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In October 2017, the National Poll on Healthy Aging surveyed a nationally representative sample of 2,007 adults aged 50–80 years to assess attitudes toward influenza (flu) vaccination policies in long-term care facilities. Support for requiring vaccinations was lowest for visitors. Policy makers can use these findings to develop sustainable vaccination strategies.

Objectives We surveyed older adults about their perceived mental health and their comfort discussing and engaging in mental health treatment. Methods A nationally representative survey of community-dwelling older adults aged 50–80 (N = 2,021), with respondents asked to rate their current mental health as compared to 20 years ago, comfort discussing their mental health, and potential hesitations to seeking treatment in the future. Results About 79.6% reported their mental health as the same or better than 20 years ago; 18.6% reported their mental health to be worse. Most respondents reported that they were comfortable (87.3%) discussing their mental health, preferring to discuss such concerns with their primary care provider (30.6%). About 28.5% of respondents did endorse some hesitation seeking mental health care in the future. Conclusions Most older adults reported that their mental health was as good if not better than it was 20 years ago and felt comfortable discussing mental health concerns.

Addressing health inequities for racial and ethnic minority populations is challenging. After passage of the Affordable Care Act, Michigan launched its Healthy Michigan Plan, which expanded Medicaid eligibility in the state. Our evaluation of the expansion provided the opportunity to study its impact on racial and ethnic minority groups, including Arab American and Chaldean American enrollees, an understudied population. Using data from telephone surveys collected in 2016, 2017, and 2018, we conducted an analysis to study the plan's impact on access to a regular source of care and health status among racial and ethnic minority groups. More than 90 percent of respondents of all racial and ethnic groups reported having a regular source of care after plan enrollment compared with 74.4 percent before enrollment. Respondents who identified as non-Hispanic White, African American, and Hispanic reported improvements in health status after plan enrollment. Our study demonstrates the potential of health insurance access to narrow health inequities between racial and ethnic groups.

Objectives: COVID-19 has strained the household finances of many Americans already experiencing increasing healthcare expenses. Concerns about the cost of care may deter patients from seeking even urgent care from the emergency department (ED). This study examines predictors of older Americans’ concerns of ED visit costs, and how cost concerns may have influenced their ED use in the early stages of the pandemic.Study Design: This was a cross-sectional survey study using a nationally representative sample of US adults aged 50-80 years (N=2,074) in June 2020.Methods: Multivariate logistic regressions assessed the relationship between sociodemographic, insurance, and health factors with cost concerns for emergency department care. Results: Of the respondents, 80% were concerned (45% very, 35% somewhat) about costs of an ED visit and 18% were not confident in their ability to afford an ED visit. Of the entire sample, 7% had avoided ED care due to cost concerns in the past two years. Of those who may have needed ED care, 22% had avoided care. Predictors of cost-related ED avoidance included: aged 50 to 54 years (4.57 aOR [95%CI 1.44-14.54]), uninsured (2.93 aOR [95%CI 1.35-6.52]), poor-fair mental health (2.82 aOR [95%CI 1.62-4.89]), and income

Background Physical function worsens with older age, particularly for sedentary and socially isolated individuals, and this often leads to injuries. Through reductions in physical activity, the COVID-19 pandemic may have worsened physical function and led to higher fall-related risks. Methods A nationally representative online survey of 2006 U.S. adults aged 50-80 was conducted in January 2021 to assess changes in health behaviors (worsened physical activity and less daily time spent on feet), social isolation (lack of companionship and perceived isolation), physical function (mobility and physical conditioning), and falls (falls and fear of falling) since March 2020. Multivariable logistic regression was used to assess relationships among physical activity, social isolation, physical function, falls, and fear of falling. Results Among respondents, 740 (36.9%) reported reduced physical activity levels, 704 (35.1%) reported reduced daily time spent on their feet since March 2020, 712 (37.1%) reported lack of companionship, and 914 (45.9%) social isolation. In multivariable models, decreased physical activity (adjusted risk ratio, ARR: 2.92, 95% CI: 2.38, 3.61), less time spent on one's feet (ARR: 1.95, 95% CI: 1.62, 2.34), and social isolation (ARR: 1.51, 95% CI: 1.30, 1.74) were associated with greater risks of worsened physical conditioning. Decreased physical activity, time spent daily on one's feet, and social isolation were similarly associated with worsened mobility. Worsened mobility was associated with both greater risk of falling (ARR: 1.70, 95% CI: 1.35, 2.15) and worsened fear of falling (ARR: 2.02, 95% CI: 1.30, 3.13). Worsened physical conditioning and social isolation were also associated with greater risk of worsened fear of falling. Conclusion The COVID-19 pandemic was associated with worsened physical functioning and fall outcomes, with the greatest effect on individuals with reduced physical activity and social isolation. Public health actions to address reduced physical activity and social isolation among older adults are needed.

Introduction COVID-19 necessitated a shift from in-person to virtual care for all patients, particularly older adults. It is unknown how older individuals’ views of telehealth changed during this time and how this may affect their future use of telehealth services. Methods We used data from a cross-sectional online survey of a nationally representative sample of 2074 U.S. adults ages 50–80 who were participants in the National Poll on Healthy Aging. We performed a descriptive and multivariable analysis of individuals’ perspectives on past and future telehealth visits, sociodemographics, and health status. Results Before March 2020, 5.8% of respondents had used telehealth, compared to 32.0% by June 2020. Of telehealth users, 36.1% indicated their most recent telehealth visit used audio-only (i.e., without video) technology. In multivariable analysis, those who never used video technology compared to those who were “very comfortable” (average marginal effect (AME) 49%, 95% CI: 36–63), identified as Hispanic (AME 19% vs White, non-Hispanic, 95% CI: 5–32), or were female (AME 9%, 95% CI: 1–17) were more likely to report audio-only use. Concerns remained about the inability to conduct physical exams (75%) and telehealth quality of care (67%), though most (64%) older adults indicated an interest in future telehealth visits. Discussion Telehealth use increased substantially among older U.S. adults during the early months of the COVID-19 pandemic; however, many reported using audio-only telehealth, an important consideration for policymakers and providers. Addressing older adults’ concerns about and barriers to telehealth visits is needed to ensure telehealth does not exacerbate disparities in their care.

The past five years have brought enormous changes in the lives of older adults and their families. During this time the University of Michigan National Poll on Healthy Aging (NPHA), co-sponsored by AARP and Michigan Medicine, has gathered the experiences and perspectives from nationally representative samples of US adults age 50-80 on a range of topics related to healthy aging. These polls have been used to elevate the voices of the older adults in the development of policies and practices to improve the health of people as they age. During the past two years, poll reports have captured how changes in lifestyle and behaviors during the COVID-19 pandemic have impacted the health and well-being of older adults. Members of the NPHA team from the University of Michigan and AARP will begin with an overview of the poll including its goals and methods. The session will then highlight key findings from the first five years of the NPHA that have important implications during and beyond the COVID-19 pandemic, with special attention to poll findings related to joys and stresses and aging in place. The presenters will also discuss how to access publicly available NPHA data. The session will wrap up with a discussion of how the perspectives and experiences of older adults gathered through the NPHA and AARP polling can be used to inform policy and advocacy to support healthy aging.

This poll aimed to better understand the complex impacts of the COVID-19 pandemic on the emotional and mental health of older adults. In August 2021, the National Poll on Healthy Aging surveyed a national sample of adults age 50–80 about joys, stresses, and resilience during the pandemic. Most reported feeling a lot (30%) or some (53%) joy these days, while 17% reported feeling very little or no joy. Reports of joy and stress differed substantially by age, sex, physical health, mental health, and household income. For example, people age 50–64 were more likely to report feeling a lot of stress compared with those age 65–80 (25% vs 13%), as were women compared with men (24% vs 15%). The findings may inform public health and policy efforts to support older adults at-risk for poor emotional and mental health, and help cultivate resilience during and after the pandemic.

Objectives: Sexual health is an important component of overall health and well-being for older adults. Despite this, little is known about the importance of sex to quality of life, as part of roman...

Informal caregivers for persons with dementia frequently report needing assistance, yet formal support service use has been low. To better understand factors associated with service use, correlates of self-reported service use (e.g. support groups, family mediation, family leave, classes/trainings, and respite care) among dementia caregivers were assessed. The National Poll on Healthy Aging conducted a nationally representative web-based survey of adults aged 50–80 (N=2,131) using Ispos’ KnowledgePanel®; 148 reported caregiving for an adult with memory loss [61.5% female; 25% non-White, 54.1% aged 50–64]. Multivariable logistic regression analyses assessed caregiver and care recipient characteristics associated with service use within the prior year. Nearly 25% of caregivers used at least one service. Caregiver characteristics associated with greater likelihood of service use included not working [7.5 OR; 2.73, 20.62 CI]; income

Objectives:Emergency preparedness becomes more important with increased age, as older adults are at heightened risk for harm from disasters. In this study, predictors of preparedness actions and confidence in preparedness among older adults in the United States were assessed.Methods:This nationally representative survey polled community-dwelling older adults ages 50-80 y (n = 2256) about emergency preparedness and confidence in addressing different types of emergencies. Logistic regression was used to identify predictors of reported emergency preparedness actions and confidence in addressing emergencies.Results:Participants’ mean age was 62.4 y (SD = 8); 52% were female, and 71% were non-Hispanic white. Living alone was associated with lower odds of having a 7-d supply of food and water (adjusted odds ratio [aOR] = 0.74; 95% confidence interval [CI]: 0.56-0.96), a stocked emergency kit (aOR = 0.64; 95% CI: 0.47-0.86), and having had conversations with family or friends about evacuation plans (aOR = 0.59; 95% CI: 0.44-0.78). Use of equipment requiring electricity was associated with less confidence in addressing a power outage lasting more than 24 h (aOR = 0.66; 95% CI: 0.47-0.94), as was use of mobility aids (OR = 0.65; 95% CI: 0.45-0.93).Conclusions:These results point to the need for tailored interventions to support emergency preparedness for older adults, particularly among those who live alone and use medical equipment requiring electricity.

To describe associations between patient factors and interest in and concerns about telehealth video visits among adults in midlife and older.A cross-sectional, nationally representative panel survey of US adults aged 50 to 80 years (N = 2256) in May 2019.Multivariable logistic regression was used to estimate the adjusted prevalence of interest in different types of video telehealth visits and concerns about telehealth for individuals with different characteristics.Individuals aged 65 to 80 (vs 50-64) years were more likely to be interested in a first-time telehealth visit (37.3% vs 31.5%; P .05) and to be concerned about not feeling personally connected to their provider (52.8% vs 46.5%; P .05). Women (vs men) were less likely to be interested in a first-time visit (29.3% vs 38.2%; P .001) and more likely to be concerned about technical difficulties (52.3% vs 42.1%; P .001). Black, non-Hispanic individuals (vs White, non-Hispanic individuals) were more likely to be interested in first-time (45.2% vs 29.8%; P .001) and return (67.7% vs 56.2%; P .01) visits. Individuals comfortable using video chat (vs never users) were more likely to be interested in a telehealth visit for any reason (all P .001) and less likely to have concerns about privacy, difficulty seeing/hearing, technical difficulties, not feeling personally connected, and lower quality of care (all P .01).Interest in and concerns about telehealth vary along the lines of sociodemographic factors and experience using the internet for video communication. These findings have implications for the design of interventions and policies to promote equitable access to health care as it increasingly moves online.

Background and Objectives The coronavirus disease 2019 (COVID-19) pandemic poses new challenges for caregivers of adults with chronic or disabling conditions. This study uses nationally representative data to examine the prevalence of pandemic care challenges and supports and their associations with caregiver mental health and interpersonal well-being. Research Design and Methods Participants include 311 caregivers aged 50–80 in the United States who were providing care for an adult with a chronic or disabling condition from the June 2020 National Poll on Healthy Aging. Five care challenges (e.g., confusion on public health guidelines) and 2 supports (e.g., physician offered information on care during COVID-19) are treated as predictors of caregiver mental health (care-related stress, self-reported mental health, and depressive symptoms) and interpersonal well-being (interpersonal conflicts, lack of companionship, and isolation). Results Each care challenge/support was endorsed by 13%–23% of caregivers. In adjusted models, difficulty getting needed medical care was associated with greater caregiver stress, depressive symptoms, and lower interpersonal well-being. All care challenges universally predicted greater caregiver stress. Caregiving supports were not independently associated with caregiver’ mental health and interpersonal well-being. Discussion and Implications Care challenges were associated with caregivers’ mental health and interpersonal well-being during the early months of the pandemic. Some of these challenges may be attributed to changing public health guidelines and practices as the pandemic unfolded, whereas others are relevant to all care contexts (e.g., less support from family). Tools and supports for caregivers must consider both changing policies and care needs.

Since 2017, the National Poll on Healthy Aging (NPHA) has surveyed older adults on a vast array of topics related to health, health care and health policy. With robust nationally representative samples of 2,000 adults age 50-80, the poll’s format allows for the fielding of timely questions with important public health and policy implications. For example, polls examining delayed care during the COVID-19 pandemic and experiences of physical deconditioning and falls helped to demonstrate the ways in which the pandemic may have long-lasting effects if strategies are not implemented to address them. In this presentation we will discuss how the NPHA has increased awareness of the facilitators and barriers to healthy aging and where gaps exist in supporting older adults to live with optimal health and well-being. This presentation will also describe how researchers can access publicly available NPHA data to inspire their own future research.

Though aging in place is a stated goal for many older adults, complications of advanced disease or disability can derail these plans. Little is known about the current preparedness of older adults to age in place. The January 2022 National Poll on Healthy Aging surveyed adults age 50-80 (n=2,277) about their home and available supports. Findings indicate that while 80% of adults believe they have the necessary features in their home to support aging in place, less than one in five had homes that were wheelchair accessible and fewer than half had other common safety and accessibility features. Older adults were most confident they could obtain help with household chores (51%) and were least confident about getting assistance with personal care (33%). Persons with disabilities (n=683) and those living alone (n=639) reported the most concerns. Several opportunities exist to better prepare older adults to successfully age in place.

Objectives Older adults regularly encounter age-based discrimination and stereotyping in their day-to-day lives. Whether this type of routine ageism negatively affects their health and well-being is unclear, in part due to the absence of validated scales that comprehensively measure this phenomenon and distinguish it from other sources of everyday discrimination. Methods This study describes the development of a novel scale, the Everyday Ageism Scale, and its psychometric evaluation using a nationally representative sample of US adults age 50–80 from the December 2019 National Poll on Healthy Aging ( N = 2012). Results Exploratory factor analysis indicated a 3-factor structure comprised of ageist messages, ageism in interpersonal interactions, and internalized ageism. The ten-item scale was psychometrically sound and demonstrated good internal reliability. Discussion Everyday ageism is a multidimensional construct. Preliminary evaluation of the Everyday Ageism Scale suggests its utility in future studies examining the prevalence of everyday ageism and its relationships with health.

Firearms are a leading cause of injury mortality across the lifespan, with elevated risks for older adult populations. To inform prevention efforts, we conducted a probability-based web survey (12/1/2019-12/23/2019) of 2048 older adults (age 50-80) to characterize national estimates of firearm ownership, safety practices, and attitudes about health screening, counseling, and policy initiatives. Among older U.S. adults, 26.7% [95%CI = 24.8%-28.8%] report owning one or more firearms. The primary motivation for ownership was protection (69.5%), with 90.4% highlighting a fear of criminal assault. 39.4% of firearm owners reported regularly storing firearm(s) unloaded and locked, with 24.2% regularly storing at least one loaded and unlocked. While most firearm owners found healthcare screening (69.2% [95%CI: 64.9-73.1]) and safety counseling (63.2% [95%CI = 58.8-67.3]) acceptable, only 3.7% of older adults reported being asked about firearm safety by a healthcare provider in the past year. Among firearm owners, there was support for state-level policy interventions, including allowing family/police to petition courts to restrict access when someone is a danger to self/others (78.9% [95%CI = 75.1-82.3]), comprehensive background checks (85.0% [95%CI = 81.5-87.9]), restricting access/ownership under domestic violence restraining orders (88.1%; 95%CI = 84.9-90.7], and removing firearms from older adults with dementia/confusion (80.6%; 95%CI = 76.8-84.0]. Healthcare and policy-level interventions maintained higher support among non-owners than owners (p's 0.001). Overall, data highlights opportunities exist for more robust firearm safety prevention efforts among older adults, particularly healthcare-based counseling and state/federal policies that focus on addressing lethal means access among at-risk individuals.

BACKGROUND: It is uncertain how Medicaid expansion under the Affordable Care Act influences the diagnosis of chronic health conditions, and the care and health of enrollees with chronic conditions. OBJECTIVE: Describe the prevalence of new and pre-existing chronic health conditions among Medicaid expansion enrollees. Examine whether perceived changes in specific types of access and self-rated health status differed between enrollees with chronic conditions and those without. Examine how gaining Medicaid coverage affected chronic disease management and well-being. DESIGN: Mixed-methods study including a telephone survey and semi-structured interviews. SETTING: Michigan’s Medicaid expansion, the “Healthy Michigan Plan” (HMP). PARTICIPANTS: 4090 survey respondents (response rate 54%) with ≥ 12 months HMP enrollment and 67 interviewees with ≥ 6 months enrollment. MAIN MEASURES: Self-reported chronic condition diagnoses, changes in physical/mental health, and healthcare access. Descriptive survey data were adjusted for survey design and nonresponse. Semi-structured interview questions about how gaining HMP coverage led to changes in health status. KEY RESULTS: Among enrollees, 68% had a self-reported diagnosis of a chronic health condition; 42% of those were newly diagnosed since HMP enrollment. In multivariable models, enrollees with chronic conditions were significantly more likely to report improved physical (adjusted odds ratio (aOR) 1.70, 95% CI (1.40, 2.07)) and mental health (aOR 1.75, (1.43, 2.15)) since HMP enrollment than enrollees without chronic conditions. Among enrollees with chronic conditions, the strongest predictors of improvements in health were having seen a primary care physician, improved mental health care access, and improved medication access. Interviewees with chronic conditions described how increased access to health care led to improvements in both physical and mental health. CONCLUSIONS: Enrollees with expanded Medicaid coverage commonly reported detection of previously undiagnosed chronic conditions. Perceived health status and access improved more often among enrollees with chronic health conditions. Improved access was associated with improved physical and mental health among this vulnerable group. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11606-019-05323-w) contains supplementary material, which is available to authorized users.

Objective Older adults commonly use products that may be used to promote sleep, such as benzodiazepines and over-the-counter medications, but the current extent of use of both prescription and nonprescription products specifically for sleep in the United States is unknown. Methods Respondents in this cross-sectional, nationally representative survey (the National Poll on Healthy Aging) of community-dwelling older adults aged 65–80 (n = 1,065) reported difficulty initiating sleep or early awakening (“sleep symptoms”) and use of prescription medication or nonprescription aids to promote sleep (“sleep product”), including prescription sleep medication, over-the-counter (OTC) sleep aids, prescription pain medication, and herbal/natural sleep aids. Logistic regression was used to determine the association of respondent sociodemographic and clinical characteristics with the use of sleep products. Results Sleep symptoms were endorsed by 67.7% of respondents (95% confidence interval [CI] 64.7%–70.7%). Use of a sleep product was reported by 35.4% (95% CI 32.4%–38.6%), with 21.9% (95% CI 19.4%–24.7%) using OTC sleep aids, 12.5% using herbal/natural aids (95% CI 10.6%–14.8%), 8.3% using prescription sleep medication (95% CI 6.7%–10.3%), and 5.0% using prescription pain medication (95% CI 3.8%–6.7%). Self-reported fair/poor mental health (relative to excellent/very good) was associated with increased odds of sleep product use (adjusted odds ratio 2.28, 95% CI 1.10–4.72, p = 0.03). Conclusion More than a third of older adults use medications or aids to help with sleep—most commonly OTC aids. Clinicians should routinely ask older patients about sleep-related difficulties and the use of nonprescription sleep aids.

The National Poll on Healthy Aging conducted an online survey of a nationally representative sample of adults age 50-80 (n=2,074) in June 2020 about experiences related to loneliness, their physical environments, and telehealth and technology use. 41% felt a lack of companionship, and 46% reported infrequent social contact. Feelings of loneliness were more likely among those who lived alone or who did not have access to features in their neighborhood and community which may offer opportunities for safe interactions. The poll also found that 26% of adults age 50-80 had a telehealth visit March through June 2020 and 64% overall reported being comfortable with video conferencing technology, with notable differences by demographic subgroup. These results highlight the need for new opportunities for older adults, especially those with the greatest social and economic need, to feel connected and to be confident using technology, both during and after the pandemic.

Major incidents of ageism have been shown to be associated with poorer health and well-being among older adults. Less is known about routine types of age-based discrimination, prejudice, and stereotyping that older adults encounter in their day-to-day lives, known as everyday ageism.To examine the prevalence of everyday ageism, group differences and disparities, and associations of everyday ageism with indicators of poor physical and mental health.This cross-sectional study was conducted using survey data from the December 2019 National Poll on Healthy Aging among a nationally representative household sample of US adults ages 50 to 80 years. Data were analyzed from November 2021 through April 2022.Experiences of everyday ageism were measured using the newly developed multidimensional Everyday Ageism Scale.Fair or poor physical health, number of chronic health conditions, fair or poor mental health, and depressive symptoms.Among 2035 adults ages 50 to 80 years (1047 [54.2%] women; 192 Black [10.9%], 178 Hispanic [11.4%], and 1546 White [71.1%]; mean [SD] age, 62.6 [8.0] years [weighted statistics]), most participants (1915 adults [93.4%]) reported regularly experiencing 1 or more forms of everyday ageism. Internalized ageism was reported by 1664 adults (81.2%), ageist messages by 1394 adults (65.2%), and interpersonal ageism by 941 adults (44.9%). Mean Everyday Ageism Scale scores were higher for several sociodemographic groups, including adults ages 65 to 80 years vs those ages 50 to 64 years (11.23 [95% CI, 10.80-11.66] vs 9.55 [95% CI, 9.26-9.84]) and White (10.43 [95% CI, 10.20-10.67]; P .001) and Hispanic (10.09 [95% CI, 9.31-10.86]; P = .04) adults vs Black adults (9.23 [95% CI, 8.42-10.03]). Higher levels of everyday ageism were associated with increased risk of all 4 negative physical and mental health outcomes examined in regression analyses (with odds ratios [ORs] per additional scale point as high as 1.20 [95% CI, 1.17-1.23] for depressive symptoms and b = 0.039 [95% CI, 0.029-0.048] for chronic health conditions; P values .001). Internalized ageism was the category associated with the greatest increase in risk of poor outcomes for all health measures (with ORs per additional scale point as high as 1.62 [95% CI, 1.49-1.76] for depressive symptoms and b = 0.063 [95% CI, 0.034-0.092] for chronic health conditions; P values .001).This study found everyday ageism to be prevalent among US adults ages 50 to 80 years. These findings suggest that commonplace ageist messages, interactions, and beliefs may be harmful to health and that multilevel and multisector efforts may be required to reduce everyday ageism and promote positive beliefs, practices, and policies related to aging and older adults.

Importance Community-dwelling older adults with dementia have a high prevalence of psychotropic and opioid use. In these patients, central nervous system (CNS)-active polypharmacy may increase the risk for impaired cognition, fall-related injury, and death. Objective To determine the extent of CNS-active polypharmacy among community-dwelling older adults with dementia in the US. Design, setting, and participants Cross-sectional analysis of all community-dwelling older adults with dementia (identified by International Classification of Diseases, Ninth Revision, Clinical Modification or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes; N = 1 159 968) and traditional Medicare coverage from 2015 to 2017. Medication exposure was estimated using prescription fills between October 1, 2017, and December 31, 2018. Exposures Part D coverage during the observation year (January 1-December 31, 2018). Main outcomes and measures The primary outcome was the prevalence of CNS-active polypharmacy in 2018, defined as exposure to 3 or more medications for longer than 30 days consecutively from the following classes: antidepressants, antipsychotics, antiepileptics, benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonist hypnotics, and opioids. Among those who met the criterion for polypharmacy, duration of exposure, number of distinct medications and classes prescribed, common class combinations, and the most commonly used CNS-active medications also were determined. Results The study included 1 159 968 older adults with dementia (median age, 83.0 years [interquartile range {IQR}, 77.0-88.6 years]; 65.2% were female), of whom 13.9% (n = 161 412) met the criterion for CNS-active polypharmacy (32 139 610 polypharmacy-days of exposure). Those with CNS-active polypharmacy had a median age of 79.4 years (IQR, 74.0-85.5 years) and 71.2% were female. Among those who met the criterion for CNS-active polypharmacy, the median number of polypharmacy-days was 193 (IQR, 88-315 polypharmacy-days). Of those with CNS-active polypharmacy, 57.8% were exposed for longer than 180 days and 6.8% for 365 days; 29.4% were exposed to 5 or more medications and 5.2% were exposed to 5 or more medication classes. Ninety-two percent of polypharmacy-days included an antidepressant, 47.1% included an antipsychotic, and 40.7% included a benzodiazepine. The most common medication class combination included an antidepressant, an antiepileptic, and an antipsychotic (12.9% of polypharmacy-days). Gabapentin was the most common medication and was associated with 33.0% of polypharmacy-days. Conclusions and relevance In this cross-sectional analysis of Medicare claims data, 13.9% of older adults with dementia in 2018 filled prescriptions consistent with CNS-active polypharmacy. The lack of information on prescribing indications limits judgments about clinical appropriateness of medication combinations for individual patients.

To investigate self-reported improved oral health and its mediators, and job-related outcomes, of Medicaid expansion beneficiaries in Michigan.This cross-sectional mixed-methods study of adult "Healthy Michigan Plan" (HMP) Medicaid expansion beneficiaries included qualitative interviews with a convenience sample of 67 beneficiaries enrolled for ≥6 months, a stratified random sample survey of 4,090 beneficiaries enrolled for ≥12 months; and Medicaid claims data. We examined unadjusted associations between demographic variables and awareness of dental coverage, self-reported dental care access, dental visits, and self-reported oral health; and between improved oral health and job seeking and job performance. Multivariate analysis examined factors associated with self-reported oral health improvement, adjusting for sociodemographic characteristics, prior health insurance, and having at least one dental visit claim.Among surveyed beneficiaries, 60 percent received ≥1 dental visit and 40 percent reported improved oral health. Adjusted odds ratios (aOR) for improved oral health were higher for African-American beneficiaries [aOR = 1.61; confidence interval (CI) = 1.28-2.03] and those previously uninsured for ≥12 months (aOR = 1.96; CI = 1.58-2.43). Beneficiaries reporting improved oral health were more likely to report improved job seeking (59.9 percent vs 51 percent; P = 0.04) and job performance (76.1 percent vs 65.0 percent; P 0.001) due to HMP. Interviewees described previously unmet oral health needs, and treatments that improved oral health, functioning, appearance, confidence, and employability.Michigan's Medicaid expansion contributed to self-reported improved oral health, which was associated with improved job outcomes. Policymakers should consider the importance of Medicaid dental coverage in reducing oral health disparities and improving the health and socioeconomic well-being of low-income adults and communities when considering this optional benefit.

Medicaid “community engagement” requirement (work, school, job training, job searching, or volunteering) waivers have received CMS approval in nine states, but there are little data on current trends in Medicaid enrollees’ engagement in these activities. Our objective was to assess longitudinal changes in enrollees’ employment and student status after implementation of Michigan’s Medicaid expansion, which expanded coverage in 2014 and now covers ~664,000 individuals. We conducted a longitudinal telephone survey in English, Spanish, and Arabic with a cohort of Medicaid expansion enrollees at 3 time points in 2016 (N = 4090, RR = 53.7%), 2017 (N = 3104; RR = 83.4%), and 2018 (N = 2608, RR = 89.4%). Survey items measured employment status and student status; demographic characteristics were obtained from Michigan Medicaid program files. We used mixed models with year as a fixed effect to assess changes in the proportion of enrollees who were employed or students, incorporating weights adjusting for sample design and nonresponse. Enrollees aged 19‐64, with incomes up to 133% of the federal poverty level (FPL). Most respondents had incomes under 100% FPL (61.7% with 0‐35% FPL, 22.9% with 36‐99% FPL, and 15.4% with 100‐133% FPL), 89.3% had at least a high school diploma/equivalent, and respondents ranged in age (39.6%, age 19‐34; 34.5%, age 35‐50; and 25.9%, age 51‐64). From 2016 to 2018, the proportion of enrollees who were employed or students increased from 54.5% to 61.4% (P

This survey study examines the self-reported health of enrollees in Michigan’s Medicaid expansion, the Healthy Michigan Plan, among respondents to surveys in 2016 and 2017., Key Points Question What longitudinal changes in self-reported health status and days of poor health among racial, ethnic, urban/rural, and very-low-income subgroups of enrollees are associated with Medicaid expansion? Findings In this survey study of 3097 respondents, reports of fair or poor health and days of poor physical health decreased over time among enrollees, especially among non-Hispanic black enrollees and those with very low incomes. There were no statistically significant differences in the number of days of poor mental health or the number of days of usual activities missed owing to poor physical or mental health over time. Meaning These findings suggest that within Medicaid expansion, the health of vulnerable populations is improving., Importance Evidence about the health benefits of Medicaid expansion has been mixed and has largely come from comparing expansion and nonexpansion states. Objective To examine the self-reported health of enrollees in Michigan’s Medicaid expansion, the Healthy Michigan Plan (HMP), over time. Design, Setting, and Participants A telephone survey from January 1 to October 31, 2016 (response rate, 53.7%), and a follow-up survey from March 1, 2017, to January 31, 2018 (response rate, 83.4%), were conducted in Michigan, which expanded Medicaid in 2014 through a Section 1115 waiver permitting state-specific modifications. Four thousand ninety HMP beneficiaries aged 19 to 64 years with at least 12 months of HMP coverage and at least 9 months in a Medicaid health plan were eligible to participate. Data were analyzed from April 1 to November 30, 2018. Main Outcomes and Measures Surveys measured demographic characteristics and health status. Analyses included weights for sampling probability and nonresponse. Comparisons between 2016 and 2017 included those who responded to both surveys (n = 3097). Results Of the 3097 respondents to the 2017 follow-up survey, 2388 (77.1%) were still enrolled in HMP (current enrollees) and 709 (22.9%) were no longer enrolled when surveyed (former enrollees). Among all follow-up respondents, a weighted 37.5% (95% CI, 35.3%-39.9%) were aged 19 to 34 years, 34.0% (95% CI, 31.8%-36.2%) were aged 35 to 50 years, and 28.5% (95% CI, 26.7%-30.3%) were aged 51 to 64 years; 53.0% (95% CI, 50.8%-55.3%) were female. Respondents who reported fair or poor health decreased from 30.7% (95% CI, 28.7%-32.8%) in 2016 to 27.0% (95% CI, 25.1%-29.0%) in 2017 (adjusted odds ratio [AOR], 0.66 [95% CI, 0.53-0.81]; P

ObjectiveTo test the association between self-reported opioid disposal education and self-reported disposal of leftover opioids among older adults.DesignWeb-based survey from the National Poll on Healthy Aging (March 2018) using population-based weighting for nationally representative estimates.SubjectsOlder adults aged 50–80 years who reported filling an opioid prescription within the past 2 years.MethodsRespondents were asked whether they received education from a prescriber or pharmacist on how to dispose of leftover opioids and whether they disposed of leftover opioids from recent prescriptions. The association between self-reported opioid disposal education and self-reported disposal of leftover opioids was estimated with multivariable logistic regression, testing for interactions with respondent demographics.ResultsAmong 2013 respondents (74% response rate), 596 (28.9% (26.8%–31.2%)) were prescribed opioids within the past 2 years. Education on opioid disposal was reported by 40.1% of respondents (35.8%–44.5%). Among 295 respondents with leftover medication, 19.0% (14.6%–24.5%) disposed of the leftover medications. Opioid disposal education was associated with a greater likelihood of self-reported disposal of leftover opioids among non-white respondents as compared with white non-Hispanic respondents (36.7% (16.8%–56.6%) vs 7.8% (0.1%–15.6%), pConclusionsIn this nationally representative survey, 49% had leftover opioids, yet only 20% of older adults reported disposal of leftover opioids. Opioid disposal education was variable in delivery, but was associated with disposal behaviors among certain populations. Strategies to promote disposal should integrate patient education on the risks of leftover opioid medications and explore additional barriers to accessing opioid disposal methods.

This study examines the perception of US individuals about their likelihood of developing dementia and their strategies to improve or maintain memory.

Older adults and their caregivers experienced dramatic changes in many aspects of their lives during the COVID-19 pandemic which resulted in important shifts in organizational and federal priorities and policies. To explore older adults’ changing experiences and perspectives amidst the pandemic, the University of Michigan National Poll on Healthy Aging (NPHA), a recurring, nationally representative household survey, polled over 2,000 adults age 50-80 at multiple timepoints through January 2021 about their feelings of loneliness and use of telehealth. In June 2020, the NPHA also surveyed adults age 50-80 about advance care planning before and during the COVID-19 pandemic and asked family caregivers about their care challenges in the three months since the pandemic. This session will start with a presentation of results from these polls, first exploring change over time in loneliness and telehealth use and then focusing on experiences related to advance care planning and caregiving challenges. Next, presenters from diverse national coalitions and organizations, including the Coalition to End Social Isolation and Loneliness, the National Academy for State Health Policy, the National Alliance for Caregiving, and the Coalition to Transform Advanced Care will describe their organizations’ efforts, including their work with research and advocacy partners, state and federal agencies, and the Biden administration to facilitate dialogue and advance activities and policies related to these timely topics.

The COVID-19 pandemic posed new challenges for caregivers. This study examines the prevalence of pandemic care challenges (e.g., decreasing care to reduce virus spread, difficulty accessing medical care) and their associations with caregiver mental health and interpersonal well-being in a nationally representative sample of 311 caregivers who participated in the June 2020 National Poll on Healthy Aging. We consider seven care challenges and supports as key predictors of caregiver mental health (care-related stress, self-reported mental health, three depressive symptoms) and interpersonal well-being (lack of companionship, isolation) in bivariate tests and ordinary least squares regressions. Each care challenge/support was endorsed by between 13-23% of caregivers. Difficulty getting needed medical care was the most predictive challenge associated with increased caregiver stress, depressive symptoms, and worsened interpersonal well-being. All care challenges predicted an increase in caregiver stress. Effective caregiver tools and supports must consider changing policies and care needs, especially during a pandemic.

This study examined the prevalence of loneliness and relationship with cooking and eating habits among older adults using data collected in December 2019 from a nationally representative sample age 50-80 through the National Poll on Healthy Aging. Older adults who live alone were more likely those who lived with others (19% vs. 8%) and those with a high PHQ-2 score were more like than those with a low PHQ-2 score (20% vs. 11%) to report that they do not cook dinner most days (0-2 times/week). Those who rated their diet as fair/poor were more likely to indicate they cook few meals a week (0-2) compared to those who reported a good or very good/excellent diet (18% vs. 11 % vs 8%). Those with a high PHQ-2 score were less likely than those with a low PHQ-2 score to say they do major food shopping less than once a week (31% vs 47%). Those with a high PHQ-2 score were more likely to say that that always ate alone in the last week compared to those with a low PHQ-2 score (17% vs 7%). These findings demonstrate that older adults who lived alone, had a higher PHQ-2 score, and had a poorer diet were more likely to cook and do grocery shopping less often. Strategies and policies to support older adults to address depressive symptoms and to increase cooking and improve diet may have many health and social benefits and will be explored through this session.

This study explored the prevalence of positive attributes of aging among older adults in a nationally representative sample age 50-80 ((N=2,048, 52% female, 71% White). Nearly 70% of older adults reported that people sought their guidance because of their wisdom and experience. Older adults reported that, as they have gotten older, they have become more comfortable with themselves (88%), have a strong sense of purpose (80%), feel more positively about aging (67%), and have found their life to be better than they had thought it would be (65%). Over half (52%) of those who said their lives were better than they thought reported very good or excellent physical health. Among those who disagreed, only one out of four (25%) reported very good/excellent physical health; similar results were found for mental health (48% vs. 22%). This session will describe positive attributes of aging and their association to physical and mental health.

As more Americans approach retirement age and eligibility for Medicare coverage, many face difficult decisions about their health insurance and health care. This session explores how adults age 50-64 are navigating these choices following implementation of the Affordable Care Act (ACA), presenting data from two nationally representative surveys: The University of Michigan’s National Poll on Healthy Aging (NPHA) and the Health and Retirement Study (HRS). Erica Solway, Associate Director of the NPHA, will begin by presenting background information about the NPHA and an overview of critical health policy issues for adults age 50-64. Jamie Luster, Research Area Specialist at the University of Michigan, will then provide NPHA findings linking concerns about health insurance affordability with delayed/forgone health care. Next, Aaron Scherer, Associate of Internal Medicine at the University of Iowa Carver College of Medicine, will discuss NPHA findings on factors associated with adults’ concern about affordability of health insurance in retirement but before Medicare eligibility begins at age 65. Finally, Renuka Tipirneni, Assistant Professor of Internal Medicine at the University of Michigan, will present findings based on the HRS on changes in health care utilization for adults age 55-64 since implementation of the ACA’s Medicaid expansion. To conclude, Erica Solway will discuss current federal health care policy proposals for adults age 50-64, including the recent introduction of the Medicare at 50 bill, and how the perspectives and experiences of adults in this age group can help inform those policies.

In October 2018, the University of Michigan National Poll on Healthy Aging conducted an online survey using a nationally representative household sample of adults age 50 to 80. One in three respondents (34%) reported feeling a lack of companionship and 27% reported feeling isolated from others some of the time or often during the past year. Those with fair or poor self-reported physical health, mental health, or hearing were more likely to report feeling a lack of companionship or feel isolated as were those who reported less frequently engaging in healthy behaviors. More than one in four (28%) reported social contact with people outside of their household once a week or less. Given the high prevalence of loneliness and its connection to poor health and health behaviors, research on this important issue and efforts to increase social engagement among older adults deserve increased attention.

Evidence suggests it may be possible to reduce the risk of developing dementia during midlife. The University of Michigan National Poll on Healthy Aging (NPHA), a nationally representative online survey, sought to determine to what extent adults age 50 to 64 anticipate and worry about developing dementia, are taking steps to prevent dementia, and are likely to participate in dementia-related research. Nearly 50% of poll respondents (n=1,025) perceived themselves as being somewhat or very likely to develop dementia. Worry about developing dementia was higher among respondents who had a family member with dementia (66.3% vs. 31.8%; Pearson’s Chi squared, p

The study objective was to assess the impact of Medicaid expansion on health and employment outcomes among enrollees with and without a behavioral health disorder (either a mental or substance use disorder).Between January and October 2016, the authors conducted a telephone survey of 4,090 enrollees in the Michigan Medicaid expansion program and identified 2,040 respondents (48.3%) with potential behavioral health diagnoses using claims-based diagnoses.Enrollees with behavioral health diagnoses were less likely than enrollees without behavioral health diagnoses to be employed but significantly more likely to report improvements in health and ability to do a better job at work. In adjusted analyses, both enrollees with behavioral health diagnoses and those without behavioral health diagnoses who reported improved health were more likely than enrollees without improved health to report that Medicaid expansion coverage helped them do a better job at work and made them better able to look for a job. Among enrollees with improved health, those with a behavioral health diagnosis were as likely as those without a behavioral health diagnosis to report improved ability to work and improved job seeking after Medicaid expansion.Coverage interruptions for enrollees with behavioral health diagnoses should be minimized to maintain favorable health and employment outcomes.

Introduction Michigan is one of 3 states that have implemented health risk assessments for enrollees as a feature of its Medicaid expansion, the Healthy Michigan Plan. This study describes primary care providers’ early experiences with completing health risk assessments with enrollees and examines provider- and practice-level factors that affect health risk assessment completion. Methods All primary care providers caring for ≥12 Healthy Michigan Plan enrollees (n=4,322) were surveyed from June to November 2015, with 2,104 respondents (55.5%). Analyses in 2016–2017 described provider knowledge, attitudes, and experiences with the health risk assessment early in Healthy Michigan Plan implementation; multivariable analyses examined relationships of provider- and practice-level characteristics with health risk assessment completion, as recorded in state data. Results Of the primary care provider respondents, 73% found health risk assessments very or somewhat useful for identifying and discussing health risks, although less than half (47.2%) found them very or somewhat useful for getting patients to change health behaviors. Most primary care provider respondents (65.3%) were unaware of financial incentives for their practices to complete health risk assessments. Nearly all primary care providers had completed at least 1 health risk assessment. The mean health risk assessment completion rate (completed health risk assessments/number of Healthy Michigan Plan enrollees assigned to that primary care provider) was 19.6%; those who lacked familiarity with the health risk assessment had lower completion rates. Conclusions Early in program implementation, health risk assessment completion rates by primary care providers were low and awareness of financial incentives limited. Most primary care provider respondents perceived health risk assessments to be very or somewhat useful in identifying health risks, and about half of primary care providers viewed health risk assessments as very or somewhat useful in helping patients to change health behaviors.

BACKGROUND: Medicaid expansion in Michigan, known as the Healthy Michigan Plan (HMP), emphasizes primary care and preventive services. OBJECTIVE: Evaluate the impact of enrollment in HMP on access to and receipt of care, particularly primary care and preventive services. DESIGN: Telephone survey conducted during January–November 2016 with stratified random sampling by income and geographic region (response rate = 53.7%). Logistic regression analyses accounted for sampling and nonresponse adjustment. PARTICIPANTS: 4090 HMP enrollees aged 19–64 with ≥ 12 months of HMP coverage MAIN MEASURES: Surveys assessed demographic factors, health, access to and use of health care before and after HMP enrollment, health behaviors, receipt of counseling for health risks, and knowledge of preventive services’ copayments. Utilization of preventive services was assessed using Medicaid claims. KEY RESULTS: In the 12 months prior to HMP enrollment, 33.0% of enrollees reported not getting health care they needed. Three quarters (73.8%) of enrollees reported having a regular source of care (RSOC) before enrollment; 65.1% of those reported a doctor’s office/clinic, while 16.2% reported the emergency room. After HMP enrollment, 92.2% of enrollees reported having a RSOC; 91.7% had a doctor’s office/clinic and 1.7% the emergency room. One fifth (20.6%) of enrollees reported that, before HMP enrollment, it had been over 5 years since their last primary care visit. Enrollees who reported a visit with their primary care provider after HMP enrollment (79.3%) were significantly more likely than those who did not report a visit to receive counseling about health behaviors, improved access to cancer screening, new diagnoses of chronic conditions, and nearly all preventive services. Enrollee knowledge that some services have no copayments was also associated with greater utilization of most preventive services. CONCLUSIONS: After enrolling in Michigan’s Medicaid expansion program, beneficiaries reported less forgone care and improved access to primary care and preventive services. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11606-019-05370-3) contains supplementary material, which is available to authorized users.

BACKGROUND: Health risk assessments (HRAs) and healthy behavior incentives are increasingly used by state Medicaid programs to promote enrollees’ health. OBJECTIVE: To evaluate enrollee experiences with HRAs and healthy behavior engagement in the Healthy Michigan Plan (HMP), a state Medicaid expansion program. DESIGN: Telephone survey conducted in Michigan January–October 2016. PARTICIPANTS: A random sample of HMP enrollees aged 19–64 with ≥ 12 months of enrollment, stratified by income and geographic region. MAIN MEASURES: Self-reported completion of an HRA, reasons for completing an HRA, commitment to a healthy behavior, and choice of healthy behavior. KEY RESULTS: Among respondents (N = 4090), 49.3% (95% CI 47.3–51.2%) reported completing an HRA; among those with a primary care provider (PCP) (n = 3851), 85.2% (95% CI 83.5–86.7%) reported visiting their PCP during the last 12 months. Most enrollees having a recent PCP visit reported discussing healthy behaviors with them (91.1%, 95% CI 89.6–92.3%) and were more likely to have completed an HRA than enrollees without a recent PCP visit (52.7%, 95% CI 50.5–52.8% vs. 36.2%, 95% CI 31.7–41.1%; p

The University of Michigan National Poll on Healthy Aging contracted with GfK to conduct an online survey in April 2017 to a national, probability-based sample of U.S. adults age 50–64 (n=1,066, completion rate=75%). Sixty percent reported getting regular dental care, but 23% only received care for serious dental problems. Those with dental coverage (72%) were more likely to receive regular preventive care and report good oral health. One-third reported feeling embarrassed about the condition of their teeth; 27% delayed or did not get needed care in the past two years. More than half indicated they do not know how they will get dental insurance when they become eligible for Medicare, and 13% assumed they would have dental coverage through Medicaid or Medicare. Policymakers and clinicians should consider the likelihood and implications of a loss of dental coverage among older adults on oral health and access to care.

Ageism can manifest in a variety of ways including in institutional policies and practices, interpersonal interactions, older adults’ internalization of ageist stereotypes, and through the media. While major incidents of age-based discrimination and their negative effects on health are more recognized, older adults also experience less momentous, but still harmful ageism in their day-to-day lives. These types of everyday ageism are also harmful to health. This symposium will highlight recent research from the University of Michigan National Poll on Healthy Aging on self-reported experiences of everyday ageism among a nationally representative sample of U.S. adults age50-80 and its connections to physical and mental health outcomes. Next, another researcher also using data from the National Poll on Healthy Aging will explore the prevalence of positive attributes of aging, its relationships to health, and ways in which it may buffer older adults from the adverse health consequences of ageism. Then speakers will highlight the Reframing Aging initiative and the ways in which GSA and other organizations are leading a national effort to address ageism through education and dissemination of research-based resources. This session will feature research, education, and advocacy efforts and will focus on the policy implications of efforts to better understand the prevalence of and strategies to counter the effects of ageism.

This study examined the prevalence of everyday ageism, routine types of age-based discrimination, prejudice, and stereotyping that older adults encounter in their daily lives, and its relationships with health in a nationally representative sample age 50-80 (N=2,048, 52% female, 71% White). Nearly all older adults said they sometimes or often experienced everyday ageism (96% age 65-80, 92% age 50-64). The most common types were beliefs that health problems were an inevitable part of getting older (78%), hearing jokes about aging/older people (61%), and seeing material suggesting that older adults were unattractive/undesirable (38%). Those reporting more experiences with everyday ageism (>3 types) were less likely than those reporting fewer types to have excellent/very good physical health (31% vs. 50%); similar results were found for mental health (60% vs. 80%). This poll documented the ubiquity of minor, but not inconsequential, everyday ageism reported by older adults and its potential ramifications for health.

The fourth speaker is Dr. Erica Solway. Dr. Solway will discuss her experience working in policy at the federal level as a Health and Aging Policy Fellow and a policy advisor with the U.S. Senate Committee on Health, Education, Labor, and Pensions Subcommittee on Primary Health and Aging and in her current involvement in policy-relevant research at the state and national level at the University of Michigan Institute for Healthcare Policy & Innovation. Dr. Solway is a senior project manager forthe evaluation of the Healthy Michigan Plan, Michigan’s Medicaid expansion program, and is also an associate director of the University of Michigan National Poll on Healthy Aging.