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Purpose: Social contact is known to be vital for older adults' mental and physical health but, because communication impairments often co-occur with other types of disability, it is difficult to generalize about the relative impact of a communication impairment on the social relationships of older adults. Specific aims of the study were to examine whether the severity of a communication impairment was associated with a range of social measures and to examine the association between these characteristics and psychological well-being. Method: Community-dwelling older adults ranging in age from 65 to 94 were recruited for the study of Communication, Health, Aging, Relationship Types and Support. The sample included 240 participants with communication disorders arising from a variety of etiologies including hearing impairment, voice disorders, head and neck cancer, and neurologic disease, as well as older adults without a communication disorder. Results: Communication impairment was a significant independent predictor for key characteristics of social relationships, including the number of friends in the social network, two types of social support, the frequency of social participation, and social self-efficacy. Communication impairment was also a significant predictor for higher levels of loneliness and depression. In addition, two distinct pathways between communication impairment and psychological well-being were identified, with social self-efficacy and reassurance of worth as mediators. Conclusions: Even after controlling for age, gender, health, and disability, communication impairment is a significant independent predictor for key aspects of the social function of older adults and demonstrates two distinct pathways to loneliness and depression.

Background The rapidly growing field of multimorbidity research demonstrates that changes in multimorbidity in mid- and late-life have far reaching effects on important person-centered outcomes, such as health-related quality of life. However, there are few organizing frameworks and comparatively little work weighing the merits and limitations of various quantitative methods applied to the longitudinal study of multimorbidity. Methods We identify and discuss methods aligned to specific research objectives with the goals of (i) establishing a common language for assessing longitudinal changes in multimorbidity, (ii) illuminating gaps in our knowledge regarding multimorbidity progression and critical periods of change, and (iii) informing research to identify groups that experience different rates and divergent etiological pathways of disease progression linked to deterioration in important health-related outcomes. Results We review practical issues in the measurement of multimorbidity, longitudinal analysis of health-related data, operationalizing change over time, and discuss methods that align with 4 general typologies for research objectives in the longitudinal study of multimorbidity: (i) examine individual change in multimorbidity, (ii) identify subgroups that follow similar trajectories of multimorbidity progression, (iii) understand when, how, and why individuals or groups shift to more advanced stages of multimorbidity, and (iv) examine the coprogression of multimorbidity with key health domains. Conclusions This work encourages a systematic approach to the quantitative study of change in multimorbidity and provides a valuable resource for researchers working to measure and minimize the deleterious effects of multimorbidity on aging populations. [ABSTRACT FROM AUTHOR]

UnlabelledHealthy social relationships are important for maintaining mental and physical health in later life. Less social support, smaller social networks, and more negative social interactions have been linked to depression, poorer immune functioning, lower self-rated health, increased incidence of disease, and higher mortality. Overwhelming evidence suggests that communication disorders adversely affect social relationships. Much less is known about whether some or all aspects of social relationships are negatively affected by a communication disorder. The relative impact of a communication disorder on social relationships, as compared to other kinds of disability, is also poorly understood. Data were analyzed from a representative national sample of community-dwelling adults aged 65 and older living in the continental United States (n=742). Results from multiple regressions indicated that difficulty communicating was significantly associated with several parameters of social relationships even after controlling for age, gender, partnership status, health, functional limitations, and visual impairment. Communication difficulty was a significant predictor of smaller social network size, fewer positive social exchanges, less frequent participation in social activities, and higher levels of loneliness, but was not a significant predictor of negative social exchanges. These findings suggest that communication disorders may place older adults at increased risk for mental and physical health problems because of social isolation, reduced social participation, and higher rates of loneliness. In addition, it appears that communication disorders may have a greater impact on positive, rather than negative, aspects of social relationships.Learning outcomesAs a result of this activity, the following learning outcomes will be realized: Readers will be able to (1) describe changes in the social relationships of older adults that occur as part of normal aging, (2) identify the aspects of social relationships that were significantly impacted by a communication difficulty, and (3) discuss possible reasons for these findings including potential clinical implications.

Those new to structural equation modeling (SEM) often encounter problems with convergence, software errors, or poor fitting models. Some basic suggestions are offered to help reduce these problems and avoid some common error messages encountered when first testing models. The tips concern initial data management steps, specification of latent variables, avoidance of factor identification problems, special precautions when estimating means, addressing poor measurement model fit, using multistep testing, fitting full structural models, attentiveness to interpretation pitfalls, and troubleshooting software warnings and errors. The advice provided is intended to help save time, effort, and trials and tribulations often encountered by beginner modelers. [ABSTRACT FROM AUTHOR]

There are few (if any) population-based prospective studies that provide information on factors associated with temporal sequencing of suicide. In this prospective population-based study, the National Health Interview Survey (NHIS), 1986-1994, was linked to the National Death Index (NDI), 1986-1997, to assess factors that predict recent (within 12 months of interview, termed "sooner") suicide versus suicide further in the future (more than 12 months after interview, termed "later"). Of the 653 completed suicides in the NHIS cohort, 13.4 percent completed suicide within a year of interview, and 86.6 percent did so after a year. Sooner decedents were more likely to be White, less educated, unemployed, and to use firearms than any other method compared with later decedents. Surprisingly, sooner decedents had higher levels of self-rated health at baseline. These results have substantial implications for clinicians and other professionals who interact with people at highest risk of suicide. Unfortunately, it may be unrealistic to expect that health care providers can modify the behavior of individuals at highest risk of suicide.

Many topics in aging research address questions about group differences in prediction. Such questions can be viewed in terms of interaction or moderator effects, and use of appropriate methods to test these hypotheses are necessary to arrive at accurate conclusions about age differences. This article discusses the conceptual, methodological, and statistical problems in one approach to investigating moderator hypotheses. The subgroup regression approach, in which separate regression analyses are conducted in two or more groups, is widely used in aging research to examine group differences in prediction, but the approach can lead to erroneous conclusions. The moderated regression approach, involving the test of a product term, is described and recommended as an a alternative approach. The question of whether social support has greater beneficial effects for younger or older adults is investigated in a study of 287 recently-bereaved adults ranging in age from 20 to 91. Using the subgroup approach, findings indicated that social support significantly predicted depressive symptoms among younger adults and did not significantly predict depressive symptoms among older adults. The moderated regression analysis, however, indicated no significant age differences in the effect of social support. These results clearly illustrate that the analysis strategy researchers choose may have important bearing on theory in aging research such as conclusions regarding the role of social support across the life span. (Contains 1 figure and 2 tables.)

Proposes a novel structural modeling approach based on latent growth curve model specifications for use with dyadic data. The approach allows researchers to test more sophisticated causal models, incorporate latent variables, and estimate more complex error structures than is currently possible using hierarchical linear modeling or multilevel structural equation models. (SLD)

Objectives Studies report racial/ethnic disparities in multimorbidity (≥2 chronic conditions) and their rate of accumulation over time as well as differences in physical activity. Our study aimed to investigate whether racial/ethnic differences in the accumulation of multimorbidity were mediated by physical activity among middle-aged and older adults. Method We assessed racial/ethnic differences in the accumulation of multimorbidity (of 9 conditions) over 12 years (2004–2016) in the Health and Retirement Study (N = 18,264, mean age = 64.4 years). Structural equation modeling was used to estimate latent growth curve models of changes in multimorbidity and investigate whether the relationship of race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White participants) to changes in the number of chronic conditions was mediated by physical activity after controlling for age, sex, education, marital status, household wealth, insurance coverage, smoking, alcohol, and body weight. Results There was a significant increase in multimorbidity over time. Initial levels and changes in multimorbidity over time varied significantly across individuals. Indirect effects of the relationship between race/ethnicity and changes in multimorbidity as mediated by physical activity were significant, consistent with the mediational hypothesis. Black respondents engaged in significantly lower levels of physical activity than White respondents after controlling for covariates, but there were no differences between Hispanic and White respondents once education was included. Discussion: These results provide important new information for understanding how modifiable lifestyle factors may help explain disparities in multimorbidity in mid-to-late life, suggesting greater need to intervene to reduce sedentary behavior and increase physical activity. [ABSTRACT FROM AUTHOR]

Three hypotheses concerning negative social interaction in later life were evaluated in this study. First, it was predicted that greater personal economic difficulty is associated with more frequent negative social interaction with social network members in general. Secondly, it was proposed that more frequent negative social interaction exacerbates the undesirable effect of personal financial strain on change in self-rated health during late life. Thirdly, an effort was made to see if some types of negative social interaction, but not others, accentuate the undesirable effects of personal economic problems on self-rated health. Data from two nationwide longitudinal surveys that were conducted in the United States revealed that greater personal financial difficulty is associated with more interpersonal conflict. The findings further indicate that the undesirable effects of personal economic difficulty on change in self-rated health are more pronounced at progressively higher levels of negative social interaction. Finally, the data suggest that one form of negative social interaction (not getting help when it is expected) is more likely to intensify the unwanted effects of personal financial strain on self-rated health than other types of negative social interaction. KEY WORDS--financial strain, negative social interaction, health.

Objectives. Various aspects of one's social ties are thought to influence the onset, progression, and course of disability in older adulthood. Although the longitudinal course of social ties and physical disability is likely to be marked by fluctuations over time and intraindividual variation, few studies have explored how patterns of change in positive and negative social exchanges relate to patterns of change in disability across time. The current study, therefore, examined the extent to which distinct longitudinal trajectories of positive and negative exchanges were associated with patterns of physical disability. Methods. We followed a sample of 482 community-dwelling older adults with little to no disability at baseline for 2 years. Results. Results identified multiple, distinct trajectory groups for positive and negative exchanges and disability. Latent class growth analyses revealed that individuals with chronically high or low positive exchanges were likely to experience low and increasing levels of disability. With respect to negative exchanges, individuals with moderately increasing negative exchanges showed patterns of increasing disability and disability remission, whereas chronically low or absent negative exchanges were associated with low and increasing levels of disability. Discussion. Findings highlight the importance of evaluating multiple trajectories of change in older adults' social exchanges and disability.

Objectives. Negative social exchanges detract considerably from older adults' emotional health, but little is known about the specific factors that make some older adults more vulnerable than others to such exchanges. This study examined whether stressful life experiences compound the impact of negative social exchanges on emotional distress. We examined both linear and nonlinear models of the joint effects of negative social exchanges and stressful life experiences. Methods. In-person interviews took place with a representative sample of 916 noninstitutionalized older adults. We examined linear and nonlinear models for three classes of stressful life experiences (relationship losses, disruptive events, and functional impairment). Results. Regression analyses that included first-order and second-order interaction temps revealed a linear pattern for loss events and functional impairment, and a nonlinear pattern for disruptive events. Discussion. This study suggests that negative social exchanges and stressful life experiences jointly affect emotional distress, but the particular nature of the joint effects varies by type and level of stressor. Negative social exchanges appear to have more severe effects in the context of some stressors but less severe effects in the context of other stressors.

The purpose of this study was to assess the independent association of physical illness and functional limitations with suicide mortality risk. The Cox proportional hazards model was used with data from the 1986-1994 National Health Interview Survey linked to the 1986-1997 National Death Index to analyze the effects of chronic physical illness and functional limitations on suicide deaths (ICD-9 E950-959). After controlling for potential confounders at baseline, functional limitations were shown to be a significant predictor of suicide. Also, psychiatric comorbidity increased the risk of completing suicide. Interestingly, chronic conditions alone were not predictive of suicide completion when functional limitation was added to the model. Implications for the clinical management of suicidal behavior among patients with chronic conditions are discussed. Keywords: suicide, physical illness, functional limitation, epidemiology, prospective study

Negative social exchanges have been more reliably related to psychological health than have positive social exchanges. Little research, however, has sought to understand how underlying appraisal processes link such exchanges to psychological health. This study examined the frequencies of occurrence and appraisals of four parallel domains of positive and negative exchanges in relation to positive well-being and psychological distress in a national sample of 916 older adults. Structural equation analyses revealed that negative exchanges were related both to less well-being and greater psychological distress, whereas positive exchanges were related only to positive well-being. Furthermore, results supported a process in which appraisals mediated the link between social exchanges and psychological health. This social appraisal process helps explain the disproportionate impact of negative exchanges on psychological health.

Little research exists on the effects of the utilization of workplace supports on work--family conflict and job satisfaction. With family systems theory as a framework, 2 waves of national survey data were collected from 234 couples (N = 468) caring for children and for aging parents. Data were analyzed with structural equation modeling techniques. Longitudinal results indicate that individuals' use of workplace supports was related to work-family conflict in the direction opposite to expectations and was related to job satisfaction in the direction consistent with expectations. Differential effects for wives versus husbands were found. In addition, couples' use of workplace supports was only minimally related to wives' outcomes. Results are discussed in terms of gender differences, family systems theory, and methodological and measurement issues related to the longitudinal study of utilization of workplace supports. Keywords: work--family conflict, workplace supports, family-friendly supports, dual-earner couples

Analysis of over 250,000 respondents from four of the largest epidemiological surveys in North America indicates that major health behaviors are largely unrelated to one another. On average, the percentage of shared variance among smoking, exercise, diet and alcohol consumption is approximately 1%. While many of these relationships are statistically significant, suggesting that the associations are nonzero in the population, they represent minute effect sizes. The weak associations among these behaviors are unlikely to be due to incorrect functional form of the relationship, measurement error, or biases in responding. The findings have implications for health behavior theories and interventions predicated on the notion that the health conscious individual attempts to improve his or her health by engaging in more than one of these behaviors at a time. Keywords: Health behaviors; Health consciousness; Alcohol; Smoking; Exercise; Diet; North America

Background. The prevalence of obesity among elderly persons in industrialized countries ranges from 15% to 20%. Little is known about variations of overweight within subgroups of the elderly population. This study examined the factors associated with overweight and obesity among older men and women. Methods. Data for 12,823 community-dwelling persons aged 65 and older from the 1996-1997 Canadian National Population Health Survey were examined. Predictors of overweight (body mass index [BMI] = 25.0-29.9 kg/[m.sup.2]) and obesity (BMI = > 30 kg/[m.sup.2]) relative to normal weight (BMI = 20.0-24.9 kg/[m.sup.2]) were examined using logistic regression analyses. Analyses were stratified by gender. The predictor variables included age, education, marital status, place of birth, region, smoking status, alcohol use, chronic conditions, physical activity, functional limitations, self-rated health, social support, and psychological distress. Results. Overall, 39% and 13% of Canadian older adults were classified as overweight and obese, respectively. Some of the risk factors for overweight were male gender, low education, being married, Canadian born, residence in the Atlantic provinces, no use of alcohol, comorbidity, physical inactivity, and limited functional status. Risk factors for obesity were similar to those for overweight except for being unmarried; American, European, and Australian born; lower and higher levels of alcohol use; poor self-rated health; and psychological distress. Conclusions. The results could lead to more effective weight-control interventions that are designed to promote increased physical activity and healthy eating habits among obese older individuals.

This study investigated whether perceived physical activity norms moderated the effects of physical activity-related social interactions on intentions to engage in physical activity among community-residing older adults (N = 217). Structural equation modeling tested whether two types of social support and social control interacted with personal norms in predicting intentions to be active. Emotional and informational support were associated with higher intentions, and negative social control was associated with lower intentions to engage in activity. Each of these effects was more prominent in the context of weak personal norms, suggesting future research and interventions should consider joint effects of support and norms. [ABSTRACT FROM AUTHOR]

Background: Obesity and multimorbidity are more prevalent among U.S. racial/ethnic minority groups. Evaluating racial/ethnic disparities in disease accumulation according to body mass index (BMI) may guide interventions to reduce multimorbidity burden in vulnerable racial/ethnic groups.Method: We used data from the 1998-2016 Health and Retirement Study on 8 106 participants aged 51-55 at baseline. Disease burden and multimorbidity (≥2 co-occurring diseases) were assessed using 7 chronic diseases: arthritis, cancer, heart disease, diabetes, hypertension, lung disease, and stroke. Four BMI categories were defined per convention: normal, overweight, obese class 1, and obese class 2/3. Generalized estimating equations models with inverse probability weights estimated the accumulation of chronic diseases.Results: Overweight and obesity were more prevalent in non-Hispanic Black (82.3%) and Hispanic (78.9%) than non-Hispanic White (70.9 %) participants at baseline. The baseline burden of disease was similar across BMI categories, but disease accumulation was faster in the obese class 2/3 and marginally in the obese class 1 categories compared with normal BMI. Black participants across BMI categories had a higher initial burden and faster accumulation of disease over time, while Hispanics had a lower initial burden and similar rate of accumulation, compared with Whites. Black participants, including those with normal BMI, reach the multimorbidity threshold 5-6 years earlier compared with White participants.Conclusions: Controlling weight and reducing obesity early in the lifecourse may slow the progression of multimorbidity in later life. Further investigations are needed to identify the factors responsible for the early and progressing nature of multimorbidity in Blacks of nonobese weight. [ABSTRACT FROM AUTHOR]

Background. Approximately 12% of the North American population aged 65 and older smoke cigarettes daily. Late-life smokers represent an important population for intervention by health practitioners. The objective of this study was to determine the extent to which contact with health practitioners (dentists or physicians) affects smoking status among older adults. Methods. We used data on a probability-based sample of community-dwelling elderly respondents (N = 13,363) from the Canadian 1996-1997 National Population Health Survey. Descriptive statistics were calculated, and multivariate logistic regression analysis was performed to examine the associations between current tobacco use and contact with health care practitioners controlling for potential confounders, especially sociodemographic characteristics, selected health conditions, self-reported health, body mass index, functional status, perceived social support, and psychological distress. Results. Older adults without a regular physician (adjusted odds ratio [AOR], 1.33; 95% confidence interval [CI], 1.11-1.59), with infrequent physical (AOR, 1.22; 95% CI, 1.07-1.40), and dental (AOR, 2.68; 95% CI, 2.07-3.47) checkups were more likely to be current smokers. Age (younger), church attendance (infrequent), drinking behavior (former or occasional), body mass index (normal weight), and psychological distress were all independently related to current smoking. Conclusions. Results indicate that patients' contact with health care providers is strongly negatively associated with smoking. More specific data are needed to learn the frequency with which physicians and dental professionals attempt to modify older individuals' smoking behavior and the degree to which such efforts are effective.