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The author examines the history of the journal "The Gerontologist" (TG) and some of the significant lines of scholarship that have emerged from its issues over six decades. Highlights include the goal of TG to publish multidisciplinary scholarship, the enactment of the Older Americans Act by U.S. President Lyndon B. Johnson in the early 1960s, and a report about the value of research for solving the problems of aging.

Background and Objectives Population aging has led to an increased interest in cognitive health and, in particular, the role that stress plays in cognitive disparities. This paper extends previous work by characterizing coronavirus disease 2019 (COVID-19) stress type prevalence and its association with cognitive health in metro-Detroit among Black, Middle Eastern/Arab (MENA), and White older adults. Research Design and Methods Data come from a regionally representative sample of adults aged 65+ in metro-Detroit (N = 600; MENA n = 199; Black n = 205; White n = 196). We used generalized linear models to compare groups on sociodemographic, objective stress, and social stress indicators. Multiple group structural equation models evaluated whether COVID-19 stress predicted cognitive health and whether that association varied across racial/ethnic groups. Results MENA and Black older adults reported higher levels of objective stress than Whites. There were no racial/ethnic group differences in social stress. More objective stress was associated with better cognitive health, and more social stress was associated with worse cognitive health. The positive effect of objective stress was especially apparent for White older adults. Discussion and Implications Though it appears that minority stress was not exacerbated in the context of pandemic stress, links between greater objective stress and better cognitive health apparent among White older adults were not evident among MENA or Black older adults. Broadening health disparities research by including underrepresented populations allows us to elevate scientific knowledge by clarifying what is universal and what is unique about the stress process. [ABSTRACT FROM AUTHOR]

Background and Objectives Licensed nursing home administrators (NHA) and directors of nursing (DON) are responsible for nursing home quality and assuring optimal performance and job satisfaction/retention of their nursing home workforce. NHA/DON-focused studies have generated important foundational knowledge over the last three decades; yet, targeted research is needed to understand and apply the complexities of the black box of this top management team. This scoping review identifies, reviews, synthesizes, and maps the topical areas of research in NHA/DON positions in U.S. nursing homes. Research Design and Methods We conducted searches of 5 databases, yielding 3,479 records; screening/review yielded 88 unique records. We used thematic analysis to code the primary foci of the studies and the variables associated with the concepts of interest. Results Most papers (n = 40) focused on role characteristics, 23 examined approaches to management and leadership, 24 focused on perceptions about the role, and the remaining 12 examined role structure. The role-related themes linked to outcomes (n = 42), processes (n = 27), and structures (n = 30). Discussion and Implications We highlight important gaps for future research and offer a call to action for research, policy, practice, and education collaborations to accelerate the rate of research and translate the findings into best practices for NHA/DON to lead and manage the nursing home workforce and build capacity to ensure person-centered, high-quality care. Based on foundational descriptive studies, it is time to use what is known to design and implement interventions that enhance the capacity of NHA/DON to improve the structures, processes, and outcomes of nursing homes. [ABSTRACT FROM AUTHOR]

Background and Objectives Evidence-based practices to manage distress behaviors in dementia (DBD) are not consistently implemented despite demonstrated effectiveness. The Veterans Health Administration (VA) trained teams to implement Staff Training in Assisted Living Residences (STAR)-VA, an intervention to manage DBD in VA nursing home settings, or Community Living Centers (CLCs). This paper summarizes multiyear formative evaluation results including challenges, adaptations, and lessons learned to support sustained integration into usual care across CLCs nationwide. Research Design and Methods STAR was selected as an evidence-based practice for DBD, adapted for and piloted in VA (STAR-VA), and implemented through a train-the-trainer program from 2013 to 2018. Training and consultation were provided to 92 CLC teams. Evaluation before and after training and consultation included descriptive statistics of measures of clinical impact and survey feedback from site teams regarding self-confidence, engagement, resource quality, and content analysis of implementation facilitators and challenges. Results STAR-VA training and consultation increased staff confidence and resulted in significant decreases in DBD, depression, anxiety, and agitation for Veterans engaged in the intervention. Implementation outcomes demonstrated feasibility and identified facilitators and barriers. Key findings were interpreted using implementation frameworks and informed subsequent modifications to sustain implementation. Discussion and Implications STAR-VA successfully prepared teams to manage DBD and resulted in improved outcomes. Lessons learned include importance of behavioral health–nursing partnerships, continuous engagement, iterative feedback and adaptations, and sustainment planning. Evaluation of sustainment factors has informed selection of implementation strategies to address sustainment barriers. Lessons learned have implications for integrating team-based practices into system-level practice. [ABSTRACT FROM AUTHOR]

Repeated claims that a dwindling supply of potential caregivers is creating a crisis in care for the U.S. aging population have not been well-grounded in empirical research. Concerns about the supply of family care do not adequately recognize factors that may modify the availability and willingness of family and friends to provide care to older persons in need of assistance or the increasing heterogeneity of the older population. In this paper, we set forth a framework that places family caregiving in the context of older adults' care needs, the alternatives available to them, and the outcomes of that care. We focus on care networks, rather than individuals, and discuss the demographic and social changes that may alter the formation of care networks in the future. Last, we identify research areas to prioritize in order to better support planning efforts to care for the aging U.S. population. [ABSTRACT FROM AUTHOR]

Background and Objectives Assisted living (AL) is a growing sector of the U.S. long-term care market, with its development driven largely by private market choices. However, consumers need information to choose the right AL community (ALC). This paper examined information available on U.S. state websites concerning ALC quality, costs, and services. Research Design and Methods Based on prior research and their analysis of a sample of state websites, researchers identified 39 key informational elements and grouped them into four categories, (a) ALC characteristics, (b) payment and services, (c) quality, and (d) website usability. Researchers then examined the presence of the 39 elements on 51 websites (U.S. states and the District of Columbia), meeting regularly to discuss findings and resolve differences. Results A majority of states provided basic information about individual ALCs (e.g. number of beds, ownership). Only 35% listed payment(s) accepted (e.g. Medicaid), and 31% indicated the availability of memory care. Nearly 70% posted inspection results, while only 43% provided information about complaints. Many met basic usability guidelines (e.g. type size), but locating content on many sites required multiple steps, and none met 5th-grade-or-below readability standards. Discussion and Implications A majority of websites provided important information, such as inspection results. However, many were lacking key elements concerning payment accepted and services. Finding what was available was burdensome. More work is needed to help states provide information that enables consumers to find ALCs that meet their needs. The lack of such information puts older adults at risk of inappropriate placements. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented which discusses various reports within the issue on topics including discrimination and cultural experiences of migrant workers in the aging care workforce, classes of transitions in relational attachment between parents and children, and how migrant workers experience discrimination from patients and from fellow workers from the majority culture.

Despite the documented and well-publicized health and well-being benefits of regular physical activity (PA), low rates of participation have persisted among American older adults. Peer-based intervention strategies may be an important component of PA interventions, yet there is inconsistent and overlapping terminology and a lack of clear frameworks to provide a general understanding of what peer-based programs are exactly and what they aim to accomplish in the current gerontological, health promotion literature. Therefore, a group of researchers from the Boston Roybal Center for Active Lifestyle Interventions (RALI) collaborated on this paper with the goals to: (a) propose a typology of peer-based intervention strategies for use in the PA promotion literature and a variety of modifiable design characteristics, (b) situate peer-based strategies within a broader conceptual framework, and (c) provide practice guidelines for designing, implementing, and reporting peer-based PA programs with older adults. We advance clarity and a common terminology and highlight key decision points that offer guidance for researchers and practitioners in using peers in their health promotions efforts, and anticipate that it will facilitate appropriate selection, application, and reporting of relevant approaches in future research and implementation work. [ABSTRACT FROM AUTHOR]

Background and Objectives Reverse mortgages are loans that allow older homeowners to borrow from their home equity with no repayment due until the borrower dies or moves out of the home. We currently know very little about how homeowners evaluate and experience reverse mortgages as solutions to their financial and housing needs in later life. Furthermore, despite an increasingly diverse population of reverse mortgage borrowers, we know little about how social inequalities may contribute to reverse mortgage decisions and their outcomes. In this paper, we examine reverse mortgage decision-making and experiences in a racially and economically diverse sample of older US homeowners. Research Design and Methods We conducted 44 in-depth interviews with older homeowners who were considering or who had obtained a reverse mortgage loan. We inductively and iteratively developed a thematic coding scheme that was applied to all interview transcripts. Results Our analysis produced a dichotomous schema of reverse mortgage decision making that was shaped by social and economic opportunities and constraints. For some participants, reverse mortgages represented strategic tools used to maximize home equity and its benefits. For others, it was an option of last resort to which participants turned when faced with the imminent loss of their home. Discussion and Implications Focusing on reverse mortgages, our analysis suggests way that social inequalities may be reproduced through financial decisions and the unequal landscapes of opportunity in which they are made. [ABSTRACT FROM AUTHOR]

Unnecessary hospitalizations of vulnerable nursing home (NH) residents can lead to hospital-acquired conditions, morbidity, mortality, and excess health care expenditures. Previous research has shown that a substantial percentage of these hospitalizations are preventable. Interventions to reduce acute care transfers (INTERACT) is a quality improvement program that has been adopted by many NHs throughout the United States. The original INTERACT toolkit was first created in a project supported by the Centers for Medicare and Medicaid Services. The toolkit was further refined and tested in a collaborative quality improvement project involving 30 NHs in 3 states, which resulted in a 17% reduction in all-cause hospitalizations. This study was limited because it was not randomized or controlled. Nevertheless, the data provide evidence that the program, even in the absence of strong regulatory oversight or financial incentives, is feasible to implement and that more active program engagement is associated with higher reductions in hospitalization. This paper describes dissemination of the INTERACT program using a pragmatic and relatively low cost model to prepare certified INTERACT Trainers in collaboration with several professional organizations. [ABSTRACT FROM AUTHOR]

According to the 2010 Census, 5.2 million people identified themselves as American Indian or Alaska Native (AIAN) in the United States. This was an increase of 39% from the prior Census, making AIANs one of the nation's fastest growing populations. The health and social programs reaching them, however, have experienced documented devastating shortfalls. Decades of inadequate resources have resulted in significant health and socioeconomic disparities. AIANs are often considered an "invisible minority." In 2012, there were 266,000 AIAN elders 65 or older who claimed one race alone. That number is projected to almost triple by 2030--when the nation's baby boomers move into the ranks of the older population. This article provides an overview of two primary mental health issues--depression and dementia--that will confront this emerging AIAN elder population. Although other health and social issues exist, this article addresses depression and dementia because they are hidden from the community and from health care agencies. This paper focuses both on the unique characteristics of the AIAN population and why it is important to address depression and dementia. The conclusion explores pragmatic policy recommendations for improving the health and long-term mental health care status of AIAN elders. [ABSTRACT FROM AUTHOR]

With an aging global population, the number of dementia cases is growing exponentially. To address the upcoming dementia crisis, the World Health Organization and Alzheimer's Disease International (2012) collaborated on an extensive report, Dementia: A Public Health Priority. In the United Kingdom, Prime Minster David Cameron initiated a national challenge on dementia, forming 3 dementia challenge champion groups aimed at improving health and care, creating dementia-friendly communities, and promoting dementia research. In the U.S., President Obama signed the National Alzheimer's Project Act, which led to the formation of the Advisory Council on Alzheimer's Research, Care, and Services and the launch of the first National Plan to Address Alzheimer's Disease. The term "dementia capable" was introduced in the 2012 Recommendations of the Public Members of the Advisory Council and has since been adopted in both the recommendations and annual updates of the national plan. This paper will first compare and contrast government usage of the concepts dementia friendly and dementia capable, along with another valuable concept, dementia positive, that was added after reviewing the literature. Finally, a new vision statement for the U.S.' national plan will be proposed and recommendations incorporating these 3 concepts in policy, research, and practice will be made. [ABSTRACT FROM AUTHOR]

This paper provides a template for the decade ahead regarding the delivery, supply, and funding of caregiver respite services. Policy changes are needed to address these issues as concerns about our country's ability to meet future caregiving needs are growing along with our aging population. Federal initiatives and state-level policies and programs affecting respite are reviewed and directions for policy advancement are highlighted. Much more work is needed to educate caregivers and the general public about the necessity for respite beginning early in the caregiving career to prevent burnout and other adverse effects. Because it is unlikely that there will be a sufficient number of direct-care workers to replace unpaid caregivers, improved policies are needed to ensure that their situation is sustainable through increased availability of high-quality respite and other services vital to caregiver health and well-being. Among the 2015White House Conference on Aging's priorities in the next decade, policies on long-term services and supports will require focused attention on family caregivers and the direct-care workforce to strengthen their ability to give care now and support their own physical, emotional, and financial needs in the future. [ABSTRACT FROM AUTHOR]

Background and Objectives Nursing homes remain subjected to institutional racial segregation in the United States. However, a standardized approach to measure segregation in nursing homes does not appear to be established. A systematic review was conducted to identify all formal measurement approaches to evaluate racial segregation among nursing home facilities, and to then identify the association between segregation and quality of care in this context. Research Design and Methods PubMed, Scopus, and Web of Science databases were searched (January 2018) for publications relating to nursing home segregation. Following the PRISMA guidelines, studies were included that formally measured racial segregation of nursing homes residents across facilities with regional-level data. Results Eight studies met the inclusion criteria. Formal segregation measures included the Dissimilarity Index, Disparities Quality Index, Modified Thiel's Entropy Index, Gini coefficient, and adapted models. The most common data sources were the Minimum Data Set (MDS; resident-level), the Certification and Survey Provider Enhanced Reporting data (CASPER; facility-level), and the Area Resource File/ U.S. Census Data (regional-level). Most studies showed evidence of racial segregation among U.S. nursing home facilities and documented a negative impact of segregation on racial minorities and facility-level quality outcomes. Discussion and Implications The measurement of racial segregation among nursing homes is heterogeneous. While there are limitations to each methodology, this review can be used as a reference when trying to determine the best approach to measure racial segregation in future studies. Moreover, racial segregation among nursing homes remains a problem and should be further evaluated. [ABSTRACT FROM AUTHOR]

Background and Objectives There is growing interest in better understanding the sectoral reach of age-friendly community practice. Action across a wide range of actors is central to achieving age-friendly societal change, according to the World Health Organization and required for governmental participation in its Global Network of Age-Friendly Cities and Communities. However, there is limited knowledge regarding the scope of sectoral reach by age-friendly communities. Research Design and Methods We used qualitative inquiry to assess sectoral efforts reported by American age-friendly communities that completed a 5-year cycle of participation (n = 40). We employed directed content analysis using a priori indicators by sectoral actors: public (i.e. government), private (i.e. business), and civil society, including nonprofit organizations and volunteers. We classify sectoral actions by type (i.e. intersectoral and multisectoral) and by clustered domain community foci (i.e. built, social, and service). Results Our study identifies the extent and types of sectoral actors and actions reported by age-friendly communities with the greatest efforts reported in the public sector, and while similarly distributed across all the domains, slightly more efforts were noted in the built environment. We also found greater intersectoral efforts (i.e. explicitly working toward shared goals) than multisectoral (i.e. not necessarily in collaboration on shared goals), particularly across government. Discussion and Implications While our study substantiates the breadth of actions toward age-friendly change, additional research is needed to examine the ways in which the public and other sectoral actions are further linked to outcomes in communities in the United States and in other countries. [ABSTRACT FROM AUTHOR]

Background and Objectives This study examined the relationship between number of attributed reasons for everyday discrimination and all-cause mortality risk, developed latent classes of discrimination attribution, and assessed whether these latent classes were related to all-cause mortality risk among U.S. older Black women. Research Design and Method Participants were from the 2006 and 2008 waves of the Health and Retirement Study (N = 1,133; 335 deaths). Vital status was collected through the National Death Index through 2013 and key informant reports through 2019. Latent class analyses were conducted on discrimination attributions. Weighted Cox proportional hazards model was used to predict all-cause mortality. Analyses controlled for demographic characteristics, socioeconomic status, and health. Results Reporting greater attributions for everyday discrimination was associated with higher mortality risk (hazard ratio [HR] = 1.117; 95% confidence interval [CI]: 1.038–1.202; p <.01), controlling for demographic characteristics, socioeconomic status, and health as well as health behaviors. A 4-class solution of the latent class analysis specified the following attribution classes: No/Low Attribution; Ancestry/Gender/Race/Age; Age/Physical Disability; High on All Attributions. When compared to the No/Low Attribution class, membership in the High on All Attributions class was associated with greater mortality risk (HR = 2.809; CI: 1.458–5.412; p <.01). Discussion and Implications Findings underscore the importance of everyday discrimination experiences from multiple sources in shaping all-cause mortality risk among older Black women. Accordingly, this study problematizes the homogenization of Black women in aging research and suggests the need for health interventions that consider Black women's multiplicity of social statuses. [ABSTRACT FROM AUTHOR]

Background and Objectives Grandparents are key resources in grandchildren care globally. However, mixed findings indicated that multiple role engagement may enhance well-being and bring demands on grandparent caregivers in different contexts. This systematic review examines the association between the intensity of grandparent caregiving and their health and well-being (i.e. physical, mental, cognitive, and life satisfaction) by continent and country/region. Research Design and Methods Systematic searches were conducted in 4 databases. Peer-reviewed articles with quantitative designs published between 1990 and November 2021 were identified. A rigorous selection process was followed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The studies were critically appraised, and their results were narratively synthesized. Results Sixty-five articles from 29 countries/regions were included. Findings suggested a concave curvilinear relationship between the intensity of grandparent caregiving and their health and well-being, with the optimal caregiving intensity varying across sociocultural contexts. In Europe, Oceania, the Middle East, and South America, providing supplementary or occasional care seems beneficial for grandparents' health and well-being, especially supporting dual-earner families. In East Asia, economic resources appear to buffer the adverse effect of primary care on grandparents' well-being. In the United States, findings vary across ethnicity/race. Discussion and Implications Collectively, the intensity of grandparent caregiving, health, and well-being is complicated by grandparents' roles in the family and cultural differences. Acknowledging the bidirectional relationship between well-being and grandparents' capacity for providing care, the well-being as outcome is a limitation. Despite so, this systematic review calls for culturally-tailored family programs to support grandparent caregiving. [ABSTRACT FROM AUTHOR]

Background and Objectives This study examined the stability over time of activities of daily living (ADL) items in 3 comparable longitudinal data sets and evaluated ADL loss sequences for older adults in the United States, South Korea, and Japan. Research Design and Methods Data from the U.S. Health and Retirement Study, and its 2 international sister surveys, were analyzed. Participants were community-dwelling adults aged 60 and older. For each data set, Rasch analysis was implemented to determine if the ordering of items remained stable across multiple waves (2006–2014), such that a single ADL hierarchy may be derived from multiwave data. Results Data fitted the Rasch model well. Item calibrations were sufficiently stable across measurement periods in each data set, reflecting a stable frame of reference. Results were also robust to sample variations. The derived ADL hierarchies based on scaled logit scores revealed that "dressing" and "bathing" were relatively more difficult items for older adults in all study populations. Discussion and Implications Scale stability is essential when exploiting longitudinal data to analyze patterns in ADL disabilities. The consistency in ADL scales across measurement periods supports their use as screening tools and identifying those at risk for transitions in care. Interventions to reduce dependency in bathing and dressing can help improve independent functioning for community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Background and Objectives Dissemination-implementation.org outlines 110 theories, models, and frameworks (TMFs): we conducted a citation analysis on 83 TMFs, searching Web of Science and PubMed databases. Research Design and Methods Search terms were broad and included "aging," "older," "elderly," and "geriatric." We extracted each TMF in identified articles from inception through January 28, 2022. Included articles must have used a TMF in research or quality improvement work directly linked to older adults within the United States. Results We reviewed 2,681 articles of which 295 articles cited at least one of 56 TMFs. Five TMFs represented 50% of the citations: Reach, Effectiveness, Adoption, Implementation, and Maintenance 1.0, Consolidated Framework for Implementation Research, Greenhalgh Diffusion of Innovation in Service Organizations, Quality Enhancement Research Initiative, Community-Based Participatory Research, and Promoting Action on Research Implementation in Health Services. TMF application varied and there was a steady increase in TMF citations over time, with a 2- to 3-fold increase in citations in 2020–2021. We identified that only 41% of TMF use was meaningful. Discussion and Implications Our results suggest TMF utilization is increasing in aging research, but there is a need to more meaningful utilize TMFs. As the population of older adults continues to grow, there will be increasing demand for effective evidence-based practices and models of care to be quickly and effectively translated into routine care. Use of TMFs is critical to building such evidence and to identifying and evaluating methods to support this translation. [ABSTRACT FROM AUTHOR]

Background and Objectives Partnerships between health care and social service organizations may contribute to lower health care use and spending. Such partnerships are increasing, including Area Agencies on Aging (AAAs) working and contracting with health care organizations. Nevertheless, knowledge about how AAAs establish and manage successful collaborations is limited. We sought to understand how AAAs establish and manage partnerships with health care organizations. Research Design and Methods We conducted an explanatory sequential mixed-methods study using a positive deviance approach. We used national-level data to identify AAAs with multiple health care partners serving areas with low utilization of nursing homes by residents with low-care needs (n = 9) and AAAs with few health care partners and high utilization for comparison (n = 3). We conducted in-depth interviews with key informants from these 12 AAAs and their partner organizations (total n = 130). A 5-person multidisciplinary team used the constant comparative method of analysis, supported by Atlas.ti software. Results Highly partnered AAAs were characterized by 3 distinctive features of organizational culture: (a) attention to external environments, (b) openness to innovation and change, and (c) risk-taking to learn, improve, and grow. AAAs and partners describe a broad set of organizational strategies and partnership development tactics, depending on their local contexts. These features were underdeveloped in AAAs with few health care partnerships. Discussion and Implications While federal and state policies can create more favorable environments for AAA–health care partnerships, AAAs can also work internally to foster an organizational culture that allows them to thrive in dynamic and challenging environments. [ABSTRACT FROM AUTHOR]

Background and Objectives Research shows that living in segregated neighborhoods may have deleterious health outcomes via social, physical, and socioeconomic contexts that deepen existing inequities. However, there has been limited scholarship examining the effects of segregation on older adults, despite an increasing focus on aging in place. Guided by the Ecological Model of Aging, we examined the effects of segregation on older adults' self-rated health and mental health, accounting for both individual characteristics and neighborhood opportunities and risks (e.g. social cohesion) and the potential moderating role of race and economic vulnerability. Research Design and Methods We used data from the first 4 rounds of the National Health and Aging Trends Study (2011–2014) merged with tract-level census data for a final sample size of 3,084 community-dwelling older adults in urban areas. We conducted multivariate regression analyses after conditioning on residential location selection variables. Results There was no significant association between neighborhood segregation and self-rated health or between segregation and anxiety and depression symptoms. Consistent with the literature, perceived social cohesion was protective of health in each model. Discussion and Implications Our findings highlight the need for more rigorous research on segregation and older residents that utilize longitudinal and spatial data. Our findings also have implications for policies and programs that aim to support the ability to age in place for older adults who have different racial identities and live in different neighborhood contexts. Because social cohesion can be a protective factor for older adults' health and mental health, policymakers and practitioners should support initiatives to increase social cohesion. [ABSTRACT FROM AUTHOR]

“Feature Article: This paper is a based on the Joseph T. Freeman Award lecture given at the Annual Meeting of The Gerontological Society of America held in New Orleans, Louisiana, in November, 2013:”Among older persons, disability in activities of daily living is common and highly morbid. The Precipitating Events Project (PEP Study), an ongoing longitudinal study of 754 initially nondisabled, community-living persons, aged 70 or older, was designed to further elucidate the epidemiology of disability, with the goal of informing the development of effective interventions to maintain and restore independent function. Over the past 16 years, participants have completed comprehensive, home-based assessments at 18-month intervals and have been interviewed monthly to reassess their functional status and ascertain intervening events, other health care utilization, and deaths. Findings from the PEP Study have demonstrated that the disabling process for many older persons is characterized by multiple and possibly interrelated disability episodes, even over relatively short periods of time, and that disability often results when an intervening event is superimposed upon a vulnerable host. Given the frequency of assessments, long duration of follow-up, and recent linkage to Medicare data, the PEP Study will continue to be an outstanding platform for disability research in older persons. In addition, as the number of decedents accrues, the PEP Study will increasingly become a valuable resource for investigating symptoms, function, and health care utilization at the end of life. [ABSTRACT FROM PUBLISHER]

Background and Objectives A wealth of empirical evidence documents improved health among older adults who participate in social activities. Alternative transportation can serve as a bridge linking older adults to social activities and improving person–environment fit. Research Design and Methods Using Waves 1–8 of the National Health and Aging Trends Study, this research examines whether alternative transportation use is associated with participation in diverse social activities among a sample of Medicare beneficiaries aged 65 or older. Additionally, this research explores whether the effect of transportation use varies across neighborhood environments. We analyzed individual trajectories of participation in social activities by estimating 2-level growth curve models. Results The use of public transportation, paratransit, getting a ride, or walking/using wheelchair/scooter to get places was associated with participating in more types of social activities. Respondents who used alternative transportation had less steep declines in participation. The effect of getting rides and using paratransit services was more pronounced among respondents living in disordered neighborhoods. Discussion and Implications This research underscores the importance of alternative transportation use and the neighborhood context for participation among older adults. Age-friendly initiatives aimed at fostering greater community engagement should think broadly about the role of multiple forms of transportation. [ABSTRACT FROM AUTHOR]

Background and Objectives The influx of people with higher socioeconomic status into large Black communities is well documented; less is known regarding smaller, aging Black communities. Older Black adults in Portland, Oregon, among America's fastest gentrifying cities with the smallest metropolitan Black population, discussed barriers to healthy aging. Perspectives centered on the experience of gentrification, displacement, and its impact on social microsystems, place security, and aging in place. Research Design and Methods One-time focus groups engaged 41 Black adults aged at least 45. A demographic survey included residence area/duration. Discussions were thematically coded. Ecological Systems Theory guided interpretation. Results The majority of participants resided within gentrifying historically Black neighborhoods (89.2%), were aged at least 65 (54.6%), and lived in their neighborhood for at least 21 years (24.3%). Emergent discussion themes were rise and fall of Black ownership, displacement, race-related stress, and financial burden. Gentrification contributed to the dismantling of Black property ownership curated over generations, increased financial burden, and threatened place security. Physical displacement strained social networks, diminishing intergenerational neighborhood ties that supported aging in place. Cultural and physical displacement weakened the sense of social cohesion and belonging and induced race-related stressful interactions with new residents within original and relocation neighborhoods. Discussion and Implications Gentrification in the Pacific Northwest echoes national trends, uprooting critical close-proximity social networks and deteriorating motivation to engage in neighborhood-based social activity. Smaller, aging Black communities may be particularly vulnerable to these effects, which critically affect aging in place. Data inform researchers and policymakers to better understand how gentrification affects smaller, aging Black communities. [ABSTRACT FROM AUTHOR]

Background and Objectives Medical providers are significant drivers of care in post-acute long-term care (PALTC) settings, yet little research has examined the medical provider workforce and its role in ensuring quality of care. Research Design and Methods This study examined the impact of nursing home medical staffing organization (NHMSO) dimensions on the quality of care in U.S. nursing homes. The principal data source was a survey specifically designed to study medical staff organization for post-acute care. Respondents were medical directors and attending physicians providing PALTC. We linked a number of medical provider and nursing home characteristics to the Centers for Medicaid and Medicare Services Nursing Home Compare quality measures hypothesized to be sensitive to input by medical providers. Results From the sample of nursing home medical providers surveyed (n = 1,511), 560 responses were received, yielding a 37% response rate; 425 medical provider responses contained sufficient data for analysis. The results of the impact of NHMSO dimensions were mixed, with many domains not having any significance or having negative relationships between provider characteristics and quality measures. Respondents who reported having a formal process for granting privileges and nursing homes with direct employment of physicians reported significantly fewer emergency visits. Discussion and Implications Further research is needed regarding what quality measures are sensitive to both medical provider characteristics and NHMSO characteristics. [ABSTRACT FROM AUTHOR]

The delivery of medical care services in U.S. nursing homes (NHs) is dependent on a workforce that comprises physicians, nurse practitioners, and physician assistants. Each of these disciplines operates under a unique regulatory framework while adhering to common standards of care. NH provider characteristics and their roles in NH care can illuminate potential links to clinical outcomes and overall quality of care with important policy and cost implications. This perspective provides an overview of what is currently known about medical provider practice in NH and organizational models of practice. Links to quality, both conceptual and established, are presented as is a research and policy agenda that addresses the gaps in the evidence base within the context of our ever-changing health care landscape. [ABSTRACT FROM AUTHOR]

Background and Objectives The coronavirus disease 2019 (COVID-19) pandemic is experienced differently across individuals, and older adults' different life experiences lead to a variety of ways of coping. The present study explores older adults' reports of what about the pandemic is stressful, and what brings joy and comfort in the midst of stress. Research Design and Methods An online survey asked 825 U.S. adults aged 60 and older to complete questionnaires assessing 3 psychological well-being indicators: perceived stress, negative affect, and positive affect. Participants also responded to open-ended questions about what was stressful and what brought joy or comfort at the time of the survey. A mixed-method approach first qualitatively analyzed the open-ended responses, content analysis identified themes most frequently reported, and quantitative analysis examined the associations between various stressors and joys and the psychological well-being indicators. Results Qualitative analysis revealed 20 stress categories and 21 joy/comfort categories. The most commonly reported stressors were confinement/restrictions, concern for others, and isolation/loneliness; the most commonly reported sources of joy/comfort were family/friend relationships, digital social contact, and hobbies. Demographic comparisons revealed variations in experience. Independent t tests revealed stress from concern for others, the unknown future, and contracting the virus to be significantly associated with poorer psychological well-being; faith, exercise/self-care, and nature were associated with more positive psychological well-being. Discussion and Implications Results are discussed in the context of stress and coping theory, highlighting the importance of understanding the unique stress experience of each individual for effective distress intervention. [ABSTRACT FROM AUTHOR]

Background and Objectives Older adults prefer to age in place, but sociodemographic, health, and socioeconomic factors may influence their decision to remain in the community. Guided by Andersen's behavioral model, we characterize incident transitions out of the community into residential care settings or nursing homes and identify predictors of these transitions. Research Design and Methods Study participants include 2,725 (weighted n = 13,704,390) community-dwelling U.S. older adults of the National Health and Aging Trends Study from 2011 to 2018. We examined the associations between sociodemographic, socioeconomic, and health factors and the probability of transition using a multinomial logit model. Results Over the study period, 86.2% of older adults remained in the community, whereas 9.0% and 4.9% transitioned to residential care settings and nursing homes, respectively. Older age, living alone, having functional and cognitive limitations, and hospitalization were associated with increased risk of transitioning to residential care settings or nursing homes from the community. Blacks and Hispanics were less likely to transition to residential care settings or nursing homes. Adults with lower income had a greater risk of transitioning to nursing homes. Medicaid enrollment did not affect the likelihood of transition. Discussion and Implications Majority of older adults remained in the community, and incident transition to residential care settings was more common than to nursing homes. Policy should target sociodemographic, health, and socioeconomic factors that enable older adults to age in place. Future work should examine whether these new residential care settings enhance the quality of life or result in subsequent transitions back into the community. [ABSTRACT FROM AUTHOR]

Background and Objectives Racial disparities in health and socioeconomic characteristics of older adults have implications for the experiences of their family and unpaid caregivers, but knowledge to date has primarily drawn from convenience samples. Using a population-based sample, we examine associations between caregiver race and caregiving-related effects. Research Design and Methods Study participants include white (n = 992) and black (n = 556) respondents to the 2015 National Study of Caregiving who assisted community-dwelling older adults with disabilities who participated in the National Health and Aging Trends Study. Guided by Pearlin's Stress Process Model, hierarchical logistic regression models were constructed to examine race differences in caregiving-related effects after adjusting for caregiving context, stressors, and resources. Results Relative to white caregivers, blacks more often provided in excess of 40 hr of care per week (54.3% vs 38.6%) and more often cared for an older adult with dementia (27.1% vs 20.7%) who was living below the federal poverty line (31.7% vs 11.9%) or was Medicaid-eligible (42.2% vs 11.8%). Black caregivers more often used supportive services (32.9% vs 24.8%). In fully adjusted regression models, black caregivers were more likely to report gains and less likely to report emotional difficulty than whites. Service utilization did not attenuate caregiving-related emotional difficulty or participation restrictions, regardless of race. Discussion and Implications Findings highlight caregiving disparities and counterintuitive differences in experiences and indicate the importance of identifying supports such as paid family leave and faith and community-based programming to better support community-dwelling low-income older adults and their family and unpaid caregivers. [ABSTRACT FROM AUTHOR]

Background and Objectives Nursing homes (NHs) are serving greater proportions of residents with serious mental illness (SMI), and it is unclear whether this affects NH quality. We analyze the highest and lowest quartiles of NHs based on the proportion of residents with SMI and compare these NHs on facility characteristics, staffing, and quality stars. Research Design and Methods National Certification and Survey Provider Enhanced Reports data were merged with NH Compare data for all freestanding certified NHs in the continental United States in 2016 (N = 14,460). NHs were categorized into "low-SMI" and "high-SMI" facilities using the lowest and highest quartiles, respectively, of the proportion of residents in the NH with SMI. Bivariate analyses and logistic models were used to examine differences in organizational structure, payer mix, resident characteristics, and staffing levels associated with high-SMI NHs. Linear models examined differences in quality stars. Results High-SMI facilities were found to report lower direct-care staffing hours, have a greater Medicaid-paying resident census, were more likely to be for-profit, and scored lower on all NH Compare star ratings in comparison to all other NHs. Discussion and Implications As the SMI population in NHs continues to grow, a large number of residents have concentrated in a few NHs. These are uniquely different from typical NHs in terms of facility characteristics, staffing, and care practices. While further research is needed to understand the implications of these trends, public policymakers and NH providers need to be aware of this population's unique—and potentially unmet—needs. [ABSTRACT FROM AUTHOR]

Background and Objectives The digital divide, or differences in access to technology, can have far-reaching consequences. This study identified disparities in access to online health-related technology. It then investigated associations between online health-related technology use and health care utilization among older adults in the United States. Research Design and Methods The study used a cross-sectional data set of 1,497 adults aged 51 and older from the 2014 Health and Retirement Study (HRS)'s supplemental module (Health Behaviors) and the RAND version of the HRS fat file. Results Older age, being a racial/ethnic minority, married, uninsured, and having lower educational attainment, lower income, and reporting poorer health were each associated with lower levels of use of online health-management tools. The use of online health-management tools was associated with a 34% greater mean number of doctor visits (incidence rate ratio = 1.34, SE = 0.10, p <.05) than nonuse. However, such use was not associated with the number or type of hospitalizations. Indeed, only health care needs as measured by self-rated health status (odds ratio [OR] = 0.58, SE = 0.18, p <.05) and the number of chronic conditions were associated with hospitalizations (OR = 1.68, SE = 0.07, p <.05). Discussion and Implications While more research is needed to clarify the purposes (e.g. prevention vs. treatment) and outcomes of health care service utilization as a function of technology use, it may be wise to proactively tackle the digital divide as one upstream strategy for improving various health and health care outcomes among older adults. [ABSTRACT FROM AUTHOR]

Perspectives from the humanities and arts (H&A) on old age have deep roots in history; they emerged over the centuries along with concurrent scientific investigations. Provisionally invited into the scientific ranks of The Gerontological Society of America (GSA) during the late 1970s, H&A prospered, but grew amid tensions. During 75th-anniversary celebrations, Society members will assess H&A's role in GSA. How can H&A continue to enrich scientific research? How can H&A further advance its own meaningful contributions? Or, should H&A and GSA reconfigure its partnership? [ABSTRACT FROM AUTHOR]

Background and Objectives Clinical decision support systems (CDSS) hold promise to influence clinician behavior at the point of care in nursing homes (NHs) and improving care delivery. However, the success of these interventions depends on their fit with workflow. The purpose of this study was to characterize workflow in NHs and identify implications of workflow for the design and implementation of CDSS in NHs. Research Design and Methods We conducted a descriptive study at 2 NHs in a metropolitan area of the Mountain West Region of the United States. We characterized clinical workflow in NHs, conducting 18 observation sessions and interviewing 15 staff members. A multilevel work model guided our data collection and framework method guided data analysis. Results The qualitative analysis revealed specific aspects of multilevel workflow in NHs: (a) individual, (b) work group/unit, (c) organization, and (d) industry levels. Data analysis also revealed several additional themes regarding workflow in NHs: centrality of ongoing relationships of staff members with the residents to care delivery in NHs, resident-centeredness of care, absence of memory aids, and impact of staff members' preferences on work activities. We also identified workflow-related differences between the two settings. Discussion and Implications Results of this study provide a rich understanding of the characteristics of workflow in NHs at multiple levels. The design of CDSS in NHs should be informed by factors at multiple levels as well as the emergent processes and contextual factors. This understanding can allow for incorporating workflow considerations into CDSS design and implementation. [ABSTRACT FROM AUTHOR]

Background and Objectives This study examined the effect of limited English proficiency (LEP) on trajectories of depressive symptoms among Mexican American older adults in the United States. Research Design and Methods The sample was drawn from Waves 1 to 6 (1993–2007) of the Hispanic Established Population for Epidemiological Studies of the Elderly (H-EPESE). A total of 2,945 Mexican American older adults were included in the analyses. A latent growth curve modeling was conducted. Results After adjusting for covariates, results show that Mexican American older adults with LEP had higher levels of depressive symptoms than those with English proficiency (EP) at baseline as well as over a 14-year period. Differential trajectories were observed between those with LEP and EP over time, indicating that those with LEP had a significantly steeper curve of depressive symptom trajectories over time than those with EP. Discussion and Implications These results suggest that LEP is a risk factor not merely for greater depressive symptomatology at each time point, but for an accelerated trajectory of depressive symptoms over time among Mexican American older adults. Overall, the findings emphasize the need to assist not only the informal support system of Mexican American older adults with LEP, but also the formal system. [ABSTRACT FROM AUTHOR]

Background and Objectives The application of mindfulness- and acceptance-based interventions (MABIs) for informal caregivers of people with dementia (PwD) is relatively novel, and the current state of the evidence base is unclear. This meta-analysis examined the effectiveness of MABIs on reducing symptoms of depression and burden in informal caregivers of PwD. The quality of included studies was evaluated and moderator variables explored. Research Design and Methods A literature search of six electronic databases (PsycARTICLES, PsycINFO, MEDLINE Complete, SCOPUS, Web of Science, and ProQuest) was conducted from the first available date to 20 December 2016. Inclusion criteria involved studies that quantitatively investigated the impact of MABIs on depression and/or burden in informal caregivers of PwD. Results Twelve studies, providing data on 321 caregivers, were included. Most used mindfulness-based stress reduction and were conducted in the United States. The average attrition among participants was 15.83%. The pre–post effect of MABIs was large for depression and moderate for burden. These effects were largely maintained at follow-up. Significant heterogeneity of effect sizes was observed, with no significant moderators identified. Study quality varied from very poor to moderately good. Discussion and Implications The low attrition and moderate to large effects suggest that MABIs are acceptable and beneficial for informal caregivers of PwD. The lack of significant moderators could advocate services using more cost-effective forms of MABIs. Further higher-quality research is needed to improve the robustness of the evidence base and enable a meta-analysis to thoroughly examine and quantify moderator variables. [ABSTRACT FROM AUTHOR]

Cancer prevention efforts are newly focused on the older adult population. Adult literacy and health literacy findings and suggestions can help shape more efficacious health communication strategies and thereby increase the "accessibility" of important health information and the potential for healthful action. National and international surveys of adult literacy skills have consistently offered problematic findings that older adults have more limited proficiencies than do younger working adults and face difficulties using commonly available materials to accomplish everyday tasks. Clinical as well as population-based studies of health literacy similarly find limited health literacy among a majority of U.S. adults and even poorer health literacy among older adults. This is of concern because health literacy studies have established clear links between limited literacy and poor health outcomes as well as diminished participation in activities related to disease prevention. Literacy experts note difficulties associated with abstract concepts and with sophisticated numeracy tasks, both associated with disease prevention. Health literacy findings and insights are important considerations in the development of health messages and materials to promote cancer prevention among older adults. [ABSTRACT FROM AUTHOR]

Background and Objectives Skin cancer incidence rates are highest among U.S. older adults. However, little is known about sun protection behaviors and sunburn among adults aged 65 years and older. Research Design and Methods We used data from the 2015 National Health Interview Survey to examine the association between sun protection behaviors (sun avoidance, wearing protective clothing, and sunscreen use) and likelihood of having experienced sunburn in the past year. Results Just over one in ten older adults (13.2%) had experienced sunburn in the past year; sunburn prevalence was nearly twice as high (20.4%) among sun-sensitive older adults. Men, ages 65–69 years, non-Hispanic whites, and those with skin that burns or freckles after repeated sun exposure were more likely to have been sunburned in the past year compared with the respective comparison groups. The only sun protection behavior significantly associated with sunburn was sunscreen use. None of the sun protection behaviors were significantly associated with a decreased risk of sunburn. Discussion and Implications The prevalence of sunburn among older adults suggests opportunities to reduce skin cancer risk within this demographic group by preventing overexposure to the sun. The lack of reduced sunburn risk among those who regularly used sun protection may be related to inadequate or inconsistent use of sun protection or the way the sun protection behaviors were measured. Multi-sector approaches to facilitate sun-safety among older adults are warranted and could include targeted efforts focused on those most likely to get sunburned, including men and those with sun-sensitive skin. [ABSTRACT FROM AUTHOR]

Background and Objectives Obesity is increasing among people residing in nursing homes, and resident obesity substantially affects services needed, equipment and facilities provided, and morbidity in this setting. The purpose of this article is to describe the scope and depth of evidence regarding the impact of obesity among nursing home residents in the United States. Research Design and Methods A systematic literature review was performed in PubMed, EMBASE, CINAHL, and Web of Science databases as well as additional hand-searched documents. Included articles were published from 1997 to March 2017. The characteristics and content of the included articles were systematically reviewed and reported. Results Twenty-eight studies met inclusion criteria for review. The median study size was 636 residents (interquartile range 40–11,248); 18 (64%) studies were retrospective and 10 (36%) were prospective in nature. Ten (36%) studies examined medical and functional morbidity, 10 (36%) examined health system effects, and 5 (18%) examined the risk of admission to nursing homes. Most studies found that obesity poses serious issues to resident health and the provision of health care, as well as broad health system and nursing challenges in the provision of high-quality nursing home care and services. Discussion and Implications Although obesity affects about one in four nursing home residents in the United States, relatively limited evidence exists on the complex challenges of obesity for their residents and their care. A continued focus on resident quality of life, health system improvement, and nursing best practices for properly caring for individuals with obesity is needed. [ABSTRACT FROM AUTHOR]

Background and Objectives The ongoing shift from defined benefit (DB) to defined contribution (DC) pension plans means that middle-aged and older adults are increasingly being called upon to manage their own fiscal security in retirement. Yet, half of older Americans are financially illiterate, lacking the knowledge and skills to manage financial resources. This study investigates whether pension plan types are associated with varying levels of financial literacy among older Americans. Research Design and Methods Cross-sectional analyses of the 2010 Health and Retirement Study (HRS) (n = 1,281) using logistic and linear regression models were employed to investigate the association between different pension plans and multiple indicators of financial literacy. The potential moderating effect of gender was also examined. Results Respondents with DC plans, with or without additional DB plans, were more likely to correctly answer various financial literacy questions, in comparison with respondents with DB plans only. Men with both DC and DB plans scored significantly higher on the financial literacy index than women with both types of plans, relative to respondents with DB plans only. Discussion and Implications Middle-aged and older adults, who are incentivized by participation in DC plans to manage financial resources and decide where to invest pension funds, tend to self-educate to improve financial knowledge and skills, thereby resulting in greater financial literacy. This finding suggests that traditional financial education programs may not be the only means of achieving financial literacy. Further consideration should be given to providing older adults with continued, long-term exposure to financial decision-making opportunities. [ABSTRACT FROM AUTHOR]

Background and Objectives We examine trends in informal care from the perspective of both community-dwelling disabled older Americans and their caregivers from 1982 to 2012. We decompose hours of care received from spouses and children according to changes in: (a) the number of potential spousal and child caregivers (“family structure”), (b) the likelihood that existing spouses and children are caregivers (“caregiving propensity”), and (c) the amount of care provided by individual caregivers (“time burden”). Research Design and Methods We examine two sets of time trends based on distinct samples of community-dwelling disabled older Americans from the 1982–2004 waves of the National Long-Term Care Survey (NLTCS) and the 2000–2012 waves of the Health and Retirement Study (HRS). Results Existing spouses’ and children’s decreasing likelihood of being caregivers led to fewer spousal and child caregivers per disabled older person in the 2004 NLTCS than the 1982 NLTCS. However, the NLTCS and HRS time trends suggest that the amount of care provided by individual caregivers was similar from 1989 to 2012. Discussion and Implications Because individual caregivers’ time burden has remained fairly constant since at least 1989, advocacy on behalf of policies that promote more and better support for caregivers is appropriate. [ABSTRACT FROM AUTHOR]

Background and Objectives: Parents of sons and daughters with disabilities have ongoing financial burdens and vulnerability due to the demands of caregiving responsibilities and their related direct and indirect costs. This study aims to investigate whether midlife and older parents of individuals with a mental health problem or a developmental disability were particularly vulnerable to the impact of the recession. Research Design and Methods: The data were drawn from Midlife in the United States (MIDUS), a longitudinal survey of a national probability sample in the United States, Waves II (2004-2006) and III (2013-2014; 84 parents of individuals with a mental health problem, 98 parents of individuals with a developmental disability, and 2,029 parents of individuals without any conditions as a comparison group). Results: The findings suggest that the midlife and older parents whose son or daughter had a mental health problem experienced more recession impacts than comparison parents, even after controlling prerecession financial status and sociodemographic characteristics. Discussion and Implications: The results indicate the need for policies that provide effective financial support and reduce restrictions on health service access in order to relieve the financial burden experienced by midlife and older parents of individuals with a mental health problem. [ABSTRACT FROM AUTHOR]

Purpose of the Study: This study examines national variations in social networks among older adults across 4 countries in diverse regions of the world: Japan, Lebanon, Mexico, and the United States. The aim is to provide insights into universal as well as unique attributes of social networks in later life. Design and Methods: The analyses examine convoy characteristics among adults aged 50+ in metropolitan areas of Japan (N = 557), Lebanon (N = 284), Mexico (N = 556), and the United States (N = 583). Data were collected using the hierarchical mapping technique on representative samples in each locale. Multilevel models were conducted by nation to examine whether convoy characteristics vary by age and closeness. Results: Network size and geographic proximity were dimensions of social networks sensitive to national context. By contrast, how age and feelings of closeness varied with contact frequency and the presence of children in networks revealed universal patterns. Furthermore, feelings of closeness varied by age with regard to size and contact frequency in Lebanon, proximity in Japan, and composition in Mexico. Implications: Identifying universal and unique characteristics of social networks in later life provide a preliminary empirical basis upon which to advance a global perspective on convoys of social relations and how they inform policies that can facilitate health and well-being among middle-aged and older people around the world. [ABSTRACT FROM AUTHOR]

Background and Objectives: Coping with predeath grief (PDG) is an unmet need in caregivers of persons with dementia (PWD). The Marwit-Meuser Caregiver Grief Inventory (MM-CGI) and its abbreviated MM-CGI-Short-Form (MM-CGI-SF) are among the few empirically developed scales that detect PDG, yet they have not been substantially validated outside United States. We evaluated the reliability and validity of the PDG scales in a multiethnic Asian population distinct from that of United States. Research Design and Methods: Family caregivers of community-dwelling PWD (n = 300) completed self-administered questionnaires containing MM-CGI and other scales of related construct. Sixty percent of the participants repeated the questionnaires 1 week later for test-retest reliability. Internal-consistency reliability was assessed by Cronbach's α, testretest reliability by intraclass-correlation-coefficient, construct validity by Spearman's correlation-coefficient, and factorial validity by confirmatory factor analysis (CFA). Cohen's κ was used to compare the agreement between MM-CGI and a commonly-used caregiver burden scale (Zarit Burden Interview). Results: MM-CGI and MM-CGI-SF demonstrated internal-consistency reliability, test-retest reliability, construct validity, and known-group validity. In CFA, MM-CGI showed modest model-fit (comparative-fit-index, CFI = .80; Tucker-Lewisindex, TLI = .79), whereas MM-CGI-SF showed better model-fit (CFI = .91; TLI = .90). Eighty-six percent of the caregivers reported average or high levels of PDG, with 18% reporting high PDG. High scores in the caregiver burden scale only showed modest agreement with high scores in MM-CGI (κ = .47). Discussion and Implications: MM-CGI and MM-CGI-SF demonstrated adequate psychometric properties and utility, beyond that of a caregiver burden scale, in detecting high PDG in a multiethnic Asian population. They open the way for PDG intervention in clinical care, as well as further exploration in caregiver research. [ABSTRACT FROM AUTHOR]

Purpose of the Study: The study identifies differences in age-expectations between older adults from Korean, Chinese, Latino, and African American backgrounds living in the United States. Design and Methods: This study uses baseline demographic, age-expectation, social, and health data from 229 racial/ ethnic minority seniors in a stroke-prevention intervention trial. Unadjusted regression models and pair-wise comparisons tested for racial/ethnic differences in age-expectations, overall, and across domain subscales (e.g., physical-health expectations). Adjusted regression models tested whether age-expectations differed across racial/ethnic groups after controlling for demographic, social, and health variables. Regression and negative binomial models tested whether age-expectations were consistently associated with health and well-being across racial/ethnic groups. Results: Age-expectations differed by race/ethnicity, overall and for each subscale. African American participants expected the least age-related functional decline and Chinese American participants expected the most decline. Although African American participants expected less decline than Latino participants in unadjusted models, they had comparable expectations adjusting for education. Latino and African American participants consistently expected less decline than Korean and Chinese Americans. Acculturation was not consistently related to age-expectations among immigrant participants over and above ethnicity. Although some previously observed links between expectations and health replicated across racial/ethnic groups, in adjusted models age-expectations were only related to depression for Latino participants. Implications: With a growing racial/ethnic minority older population in the United States, it is important to note older adults' age-expectations differ by race/ethnicity. Moreover, expectation-health associations may not always generalize across diverse samples. [ABSTRACT FROM AUTHOR]

An age-stereotype paradox has developed in the United States due to factors that would suggest age stereotypes should be increasing in positivity over time; whereas, recent evidence shows they are becoming more negative. Reasons for predicting an increase in positivity are presented, followed by reasons that help to explain why the reverse is occurring. To illustrate the age-stereotype paradox, four domains that help to shape the status of older individuals were selected: health, intergenerational contact, legislation, and social climate. Two proposals are then made for eliminating the paradox by reversing the age-stereotypes negativity trend: establishment of an anti-aging czar and the launching of an aging-rights movement. [ABSTRACT FROM AUTHOR]

Purpose: This policy study analyzed states' residential care and assisted living (RC/AL) regulations for dementia care requirements. Estimates suggest that at least half of RC/AL residents have dementia, and 22% of settings provide or specialize in dementia care. Residents with dementia might benefit from regulations that account for specific behaviors and needs associated with dementia, making states' RC/AL regulations address dementia care an important policy topic. Design and Methods: This study examined RC/AL regulations in all 50 states and the District of Columbia for regulatory requirements on five topics important to the quality of life of RC/AL residents with dementia: pre-admission assessment, consumer disclosure, staffing types and levels, administrator training, and physical environment. Results: Sixteen states license or certify dementia care units within RC/AL settings. All states had at least one dementia care requirement, though only four states had requirements for all five of the topics reviewed. Most states addressed administrator training, consumer disclosure, and physical environment, 17 addressed staffing types and levels, and 14 addressed pre-admission assessment for dementia. Thus, most states rely on general RC/AL regulations to cover dementia care policies and practices. Implications: This policy study provides a resource for researchers who do cross-state studies of dementia care in RC/AL settings and state policymakers who are updating RC/AL regulations, including those responding to a 2014 Centers for Medicare and Medicaid Services rule change. [ABSTRACT FROM AUTHOR]

Purpose: For decades, scholars have studied the effects of immigration on the U.S. social security system. To date, this research has been primarily limited to migrants within the United States and does not consider those who return to their countries of origin. We estimate the proportion of male Mexican return migrants who contributed to the U.S. social security system and analyze their socioeconomic characteristics and migration histories. We also estimate the proportion that receive or expect to receive U.S. social security benefits. Design and Methods: Using probit regression on the 2012 Mexican Health and Aging Study (MHAS), we describe the predictors of having contributed to the U.S. social security system among Mexican males in Mexico aged 50 years and older who at some point lived in the United States. Results: We find that 32% of male return migrants reported having contributed to the U.S. social security system, but only 5% of those who contributed, received or expected to receive benefits. Those who reported having contributed spent more years in the United States and were more likely to be U.S. citizens or legal permanent residents than those who did not contribute. Implications: Immigrants often pay Old-Age, Survivors, and Disability Insurance taxes using legitimate or illegitimate social security numbers and return to their home countries without collecting U.S. social security benefits. [ABSTRACT FROM AUTHOR]

Purpose: Most Americans' low opinion of the nursing home (NH) sector could derive, in part, from the way in which it is portrayed in the media. This study furthers understanding of media portrayal of the NH sector by identifying how NHs were depicted in 51 U.S. newspapers from 1999 to 2008. Design and methods: Keyword searches of the LexisNexis database were performed to identify 16,280 NH-related articles. Article content was analyzed, and tone, themes, prominence, and central actor were assessed. Basic frequencies and descriptive statistics were used to examine article content across regions, market type, and over time. Results: Findings reveal considerably less NH coverage in the Western United States and a steady decline in NH coverage nationally over time. Most articles were news stories; more than one third were located on the front page of the newspaper or section. Most articles focused on NH industry and government interests, very few on residents/family and community concerns. Most articles were neutral or negative in tone; very few were positive or mixed. Common themes included quality, financing, and legal concerns. Tone, themes, and other article attributes varied across region, market type, and over time. Implications: Overall, findings reveal changes in how newspapers framed NH coverage, not only with respect to tone but also with respect to what dimensions of this complex issue have been emphasized during the time period analyzed. Variation in media coverage may contribute to differences in government and public views toward the NH sector across regions and over time. [ABSTRACT FROM AUTHOR]

Purpose: Much like sexism, ageism is a multifaceted prejudice; it involves benevolent and hostile attitudes toward older adults. There are many scales designed to measure hostile ageism, yet none dedicated to measuring benevolent ageism. In the current studies, we developed and validated a 13-item measure: the Ambivalent Ageism Scale (AAS). Design and Methods: We employed four stages of scale development and validation. In Stage 1, we created 41 benevolent ageist items adapted from existing ageism measures. In Stages 2 and 3, we further refined the pool of items through additional testing and factor analysis and retained nine items loading strongly on two factors related to benevolent ageism: cognitive assistance/physical protection and unwanted help. In order to enable researchers to contrast benevolent and hostile attitudes, we then added four hostile ageist items. In Stage 4, we assessed the test-retest reliability of the 13-item scale. Results: The AAS had good test-retest reliability (r = .80) and good internal consistency (α = .91). As predicted, the benevolent and hostile ageism subscales differentially predicted attitudes toward older adults: higher scores on the hostile subscale predicted lower competence and warmth ratings, whereas higher scores on the benevolent subscale predicted higher warmth perceptions. Implications: The AAS is a useful tool for researchers to assess hostile and benevolent ageism. This measure serves as an important first step in designing interventions to reduce the harmful effects of both hostile and benevolent ageism. [ABSTRACT FROM AUTHOR]

Purpose of the study: Using the National Health and Aging Trends Study (NHATS), we examined activity preferences and participation among individuals with and without cognitive impairments. Design and methods: Respondents were classified as having No Dementia (n = 5,264), Possible Dementia (n = 893), or Probable Dementia (n = 518). Respondents rated importance of and actual participation (yes/no) in four activities (visiting friends/family, religious services, clubs/classes, going out for enjoyment). We also examined whether transportation or health limited participation. Results: Overall, visiting friends/family was most important (64.03%); although relative importance of activities varied with cognitive status. Compared to cognitively healthy individuals, those with possible and probable dementia were less likely to indicate activities were important and engage in valued activities (ps < .0001). Additionally, poor health limited participation in activities for those cognitively intact or with possible dementia; this was not true for those with probable dementia. Transportation difficulty limited going out for enjoyment for a greater percentage of those with cognitive impairment than those without impairment. Implications: Regardless of cognitive level, older adults highly value activities; however, actual participation may decrease with greater impairment in cognitive and physical health and with transportation challenges. Developing tailored interventions for specific populations to achieve desired activity goals is needed. [ABSTRACT FROM AUTHOR]