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Purpose: Throughout the 1990s, assisted living was the most rapidly growing form of senior housing. The purpose of this paper is to describe the existing supply of assisted living facilities (ALFs) and examine the extent to which they matched the philosophy of assisted living. Design and Methods: The study involved a multistage sample design to produce nationally representative estimates for the ALF industry. Administrators of nearly 1,500 eligible ALFs were interviewed by telephone. Results: As of 1998, there were an estimated 11,459 ALFs nationwide, with 611,300 beds and 521,500 residents. Nearly 60% offered a combination of low services and low or minimal privacy, whereas only 11% offered relatively high services and high privacy. Seventy-three percent of the resident rooms or apartments were private. Aging-in-place was limited by discharge policies in most ALFs for residents who needed help with transfers, had moderate to severe cognitive impairment, had any behavioral symptoms, or needed nursing care. The industry is largely private pay and unaffordable for low- or moderate-income persons aged greater than or equal to 75 unless they use assets as well as income to pay. Implications: ALFs differed widely in ownership, size, policies, and the degree to which they manifested the philosophy of assisted living. This diversity represents a challenge for consumers in terms of selecting an appropriate facility and for policy makers in terms of deciding what role they want assisted living to play in long-term care.

These five articles systematically discuss the shifts in social policy in the first four years of the Reagan administration and how they affected the elderly. Changes included are federal budget cuts, distribution of income, material needs status of older adults, status of the poor, income inequality among the elderly, and measuring hardship. (ABL)

Current policies concerning income in old age are framed in terms of important Social Security and private pension developments. Criticisms of the "new Social Security" are viewed in the context of major problems associated with the options, especially private pensions. (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]

Chile is a developing country with a rapidly expanding economy and concomitant social and cultural changes. It is expected to become a developed country within 10 years. Chile is also characterized as being in an advanced demographic transition. Unique challenges are posed by the intersection of rapid economic development and an aging population, making Chile an intriguing case study for examining the impact of these societal-level trends on the aging experience. This paper highlights essential characteristics of this country for understanding its emerging aging society. It reveals that there is a fundamental lack of adequate and depthful epidemiologic and country-specific research from which to fully understand the aging experience and guide new policies in support of health and well-being.

This paper describes elderly support and intergenerational transfer by gender, marital status, and place of residence for 150 elderly persons in Zimbabwe. The survey was conducted in September 1988, and includes information on background characteristics, income, and cash support from all sources, noncash support, and the support of elders to others. Conclusions and implications are discussed.

This paper examines one aspect of the economic impact of elderly migration, the transfer of income from state to state, a concern of policymakers, planners, and researchers. Using 1980 census microdata files it was determined that billions of dollars are transferred between states each year, some states (especially Florida) gaining and others losing. The 1980/1981 Consumer Expenditure Interview Survey was used to estimate the consumption patterns of the typical migrant household. These findings are discussed in the context of state economic development.

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]

Background and Objectives The Great Recession disproportionately impacted older adults and women of color, suggesting that women may be entering retirement without adequate assets. However, the current literature lacks a detailed account of women's experiences of mortgage trouble and foreclosure, as well as a longitudinal view of how these experiences impacted their overall financial assets. Research Design and Methods Grounded in cumulative inequality theory, this mixed methods study employed a QUAL→quan approach to gather qualitative data from a sample of 21 older adult women regarding their experiences of mortgage trouble. Quantitative longitudinal data was gathered for a subsample of the Early Baby Boomer Cohort using the Health and Retirement Study. Results Qualitative findings indicated women approaching retirement experienced chronic underemployment, wage stagnation, and financial volatility as contributors to asset depletion and eventual mortgage default or foreclosure. Quantitative results indicated asset depletion both during and post-Recession was considerably more pronounced among older adult women of color compared to older adult White men. Discussion and Implications These findings suggest that a lifetime of financial disadvantage coupled with macroeconomic instability situates older adult women, particularly women of color, in a financially vulnerable position for retirement. The ways in which 2017 attacks on the Consumer Financial Protection Bureau, Dodd-Frank, and the Fiduciary rule carry potential to further destabilize this population are also discussed. [ABSTRACT FROM AUTHOR]

Purpose : This article is one in a series of articles in this supplement addressing best practice for quality dementia care. The Alzheimer's Association, in revising their Dementia Care Practice Recommendations for 2017 has identified staff across the long-term care spectrum as a distinct and important determinant of quality dementia care. The purpose of this article is to highlight areas for developing and supporting a dementia-capable workforce. Methods : The Alzheimer's Association Principles For Advocacy To Assure Quality Dementia Care Across Settings provide a framework to examine interventions to support the dementia care workforce in long-term care settings. Evidence-based approaches that represent these principles are discussed: (a) staffing, (b) staff training, (c) compensation, (d) supportive work environments, (e) career growth and retention, and (f) engagement with family. Results : Although not all settings currently require attention to the principles described, this article proposes these principles as best practice recommendations. Recommendations and future research considerations to further improve the lives of those who live and work in nursing homes, assisted living, hospice, and home care, are proposed. Additional areas to improve the quality of a dementia care workforce person-centered care information, communication and interdepartmental teamwork, and ongoing evaluation are discussed. [ABSTRACT FROM AUTHOR]

Purpose of the Study: Earlier studies have identified a pattern of cumulative advantage leading to increased within-cohort economic inequality over the life course, but there is a need to better understand how levels of inequality by age have changed in the evolving economic environment of recent decades. We utilized Survey of Income and Program Participation (SIPP) data to compare economic inequality across age groups for 2010 versus 1983-1984. Design and Methods: We examined changing age profiles of inequality using a summary measure of economic resources taking into account income, annuitized value of wealth, and household size. We adjusted for survey underreporting of some income and asset types, based on National Income Accounts and other independent estimates of national aggregates. We examined inequality by age with Gini coefficients. Results: Late-life (65+) inequality increased between the 2 periods, with Gini coefficients remaining higher than during the working years, but with a less steep age difference in inequality in 2010 than in 1983-1984. Inequality increased sharply within each cohort, particularly steeply in Depression-era, war-baby, and leading-edge baby boom cohorts. The top quintile of elderly received increasing shares of most income sources. Implications: Increasing inequality among older people, and especially in cohorts approaching late life, presages upcoming financial challenges for elderly persons in the lower part of the income distribution. Implications of this increasingly high-inequality late-life environment need to be carefully evaluated as changes are considered in Social Security and other safety-net institutions, which moderate impacts of economic forces that drive increasingly disparate late-life economic outcomes. [ABSTRACT FROM AUTHOR]

Purpose of the Study: Lesbian, gay, and bisexual (LGB) adults have elevated rates of high-risk alcohol consumption compared with heterosexual adults. Although drinking tends to decline with age in the general population, we know little about LGB older adults' drinking. Using 2014 data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS), we aimed to identify factors associated with high-risk drinking in LGB older adults. Design and Methods: A U.S. sample of 2,351 LGB adults aged 50-98 years completed a survey about personal and social experiences, substance use, and health. Multinomial logistic regression was conducted to identify predictors of past-month high-risk alcohol consumption. Results: Approximately one fifth (20.6%) of LGB older adults reported high-risk drinking, with nonsignificantly different rates between men (22.4%) and women (18.4%). For women, current smoking and greater social support were associated with greater likelihood of high-risk drinking; older age, higher income, recovery from addiction, and greater perceived stress were associated with lower likelihood. For men, higher income, current smoking, and greater day-to-day discrimination were associated with greater likelihood of high-risk drinking; transgender identity and recovery from addiction were associated with lower likelihood. Implications: Social contexts and perceived drinking norms may encourage higher levels of alcohol consumption in LGB older women, whereas men's drinking may be linked with discrimination-related stress. Prevention and intervention with this population should take into account gender differences and sexual minority-specific risk factors. With future waves of data, we will be able to examine LGB older adults' drinking trajectories over time. [ABSTRACT FROM AUTHOR]

Objectives: This study systematically analyzed convoys of social relations to investigate the ways in which gender and income shape patterns of social relations across the life course in Lebanon. Methods: Data were drawn from a representative sample of adults aged 18 and older in Greater Beirut, Lebanon (N = 500). Multiple linear regression and multilevel models were conducted to examine main and interactive effects of age, gender, and income on social relations. Results: Findings indicate main effects of age, income, and gender on network structure and relationship quality. Older age was associated with larger network size, greater proportion of kin in network, higher positive and lower negative relationship quality. Higher income was associated with larger network size and decreased contact frequency. Female gender was also associated with decreased contact frequency. Gender interacted with income to influence network size and network composition. Higher income was associated with a larger network size and higher proportion of kin for women. Discussion: Findings suggest diversity in the experience of social relations. Such nuance is particularly relevant to the Lebanese context where family is the main source of support in old age. Policy makers and program planners may need to refrain from viewing social relations simplistically. [ABSTRACT FROM AUTHOR]

This spotlight offers a unique window into factors affecting aging in Lebanon. As a bridge between east and west, both geographically and culturally, Lebanon has the fastest growing older adult population in the Arab region, but few societal resources to address its needs. In a country with a history of political instability and war, but also a culture with strong family values, aging adults in Lebanon are vulnerable in some ways and advantaged in others. Outmigration of youth is an important determinant of the well-being of the elderly. While often advantaged by remittances sent by their children, older Lebanese adults have less access to instrumental social and personal support previously provided by young adults in the family. How Lebanon manages these challenges is likely to foreshadow the future aging experience for much of the Arab region. [ABSTRACT FROM AUTHOR]

Purpose: This article expands on earlier analyses that assessed whether the recent recession influenced retirement expectations. Design and Methods: Acknowledging that planning for retirement is a complex process influenced by personal preferences, resources, economic factors, institutional policies, and social norms, we test more comprehensive models than those used in previous studies, using data from the 2006 and 2008 waves (Waves 8 and 9) of the Health and Retirement Study. Results: Our results confirm that economic changes impinge on retirement expectations, but they also show stronger influences of other factors such as debts and the work environment. Implications: As the baby boom cohorts approach retirement age, it will be important to better understand how workers consider macro factors such as the state of the economy and firm-level factors and personal finances when planning for retirement. [ABSTRACT FROM PUBLISHER]

Purpose: This study compared the official poverty rate for adults aged 65 years and older with alternative measures that portray the true resources and needs of older adults. Design and Methods: The analysis used data from the 2004 Health and Retirement Study on income, assets, in-kind transfers, and out-of-pocket medical expenses. It also incorporated the effects of federal and state income taxes on net incomes, and accounted for the potential annuity value of assets in measuring resources. Results: The alternative poverty measures that account for out-of-pocket health spending estimate that between 0.3 and 1.5 million more older adults live in poverty than acknowledged by the official measure. Implications: These results highlight the need to update poverty measures so that they better reflect older adults’ circumstances. This will become increasingly important as policymakers consider reforms to improve solvency in the Social Security and Medicare programs that may require benefit cuts or increased cost sharing. [ABSTRACT FROM PUBLISHER]

Purpose: The purpose of this article was to review existing knowledge about assisted living (AL) use by traditionally underserved populations, including people of color, low-income people, and those living in rural communities. Design and Methods: We reviewed methodologies and findings of research on AL and residential care up to June 2004. Results: Some studies suggested that low-income people and people of color either are less likely to utilize AL or receive AL in settings with less space and amenities and/or lower scores in selected quality measures. Generalizations from national or multistate studies to the population have methodological limitations. Numerous topics remain unstudied, including the pricing of AL, the experience of choosing an AL facility, the presence of discriminatory admission and retention practices, and the role of resident preferences. Data on access to AL in rural areas are inconclusive. Implications: We offer recommendations for national surveys to better classify supportive housing settings. Furthermore, we suggest quantitative and qualitative studies to illuminate the experience of low-income, racial/ethnic minority, and rural populations in AL settings. [ABSTRACT FROM PUBLISHER]

Purpose: We compare the economic consequences of widowhood for preretirement age and early-retirement age Black, Hispanic, and non-Hispanic White women. Methods: We use the 1992 and 2000 waves of the Health and Retirement Study to assess the effects of widowhood on the household incomes and assets of non-Hispanic White, Black, and Hispanic women who were 51 years of age or older at baseline (N = 4,544). Results: For women of all racial and ethnic groups, marital disruption, including widowhood, results in a substantial decline in household income and assets. Net of demographic controls, the relative loss is far greater for Black and Hispanic widows than for non-Hispanic White widows. Implications: The data reveal a substantial widowhood penalty for total household income and net worth for women in each racial and ethnic group. However, the findings suggest that minority widows are at a particularly high risk of poverty in late life, given that they have lower incomes and fewer assets to begin with. Implications of the results for the financial security of women approaching retirement are discussed. [ABSTRACT FROM AUTHOR]

Using income data from the 1960,1970, and 1980 U.S. Censuses of Population, the relative change in income of older women was examined from several perspectives. As expected, the income distribution of cohorts entering old age more recently is well above that of the preceding cohorts, and there is some decline in inequality among older women over the past 20 years. The position of older women relative to middle-aged women, however, has not improved, and cohorts continue to experience large drops in income as they enter old age. [ABSTRACT FROM PUBLISHER]