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Background: Frailty is multifactorial; however, psychosocial stressors contributing to frailty are poorly understood. This study aimed to examine whether gender, race/ ethnicity, and education are associated with differential exposure to psychosocial stressors, determine psychosocial stressors contributing to frailty, and explore the mediating psychosocial stressors pathway. Methods: This cross‐sectional study involved 7679 community‐dwelling older adults (≥65) from the Health and Retirement Study (2006 and 2008 waves). Psychosocial stressors such as loneliness, low subjective social status, financial strain, poor neighborhood cohesion, everyday discrimination, and traumatic life events were measured. Frailty was defined by the Fried phenotype measure. Multivariable logistic regressions were used to examine the association of gender, race/ethnicity, and education with psychosocial stressors, psychosocial stressors associated with frailty, and the mediating psychosocial stressors pathway. Results: Females experienced greater financial strain but lower discrimination (both p < 0.05). Older adults who identified as Hispanic, Black, and racially or ethnically minoritized experienced low subjective social status, high financial strain, low neighborhood cohesion, and high discrimination than their White counterparts (all p < 0.05). Those with lower education experienced high loneliness, low subjective social status, high financial strain, low neighborhood cohesion but lower traumatic life events (all p < 0.05). Psychosocial stressors: High loneliness, low subjective social status, high financial strain, and low neighborhood cohesion (all p < 0.05) independently increased the odds of frailty. The mediating pathway of psychosocial stressors was not significant. Conclusion: Disparities exist in exposure to psychosocial stressors associated with frailty. Multilevel interventions are needed to reduce the influence of psychosocial stressors on frailty. [ABSTRACT FROM AUTHOR]

Purpose of the study: The primary aim of this investigation was to determine whether caregiver confidence in their care recipients' functional capabilities predicts changes in the performance of activities of daily living (ADL) among elderly home care recipients. A secondary aim was to explore how caregiver confidence and care recipient functional self-efficacy jointly influence changes in ADL performance over time. Design and Methods: The sample included 5,138 elderly recipients of home and community-based long-term care in Michigan. ADL performance was assessed multiple times over a 2-year period. Caregiver confidence was measured at baseline with a single item. Multilevel modeling was used to estimate the effect of caregiver confidence on changes in ADL performance over time, controlling for baseline self-efficacy, ADL performance, and other factors that might confound the relationship. Based on caregiver confidence and elder self-efficacy, we created 4 groups of elder caregiver dyads to explore the combined effect of caregiver and elder confidence on change in ADL performance. Results: Elders whose caregivers were confident in their capacity for greater functional independence experienced greater improvement in ADL performance than those whose caregivers were not confident. Elders in dyads in which both members expressed confidence experienced more improvement in ADL performance than those in dyads in which either one or both members lacked confidence. Implications: Interventions to strengthen caregivers' confidence in their care recipients' functional capabilities may slow functional losses among home care elders. Additional research is needed to confirm these findings and identify the factors that influence caregiver confidence.

Objectives To examine the association between prepandemic social integration and posttraumatic stress disorder (PTSD) symptoms during the coronavirus disease 2019 (COVID-19) pandemic and test whether the association is mediated by social support received and social events missed during the pandemic. We also explored age, race, gender, and socioeconomic differences in the association. Methods We adopted a prospective design. Path analysis was conducted using data from the COVID-19 supplement (2020) and the 2019 wave of the National Health and Aging Trends Study (NHATS). The sample represents Medicare beneficiaries aged 70 years and older (N  = 2,694). Social integration was measured using a six-item index. A standardized scale assessed PTSD symptoms. Both social support received and social events missed were single-item measures. The analysis controlled for sociodemographic characteristics, prepandemic physical and mental health, and coronavirus exposure during the pandemic. Results Prepandemic social integration was positively associated with PTSD symptoms during the pandemic. The association was primarily mediated by social events missed—high levels of prepandemic social integration were associated with missing more social events during the pandemic resulting in more PTSD symptoms. Social support received was also a mediator—social integration was positively associated with social support received during the pandemic, with more received support associated with greater PTSD symptoms. Prepandemic social integration had no significant direct effect on PTSD symptoms. The direct, indirect, and total effects of social integration on PTSD symptoms did not significantly differ by age, race, gender, education, or poverty status. Discussion Social integration may carry mental health risks in times of infectious disease outbreaks. [ABSTRACT FROM AUTHOR]

Objectives. To estimate the prevalence of successful aging in the United States, with the broad aim of contributing to the dialogue on Rowe and Kahn's concept of successful aging, Methods. Using data from the Health and Retirement Study. the prevalence of successful aging was calculated for adults aged 65 years and older at four time points: 1998, 2000, 2002, and 2004. Successful aging was operationalized in accordance with Rowe and Kahn's definition, which encompasses disease and disability, cognitive and physical functioning, social connections, and productive activities. Results. No greater than 11.9% of older adults were aging 'successfully' in any year. The adjusted odds of successful aging were generally lower for those of advanced age. male gender, and lower socioeconomic status. Between 1998 and 2004, the odds of successful aging declined by 25%, after accounting for demographic changes in the older population. Discussion. Few older adults meet the criteria put forth in Rowe and Kahn's definition of successful aging, suggesting the need for modification if the concept is to be used for broad public health purposes. Disparities in successful aging were evident for socially defined subgroups, highlighting the importance of structural factors in enabling successful aging. Key Words: Health disparities--Healthy aging--Prevalence--Successful aging. doi: 10.1093/geronb/gbp101

This study aims to evaluate factors associated with health care utilization (HCU) and to assess vertical and horizontal equity in utilization among Nepali older adults. Data are from an existing cross-sectional study involving systematic random sampling of 260 older adults in Far-Western (Sudurpaschim) Province of Nepal. Andersen's theoretical framework was used to assess predisposing, enabling, and need factors that have the potential to influence health care utilization. Multivariable logistic regression analyses were conducted to examine potential correlates of HCU. Horizontal and vertical equity were assessed using concentration curve and index. More than one-third of participants had not visited a health facility in the prior 12 months. Nine in 10 participants did not know about the government's free health service for older adults. Joint/extended family type, Ayurvedic/Homeopathic health care preference, higher-income tertile, and presence of chronic conditions were associated with higher odds of health care utilization in adjusted analyses. The concentration curve for HCU lies below the line of equity, and the subsequent index is positive, indicating that HCU was concentrated among richer individuals. If the government of Nepal is to achieve its goal of universal health care, the existing pro-rich inequity in HCU needs to be addressed. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to examine the relationship between psychological well-being (PWB) and cognitive function in older adults in China. Methods: Data are from the Chinese Longitudinal Healthy Longevity Survey. Analyses were restricted to 9,487 older persons (age ≥ 60) without cognitive impairment at baseline. Respondents were followed over a 12-year period. Cognitive function was assessed using the Chinese version of the Mini-Mental State Examination (C-MMSE). PWB was assessed using a composite index capturing optimism, conscientiousness, neuroticism, loneliness, personal control, self-esteem, and happiness. Results: Multilevel mixed effects generalized linear models showed that respondents with greater PWB had a slower rate of cognitive decline over time, adjusting for sociodemographic and health characteristics. In addition, multilevel multinomial logistic regression models showed that greater PWB was associated with lower odds of developing cognitive impairment. Conclusions: Findings suggest that fostering PWB may prevent or delay adverse cognitive changes. [ABSTRACT FROM AUTHOR]

Objectives: We examined the associations of aspects of the immigrant experience—acculturation, neighborhood belonging, and perceived discrimination—with healthy aging in older Chinese Americans and explored whether the associations vary by age and gender. Method: The sample included 3,056 older Chinese Americans. Healthy aging was defined as no disability, no cognitive impairment, and high physical functioning, coded dichotomously (1 = meets all criteria, 0 = otherwise). Acculturation, neighborhood belonging, and perceived discrimination were measured using standardized scales. Results: About 31% of the sample experienced healthy aging. Acculturation was positively associated with healthy aging, with stronger associations in older age and women. A greater sense of neighborhood belonging was associated with higher odds of healthy aging; experiences of discrimination were associated with lower odds. Discussion: Interventions to promote healthy aging in Chinese Americans are needed. Programs that support immigrants with low acculturation levels, strengthen immigrants' connectedness to their neighbors, and promote inclusiveness may improve population health. [ABSTRACT FROM AUTHOR]

We investigated the relationship between driving status and religious service attendance among older Americans and how the perceived importance of religion influences the relationship. Data are from the 2012 wave of the Health and Retirement Study (n = 9,660). After controlling for covariates, the odds of regular religious service attendance were reduced by 55% for non-drivers relative to active drivers among those who indicated that religion was very important in their lives. No significant association was observed in those who rated religion as somewhat/not too important. Future research should explore how non-drivers who value religion make decisions about religious service attendance. [ABSTRACT FROM AUTHOR]

The objectives of this investigation were to identify a valid and practical benchmark for the assessment of healthy aging in the Chinese population and examine its socio-structural correlates. Using data from the 2011 China Health and Retirement Longitudinal Study, we investigated the validity of a continuum of healthy aging definitions. We found that definitions of healthy aging that emphasize disease of "significance" and functional health offer a valid and practical approach to the assessment of healthy aging. Results of multilevel logistic regression analyses indicate that socio-structural characteristics of individuals (age, gender, education, and pension status), their households (structure and wealth), and communities (infrastructure and geographic region) are significantly associated with the odds of healthy aging. Policy-level interventions are needed to enable individuals, regardless of their gender, socioeconomic status, and place of residence to experience a healthy old age. [ABSTRACT FROM AUTHOR]

Animal-assisted activity programs are commonly used in long-term care facilities to enhance the well-being of older residents. Although research suggests that older adults benefit from these programs, little is known about the experience from the perspective of older adults themselves. In this qualitative study, we used direct observation and in-depth interviews to gain an understanding of the experience of participating in a unique rabbit-assisted activity program delivered in a Midwestern residential facility. Several benefits were identified, with no negative experiences articulated by the participants. In addition to finding the rabbits soothing, the rabbits served as a source of social support for some participants and encouraged social interaction. Participants generally felt that rabbits are good animals to use for this type of activity, but expressed a desire for more frequent, longer, and more interactive visits. Facilities considering animal-assisted activities (AAA) programs should consider these factors when designing their programs. [ABSTRACT FROM AUTHOR]

Purpose of the Study: Using an operational continuum of healthy aging developed by U.S. researchers, we sought to estimate the prevalence of healthy aging among older Spaniards, inform the development of a definition of healthy aging in Spain, and foster cross-national research on healthy aging. Design and Methods: The ELES pilot study is a nationwide, cross-sectional survey of community-dwelling Spaniards 50 years and older. The prevalence of healthy aging was calculated for the 65 and over population using varying definitions. To evaluate their validity, we examined the association of healthy aging with the 8 foot up & go test, quality of life scores and self-perceived health using multiple linear and logistic regression. Results: The estimated prevalence of healthy aging varied across the operational continuum, from 4.5% to 49.2%. Prevalence figures were greater for men and those aged 65 to 79 years and were higher than in the United States. Predicted mean physical performance scores were similar for 3 of the 4 definitions, suggesting that stringent definitions of healthy aging offer little advantage over a more moderate one. Implications: Similar to U.S. researchers, we recommend a definition of healthy aging that incorporates measures of functional health and limiting disease as opposed to definitions requiring the absence of all disease in studies designed to assess the effect of policy initiatives on healthy aging. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to examine the correlates of healthy aging in the context of educational disadvantage and the extent to which identified correlates are shared with the wider, more educationally advantaged population. Method: Data are from the 2012 Health and Retirement Study. The analytic sample included 17,484 self-respondents ≥50 years of age. Educational disadvantage was defined as having less than a high school diploma. Using logistic regression, healthy aging was regressed on demographic, early-life, and health-related factors by educational status. Results: Among educationally disadvantaged adults, demographic characteristics (e.g., age), health practices (e.g., physical activity), and the presence of health conditions were independently correlated with healthy aging. With few exceptions, correlates of healthy aging were similar among educationally advantaged and disadvantaged adults. Discussion: Ordinary factors are associated with healthy aging among adults without a high school diploma, suggesting that healthy aging is possible for larger numbers of adults aging in the context of educational disadvantage. [ABSTRACT FROM AUTHOR]

Objective: The primary objective of this study was to examine gender differences in engagement in physical activity over time among older U.S. adults with diabetes. Method: Using data from the Health and Retirement Study, we investigated physical activity between 2004 and 2010 among 1,857 adults aged 65 years and above with diabetes. Results: Less than half of adults were physically active at baseline. The probability of physical activity declined over the 6-year period, with no significant gender variation in the effect of time. Because the odds of physical activity were lower for women at baseline and the effect of time did not vary by gender, the trajectory of physical activity was less favorable for women than men. Discussion: The women in this cohort of older Americans started and remained less active than their male counterparts. Investigations covering a larger portion of the life course and those examining the impact of life events and transitions on physical activity among adults with diabetes are needed. [ABSTRACT FROM AUTHOR]