability has been declining in the United States since the 1980s. This study provides the first comprehensive investigation into the reasons for this trend. Methods: The study draws on evidence from two sources: original data analyses and reviews of existing studies. The original analyses include trend models of data on the need for help with daily activities and self-reported causes of such limitations for the population aged seventy and older, based on the National Health Interview Surveys from 1982 to 2005. Findings: Increases in the use of assistive and mainstream technologies likely have been important, as have declines in heart and circulatory conditions, vision, and musculoskeletal conditions as reported causes of disability. The timing of the improvements in these conditions corresponds to the expansion in medical procedures and pharmacologic treatment for cardiovascular disease, increases in cataract surgery, increases in knee and joint replacements, and expansion of medications for arthritic and rheumatic conditions. Greater educational attainment, declines in poverty, and declines in widowhood also appear to have contributed. Changes in smoking behavior, the population's racial/ethnic composition, the proportion of foreign born, and several specific conditions were eliminated as probable causes. Conclusions: The substantial reductions in old-age disability between the early 1980s and early 2000s are likely due to advances in medical care as well as changes in socioeconomic factors. More research is needed on the influence of health behaviors, the environment, and early- and midlife factors on trends in late-life disability. [ABSTRACT FROM AUTHOR]

Although the prevalence of late-life disability has been declining, how best to promote further reductions remains unclear. This article develops and then demonstrates an approach for comparing the effects of interventions on the prevalence of late-life disability. We review evidence for three potentially high-impact strategies: physical activity, depression screening and treatment, and fall prevention. Because of the large population at risk for falling, the demonstrated efficacy of multi-component interventions in preventing falls, and the strong links between falls and disability, we conclude that, in the short run, multi-component fall-prevention efforts would likely have a higher impact than either physical activity or depression screening and treatment. However, longer-term comparisons cannot be made based on the current literature and may differ from short-run conclusions, since increases in longevity may temper the influences of these interventions on prevalence. Additional research is needed to evaluate longer-term outcomes of interventions, including effects on length and quality of life. [ABSTRACT FROM AUTHOR]

To examine the effects of varying diagnostic and pharmaceutical criteria on the performance of claims-based algorithms for identifying beneficiaries with hypertension, heart failure, chronic lung disease, arthritis, glaucoma, and diabetes.Secondary 1999–2000 data from two Medicare+Choice health plans.Retrospective analysis of algorithm specificity and sensitivity.Physician, facility, and pharmacy claims data were extracted from electronic records for a sample of 3,633 continuously enrolled beneficiaries who responded to an independent survey that included questions about chronic diseases.Compared to an algorithm that required a single medical claim in a one-year period that listed the diagnosis, either requiring that the diagnosis be listed on two separate claims or that the diagnosis to be listed on one claim for a face-to-face encounter with a health care provider significantly increased specificity for the conditions studied by 0.03 to 0.11. Specificity of algorithms was significantly improved by 0.03 to 0.17 when both a medical claim with a diagnosis and a pharmacy claim for a medication commonly used to treat the condition were required. Sensitivity improved significantly by 0.01 to 0.20 when the algorithm relied on a medical claim with a diagnosis or a pharmacy claim, and by 0.05 to 0.17 when two years rather than one year of claims data were analyzed. Algorithms that had specificity more than 0.95 were found for all six conditions. Sensitivity above 0.90 was not achieved all conditions.Varying claims criteria improved the performance of case-finding algorithms for six chronic conditions. Highly specific, and sometimes sensitive, algorithms for identifying members of health plans with several chronic conditions can be developed using claims data. [ABSTRACT FROM AUTHOR]

To examine affect and physiological stress in frail older adults in response to a voluntary nursing home relocation.Randomized, controlled trial.Long-term care facility located within the greater Philadelphia, Pennsylvania, community.Seventy-seven nursing home residents, aged 65 and over.Experimental group residents were relocated to a newly built nursing home facility with a cluster design in the fall of 2001; control group residents were moved after study completion in the spring of 2002.Mini-Mental State Examination scores, Observed Affect Rating Scale scores, salivary cortisol, blood pressure, and pulse obtained 1 week before moving and 1 week and 4 weeks after moving.Relocated nursing home residents demonstrated significant differences in salivary cortisol and mood from a randomly selected group of residents that had not yet moved. Relocation resulted in significantly higher cortisol levels 1 week after the move (P=.005), followed by a significant decline in afternoon cortisol at 4 weeks after the move (P=.03). Moreover, relocated residents had significantly lower depression and anxiety symptoms and pulse rates than residents who had not yet moved.These findings have important implications for planning medical and social services for relocated elderly. Efforts should be made to prepare individuals for the initial stressors associated with relocation, but it also appears that the stress imposed by relocation is time limited and may begin to ease as early as 4 weeks postmove. [ABSTRACT FROM AUTHOR]

To investigate socioeconomic disparities in access to home health visits and durable medical equipment by persons enrolled in two Medicare managed care health plans. A telephone survey of 4,613 Medicare managed care enrollees conducted between April and October of 2000 and linked to administrative claims for a subsequent 12-month period. We estimated a series of logistic regression models to determine which socioeconomic factors were related to home health visits and the use of durable medical equipment (DME) among Medicare managed care enrollees. Controlling for health and demographic differences, Medicare managed care enrollees in the lowest tertile for nonhousing assets had 50 percent greater odds than those in the highest tertile of having one or more home health visits. All else equal, enrollees with less than a high school education had 30 percent lower odds than those who had graduated from high school of using durable medical equipment. Medicare managed care enrollees of low socioeconomic status do not appear to have reduced access to home health visits; however, use of durable medical equipment is considerably lower for enrollees with less than a high school education. Physicians and therapists working with Medicare managed care enrollees may want to actively target DME prescriptions to those with educational disadvantages. [ABSTRACT FROM AUTHOR]

Investigates transitions in and out of Medicaid for a cohort of single adult women of childbearing age in the United States. Utilization of a discrete-time duration model; Analysis of data from the Survey of Income and Program Participation; Health insurance transitions; State health policy.

Presents a study to investigate charge and payments differentials for home health services across different payors in the United States. Details on data from the 1992 National Home and Hospice Care Survey; Method in which the study was conducted; Conclusion of study.