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There is also a growing array of support systems and technological innovations to help people with disabilities participate in school, work, and leisure activities as well as to help older people live independently. These changes have created new opportunities for many Americans with disabilities and provide the framework for affording people of all ages and abilities the opportunity to participate fully in the nation's social, political, and economical activities.

Objectives. We explore whether spousal caregiving is associated with enhanced well-being for older husbands and wives. Method. We use time diary data from the 2009 Panel Study of Income Dynamics and Disability and Use of Time supplement. We measure experienced well-being as ratings of happiness and frustration during activities recalled for the previous day. We estimate separately for husbands and wives 3 distinct effects on experienced well-being: having a spouse with a disability; doing household or personal care tasks (“chores”) for someone other than a spouse with a disability; and doing such tasks for a spouse with a disability (“care”). Results. For husbands, neither care status nor spouse’s disability status are associated with experienced well-being. In contrast, for wives, carrying out chores is associated with lower reports of happiness compared with other activities and providing care to one’s husband is associated with greater reports of happiness than carrying out chores. Discussion. For women, chores such as meal preparation, laundry, and cleaning—but not caregiving per se—are associated with worse experienced well-being than other activities. Findings underscore that there are positive aspects of spousal caregiving for older wives that offset the innately unpleasant nature of household tasks. [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]

Duration-based measures of happiness from retrospectively constructed daily diaries are gaining in popularity in population-based studies of the hedonic experience. Yet experimental evidence suggests that perceptions of duration-how long an event lasts-are influenced by individuals' emotional experiences during the event. An important remaining question is whether observational measures of duration outside the laboratory setting, where the events under study are engaged in voluntarily, may be similarly affected, and if so, for which emotions are duration biases a potential concern. This study assesses how duration and emotions co-vary using retrospective, 24-h diaries from a national sample of older couples. Data are from the Disability and Use of Time supplement to the nationally representative U.S. Panel Study of Income Dynamics. We find that experienced wellbeing (positive, negative emotion) and activity duration are inversely associated. Specific positive emotions (happy, calm) are not associated with duration, but all measures of negative wellbeing considered here (frustrated, worried, sad, tired, and pain) have positive correlations (ranging from 0.04 to 0.08; p < .05). However, only frustration remains correlated with duration after controlling for respondent, activity and day-related characteristics (0.06, p < .01). The correlation translates into a potentially upward biased estimate of duration of up to 10 min (20 %) for very frustrating activities. We conclude that estimates of time spent feeling happy yesterday generated from diary data are unlikely to be biased but more research is needed on the link between duration estimation and feelings of frustration. [ABSTRACT FROM AUTHOR]

Highlights: [•] We discuss self-selection bias in neighborhoods and health research literature. [•] We use difference-in-difference estimation technique examine the self selection bias. [•] Conventional estimates underestimate the effect of economic environment on health. [Copyright &y& Elsevier]

Objectives. To inform public health efforts to promote independent functioning among older adults, we have provided new national estimates of late-life disability that explicitly recognize behavioral adaptations. Methods. We analyzed the 2011 National Health and Aging Trends Study, a study of Medicare enrollees aged 65 years and older (n = 8077). For 7 mobility and self-care activities we identified 5 hierarchical stages-fully able, successful accommodation with devices, activity reduction, difficulty despite accommodations, and receipt of help-and explored disparities and associations with quality of life measures. Results. Among older adults, 31% were fully able to complete self-care and mobility activities. The remaining groups successfully accommodated with devices (25%), reduced their activities (6%), reported difficulty despite accommodations (18%), or received help (21%). With successive stages, physical and cognitive capacity decreased and symptoms and multimorbidity increased. Successful accommodation was associated with maintaining participation in valued activities and high well-being, but substantial disparities by race, ethnicity, and income existed. Conclusions. Increased public health attention to behavioral adaptations to functional change can promote independence for older adults and may enhance quality of life. [ABSTRACT FROM AUTHOR]

This article updates trends from five national U.S. surveys to determine whether the prevalence of activity limitations among the older population continued to decline in the first decade of the twenty-first century. Findings across studies suggest that personal care and domestic activity limitations may have continued to decline for those ages 85 and older from 2000 to 2008, but generally were flat since 2000 for those ages 65-84. Modest increases were observed for the 55- to 64-year-old group approaching late life, although prevalence remained low for this age group. Inclusion of the institutional population is important for assessing trends among those ages 85 and older in particular. [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]

Abstract: This paper investigates the link between disability and subjective wellbeing, using data from the 2009 Disability and Use of Time supplement to the Panel Study of Income Dynamics, the longest running national panel study in the United States. Disability is construed broadly to include both the presence of any physical, cognitive, or sensory impairment or activity limitation and also the severity of underlying impairments. Subjective wellbeing is measured using two distinct approaches: reports of life satisfaction and of moment-to-moment wellbeing—both positive and negative—on the previous day. The latter, collected through 24-h time diaries, also offers for the first time the ability to explore the role of participation in particular kinds of activities linking disability to subjective wellbeing. The analytic sample included married persons ages 60 and older and their spouses (n = 751 married individuals) who completed 1498 diaries. Several new findings emerged: no matter what the measure of wellbeing, older married adults with disability report worse subjective wellbeing than those without, and neither different demographic and socioeconomic profiles nor differences in participation fully account for these disparities. Influences of disability on global life satisfaction and episodic reports of happiness were relatively small and of comparable size. However, notably sizeable differences were identified in the cumulative number of pleasant minutes experienced yesterday by disability status - on the order of 71 fewer minutes on average for those with a disability of average severity. Differences appear to be more strongly linked to somatic symptoms of pain and feeling tired than to differential intensity of experiencing happiness, sadness, frustration, or worry. We also found limited support for the notion that participation partially mediates the relationship between disability and global, but not episodic, subjective wellbeing. [Copyright &y& Elsevier]

Objective To investigate whether the health and functioning of the Baby Boom generation are better or worse than those of previous cohorts in middle age. Methods Trend analysis of vital statistics and self-reports from the National Health Interview Survey for the 40–59 population. Specific outcomes (years of data): mortality (1982–2004); poor or fair health (1982–2006); nine conditions (1997–2006); physical functional limitations (1997–2006); and needing help with personal care, routine needs, or either (1997–2006). Results In 2005, the mortality rate of 59-year-olds, the leading edge of the Baby Boom, was 31% lower than that of 59-year-olds in 1982 (8.3 vs. 12.1 per 1,000). There was a similar proportional decline in poor/fair health, but the decline reversed in the last decade. From 1997 to 2006, the prevalence of reports of four conditions increased significantly, but this trend may reflect improvements in diagnosis and treatment. Functional limitations and need for help with routine needs were stable, but the need for help with personal care, while quite low, increased. Discussion Trends varied by indicator, period, and age. It is surprising that, given the socioeconomic, medical, and public health advantages of Baby Boomers throughout their lives, they are not doing considerably better on all counts. [ABSTRACT FROM PUBLISHER]

Objectives. We examined the influence of neighborhood environment on the weight status of adults 55 years and older. Methods. We conducted a 2-level logistic regression analysis of data from the 2002 wave of the Health and Retirement Study. We included 8 neighborhood scales: economic advantage, economic disadvantage, air pollution, crime and segregation, street connectivity, density, immigrant concentration, and residential stability. Results. When we controlled for individual- and family-level confounders, living in a neighborhood with a high level of economic advantage was associated with a lower likelihood of being obese for both men (odds ratio [OR] = 0.86; 95% confidence interval [CI] = 0.80, 0.94) and women (OFU0.83; 95% CI = 0.77, 0.89), Men living in areas with a high concentration of immigrants and women living in areas of high residential stability were more likely to be obese. Women living in areas of high street connectivity were less likely to be overweight or obese. Conclusions. The mechanisms by which neighborhood environment and weight status are linked in later life differ by gender, with economic and social environment aspects being important for men and built environment aspects being salient for women. [Am J Public Health. 2008;98:2065-2071. doi:10.2105/AJPH.2007.127712) [ABSTRACT FROM AUTHOR]

This paper uses the US Health and Retirement Study to explore linkages between neighborhood conditions and stages of the disablement process among adults aged 55 years and older in the United States. We consider multiple dimensions of the neighborhood including the built environment as well as social and economic conditions. In doing so, we use factor analysis to reduce indicators into eight neighborhood scales, which we incorporate into two-level logistic regression models along with controls for individual-level factors. We find evidence that economic conditions and the built environment, but not social conditions, matter. Neighborhood economic advantage is associated with a reduced risk of lower body limitations for both men and women. We also find for men that neighborhood economic disadvantage is linked to increased chances of reporting personal care limitations, particularly for those aged 55–64 years, and that high connectivity of the built environment is associated with reduced risk of limitations in instrumental activities. Our findings highlight the distinctive benefits of neighborhood economic advantage early in the disablement process. In addition, findings underscore the need for attention in the design and evaluation of disability-prevention efforts to the benefits that accrue from more physically connected communities and to the potential harm that may arise in later life from living in economically disadvantaged areas. [Copyright &y& Elsevier]

Investigations into the reasons for declines in late-life disability have largely focused on the role of contemporaneous factors. Adopting a life-course perspective as a backdrop, in this paper we ask whether there also has been a role for selected early- and mid-life factors in the decline, and if so whether these factors have been operating through changes in the risks of disability onset or recovery. Drawing on five waves from 1995 to 2004 of the U.S. Health and Retirement Study, we found for the 75 years and older population in the United States that the prevalence of difficulty with activities of daily living (ADL) declined from 30.2% in 1995 to 26.0% in 2004, whereas the trend in difficulty with instrumental activities of daily living (IADL) was flat. Onset of ADL limitations also was reduced during this period while recovery increased. Changes in the educational composition of the older population were linked to declines in the prevalence of ADL limitations, but there were also modest contributions of changes in mother''s education, self-rated childhood health, and lifetime occupation. Declines in late-life vision impairments and increases in wealth also contributed substantially to the downward trend, and had chronic conditions not increased, it would have been even larger. Reductions in the onset of ADL limitations were partly driven by changes in educational attainment of respondents and their mothers and, in late-life, better vision and wealth. In contrast, the recovery trend was not accounted for by changes in early- or mid-life factors. We conclude that early- and mid-life factors have contributed along with late-life factors to U.S. late-life disability trends mainly through their influence on the onset of, rather than recovery from, limitations. [Copyright &y& Elsevier]

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]

Objectives. Although racial and ethnic disparities in disability are well established and technology is increasingly used to bridge gaps between functional deficits and environmental demands, little research has focused on racial and ethnic disparities in device use. This study investigated whether use of mobility devices differs by race and ethnicity and explored several reasons for this difference. Methods. The sample included community-dwelling adults aged 65 and older from the 2002 and 2004 waves of the Health and Retirement Study. We used predisposing, need, and enabling factors to predict mobility device use alone and combined with personal care. Results. Blacks had the highest rates of using mobility devices, followed by Hispanics and then Whites. Need and enabling factors explained differences between Blacks and Whites in wheelchair use but not cane use or use of devices without personal care. Other predisposing factors explained most differences between Hispanics and Whites. Discussion. Because minorities appear to be using mobility devices in proportion to underlying need, increasing device use by minorities may not reduce disparities in mobility disability. Efforts to address racial/ethnic disparities in mobility disability in late life, therefore, may need to focus on differences in underlying functional decline rather than the accommodation of it. [ABSTRACT FROM AUTHOR]

Using data from the 1997-2004 National Health Interview Survey (NHIS), we examine the role of chronic conditions in recent declines in late-life disability prevalence. Building upon prior studies, we decompose disability declines into changes in the prevalence of chronic conditions and in the risk of disability given a condition. In doing so, we extend Kitigawa's (1955) classical decomposition technique to take advantage of the annual data points in the NHIS. Then we use respondents' reports of conditions causing their disability to repartition these traditional decomposition components. We find a general pattern of increasing prevalence of chronic conditions accompanied by declines in the percentage reporting disability among those with a given condition. We also find declines in heart and circulatory conditions, vision impairments, and possibly arthritis and increases in obesity as reported causes of disability. Based on decomposition analyses, we conclude that heart and circulatory conditions as well as vision limitations played a major role in recent declines in late-life disability prevalence and that arthritis may also be a contributing factor. We discuss these findings in light of improvements in treatments and changes in the environments of older adults. [ABSTRACT FROM AUTHOR]

Objectives. We addressed three questions: Have recent improvements in old-age disability been mirrored in changes in self-reported general health status? Are general health status trends similar for younger and older Americans? Have changes in general health status been uniform across demographic and socioeconomic groups? Methods. Using logistic regression, we analyzed data from the 1982-2003 National Health Interview Surveys (n = 1,445,872 aged 18-69; n = 178,384 aged 70 and older). Results. The proportion of people aged 70 and older reporting disability declined at 1.38% per year and the proportion 70 and older reporting poor/fair health declined at 1.85% per year. There was less of a decline in reports of poor/fair health at younger ages. Trends for the 18-69 population showed widening health disparities by income but narrowing of the race/ethnicity and education gaps. In the older population, there was no change for those aged 80-84 and 85 and older, the race/ethnicity gap persisted, and both education and income differentials widened over time. Discussion. Declines in proportions reporting poor/fair health among the older population in recent decades mirror declines in disability. Although the younger population has not experienced such progress, its prevalence of poor/fair health is low throughout the 21-year analysis period. Of concern are the growing socioeconomic disparities in health for both younger and older populations. [ABSTRACT FROM AUTHOR]

Objectives. Assistive technology (AT) may improve quality of life and reduce dependence for older persons with disabilities. In this article, we examine tradeoffs between the use of AT and reliance on personal care, with attention to factors that may influence those relationships. Methods. We jointly modeled hours of formal and informal care with use of AT in order to address the interdependence of these outcomes in ways not taken into account in previous studies. We analyzed a national sample of older persons with difficulty in activities of daily living drawn from Phase 2 of the 1994–1995 National Health Interview Survey (NHIS) Disability Supplement. Results. Our findings show that the use of AT was associated with reductions in informal care hours, especially for those who were unmarried, better educated, or had better cognitive abilities, but appeared to supplement formal care services for these groups. Individuals with cognitive impairment were less likely than others to substitute AT with either type of personal care. Discussion. These models raise the possibility that reductions of informal care hours may be accomplished with a combination of formal care and assistive devices, rather than from either alternative alone. [ABSTRACT FROM AUTHOR]

Purpose: This study systematically reviews approaches that national surveys have used to measure the use of assistive devices and examines the implications of these different approaches for prevalence estimates of device use and disability in late life. Design and Methods: Cross-sectional data from six national surveys are used to compare rates of assistive device use and disability among community-dwelling adults aged 65 and older. Results: Estimates of the use of any device are similar across surveys, ranging from 14% to 18% for the population of adults aged 65 and older. However, one survey design element-the restriction of device-use questions to those reporting difficulty with daily activities-omits a potentially sizeable group: those who use devices but report no difficulty. Including this group of device users significantly increases the prevalence estimates of both device use and disability. Implications: The use of assistance and perceptions of difficulty are inextricably interwoven, and attention to the measurement of these concepts is needed. Survey designers may want to consider asking questions about assistive device use independent of questions about difficulty. In addition, researchers who study disability may want to consider including those who report using devices but no difficulty, a group that may become more prevalent as new cohorts age. [ABSTRACT FROM AUTHOR]

Presents information on a study which examined differences in reports of residual disability and unmet need by type of long-term care arrangement, assistive technology or personal care. Measures of assistive technology and personal care; Measures of effectiveness; Results and discussion.

A correction to the article "Change OverTime in Caregiving Networks for Older Adults With and Without Dementia," by Brenda C. Spillman, Vicki A. Freedman, Judith D. Kasper, and Jennifer L. Wolff, which was published in a 2019 issue of the journal is presented.

The authors comment on the connection between remaining lifetime and the trajectory of late-life disability. Few critics have argued that using time to death (TTD) as a predictor of disability confuses the direction of causality. They said the author's our approach to imputation of TTD among censored observations is not valid because TTD is not missing at random (MAR).

The article focuses on the challenge involved in incorporating disability into theory of health change in old age. Disability is a social construct that has no agreed-upon definition. It also has a broad classification. Measuring disability in surveys is particularly challenging as well.

Discusses various aspects concerning the cognitive ability in the aged using data from the Health and Retirement Study. Inconsistencies of data; Challenges in measuring cognitive functioning; Social conditions of aged with cognitive impairments.

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]