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Objectives. Although there is substantial evidence of declining prevalence of disability among the older population during the late 1980s and 1990s, evidence on trends in the underlying dynamics of disability is lacking. For this study, we estimated models of transitions between discrete disability and vital states that incorporated simple linear time trends. Methods. We analyzed data from the 1982-1994 interviews of the New Haven Established Populations for Epidemiologic Studies of the Elderly study and used three alternative measures of disability status. We estimated separate models of disability prevalence and disability transitions by gender. Results. Eleven of 12 estimated trends in transition rates were statistically significant. For men and women, and for three alternative disability indicators, we found downward trends in rates of both onset of and recovery from disability among people aged 75 and older. We did not find any consistent pattern of trends in disability among those aging into the 75 and older group during this period. Discussion. Our findings are consistent with declining population-level disability prevalence only if any downward trend in onset outweighs the downward trend in recovery. These findings axe also consistent with a trend toward more severe disability problems among the disabled population.

Objectives. The purpose of this study was to test with panel data an extended model of the stress process recognizing the separate effects of a parent's need for care and an adult child's caring activities. Methods. Using data from the 1996, 1998, and 2000 waves of the Health and Retirement Study, we estimated nonlinear mixed models of mental health outcomes. We assessed mental health for separate samples of 3,350 men and 3,659 women by using an 8-item scale of depressive symptoms. We also explored the sensitivity of results to alternative measures and model specifications. Results. We found that female, but not male, caregivers whose parents needed care exhibited adverse mental health consequences. However, we found that, generally, both male and female noncaregivers whose parents needed care were more likely to report symptoms of depression than were noncaregivers without disabled parents. Additional findings suggest that the stress process is still more complex among married couples. Discussion. This study distinguishes the outcomes of parental care needs from those attributable to caregiving activities. Adverse psychological outcomes appear to be dispersed throughout the family. To focus narrowly on active caregivers is to underestimate the social burdens of disability at older ages.

This paper introduces the Special Issue of four empirical studies on the provision of family support to older people that have been written members of the Family Support for Older People: Determinants and Consequences (FAMSUP) network. They have in common the use of individual-level data and recognition of the importance of demographic forces, cultural variations and public policy in shaping patterns of elder care. The four papers are also explicitly comparative, and emphasise both between- and within-country differences. The European countries examined by the FAMSUP researchers exhibit several broadly similar demographic trends, but these are superimposed on very different policy regimes. The 'macro' focus of much comparative policy-oriented research facilitates the identification and description of population ageing, while illuminating the policy issues raised by demographic change. A macro-focus is also characteristic of much comparative welfare-state analysis. The 'micro' orientation of the research presented in this collection typically treats the policy environment as an implicit or residual category. We argue that progress in understanding comparative patterns of elder care, and in developing policy responses to demographic change, will be facilitated through blending the macro and micro perspectives, in which variations in the policy environment are explicitly linked to individual- and family-level behaviour. KEY WORDS--elder care policy, cross-national, family support, older people.

Objectives. Assistive technology (AT) may improve quality of life and reduce dependence for older persons with disabilities. In this article, we examine tradeoffs between the use of AT and reliance on personal care, with attention to factors that may influence those relationships. Methods. We jointly modeled hours of formal and informal care with use of AT in order to address the interdependence of these outcomes in ways not taken into account in previous studies. We analyzed a national sample of older persons with difficulty in activities of daily living drawn from Phase 2 of the 1994-1995 National Health Interview Survey (NHIS) Disability Supplement. Results. Our findings show that the use of AT was associated with reductions in informal care hours, especially for those who were unmarried, better educated, or had better cognitive abilities, but appeared to supplement formal care services for these groups. Individuals with cognitive impairment were less likely than others to substitute AT with either type of personal care. Discussion. These models raise the possibility that reductions of informal care hours may be accomplished with a combination of formal care and assistive devices, rather than from either alternative alone.

Purpose: We call attention to the widespread belief that the United States is an 'increasingly mobile society,' despite the fact that overall mobility has generally declined since about 1950, and interstate mobility has generally not increased during the same period. We review and extend past research documenting these mobility trends. Design and Methods: We describe population-level mobility for people of all ages as well as for several adult age groups, using published data from the U.S. Current Population Survey. We use simple regression methods to estimate the size and significance of mobility trends. Results: Overall mobility rates have declined for individuals of all ages and among all age groups. The largest average annual declines occur for 20- to 29-year-olds, although the rate of decline for those aged 65 and older is also large. Interstate mobility has declined slightly or remained constant, except among adults between 45 and 64 years old. Implications: Although there may be good reasons to worry about the future of family care provided to elderly individuals, increased geographic mobility does not appear to be one of them. We speculate on reasons why the false belief persists. Key Words: Mobility, Migration, Census data, Trends

Objectives. We describe how paid and unpaid home care hours received by older unmarried Americans change in response to disability dynamics. We test whether responses to disability declines and improvements are symmetric; that is, we test whether reductions in care hours that are due to disability improvements are of similar magnitude to increases in care hours that are due to disability declines. Methods. Using a national sample of older unmarried Americans, we examine changes in total hours, paid hours, and unpaid hours of care in response to declines and improvements in personal care (activities of daily living, or ADLs) and routine care (instrumental ADLs, or IADLs) disability. We model changes in the total hours of care received in the past month and jointly model changes in unpaid and paid hours, using Tobit models. Results. Changes in the total hours of care received respond to both increases and decreases in the count of ADL limitations and appear close to symmetric. In contrast, responses to IADL disability dynamics appear to be far less symmetric: Although increases in the count of IADL limitations are met with substantial increases in the total hours of care, decreases are not met with correspondingly large declines in care. The same general pattern is found for unpaid and paid care, and for Medicaid-funded home care. Discussion. Disability and care are not static constructs in old age. Older unmarried persons experience worsening, stabilizing, and recovery of function, and their care hours change accordingly. Evaluations of home care programs must be cognizant of such dynamic realities.

Purpose: This study examines depressive symptoms among adult children of elderly parents; it views the parents' care needs and child's care activities as two separate stressors, different combinations of which may affect both caregiving and noncaregiving family members. Design and Methods: A sample of 4,380 women and 3,965 men from the first wave of the Health and Retirement Study was analyzed by use of four alternative forms of multiple regression analysis. Using the Center for Epidemiological Studies Depression scale, respondents reported on their depressive symptoms, as well as on parental disability and care provided by themselves, their spouses, and siblings. Results: Noncaregivers reporting severe parental disability were significantly more likely to experience depression symptoms. Evidence of increased manifestations of depression was not found among those caring for severely disabled relatives; nor was it found among those providing care in the absence of severe parental care needs. Having a caregiving sibling was associated with increased CES-D scores among noncaregivers. Implications: In the current literature, personal care needs of a close relative are named among significant disturbances in the lives of caregivers. By extending this approach to members of a family network regardless of caregiver status, this study allows us to distinguish the magnitude of negative outcomes of serious parental care needs while clarifying the impact uniquely attributable to caregiving activities. Key Words: Parental care needs, Informal care, Positive and negative consequences of care, Caregiver's Family

Objectives. We investigate the association between an extensive set of location-specific factors and the propensity of retirement-age individuals to remain in, or relocate to, those locations. In particular we investigate whether state and local fiscal factors influence the migration decisions of retirees, and we study the relative importance of fiscal and other factors in these decisions. Methods. We place decisions regarding whether to move and where to locate in a single discrete-choice framework. We estimate an individual-level location-choice model by using a combination of place-characteristics data and Census county-to-county migration data for the period 1985-1990. Results. We find that levels of tax burdens and public services can affect location decisions. Of the fiscal variables, income taxes have the largest relative effects. However, other factors, including climate, economic conditions, and population characteristics, appear to play much larger roles in migration and location decisions. Discussion. Although income tax reductions might influence the location decisions of recent retirees, whether or not the economic benefits associated with these population gains outweigh the accompanying revenue losses is an important area for further research. A more cost-effective strategy may be for states to focus on marketing their amenities rather than using fiscal policy to recruit retirees.

The purpose of this study was to identify quadriceps femoris strength thresholds below which performance on ambulatory tasks is compromised. A second purpose was to evaluate whether self-reported functioning matches evaluated performance of the activities. Subjects (N = 100; age 73 [+ or -] 0.9 years) participated in isometric knee extension strength tests, performed three functional ambulatory tasks (chair rise, gait speed, and stair ascent and descent), and answered standard survey questions assessing physical function. Significant relationships were observed between functional performance and the ratio of isometric leg extension peak torque to body weight (STR/WT) for each activity (p < .0001). For each activity, thresholds of STR/WT between 3.0 and 3.5 N m/kg were observed, below which the likelihood for success was reduced. Thresholds were determined by calculating the value of STR/WT that minimized the classification error. Individuals with a STR/WT < 3.0 N m/kg are at a substantial risk for impaired function in chair rise, gait speed, and stair ascent and descent. Sensitivity and specificity of STR/WT as a predictor of functional success ranged from 76% to 81% and from 78% to 94%, respectively, depending on activity. This is of clinical significance, as the STR/WT thresholds can identify individuals with preclinical disability (beginning to have difficulty with ambulatory tasks) as opposed to those in whom an outright disability is observed. This may be useful for targeting individuals for strengthening interventions and developing specific intervention goals.

This study analyzes trends in the percentage of older women living alone in 21 European and North American countries over the period of 1960-1992. The general pattern is one of substantial annual increases in the percentage of elderly women living alone. This trend is shown to result mainly from demographic changes, with little evidence of a role for economic variables. The analysis suggests a reversal of the current trend in coming years, as mothers of postwar baby booms reach old age.

As the population of the country ages, more attention is being paid to the living arrangements of older people, usually singling out a specific alternative, such as institutionalization or formal care services. Almost without exception, researchers have assumed that all people have all options of care, including being cared for by a relative. This option exists only when relatives exist, but there are also other effects; for example, a elderly widow is less likely to live with a sibling or a parent if adult children are available. The living arrangements of 2,328 elderly widows selected from the 1982 National Long-Term Care Survey (NLTCS) were analyzed to determine the effect of the availability of children on living arrangement, type of caregiver, and type of care network. It was found that when children, especially daughters, were available, the elderly were most likely to live with them rather than have other arrangements. Sons were more likely to provide financial assistance for buying services. Older women with large families were more likely to live alone and receive informal care than those with smaller families. Children seem to be better situated to provide assistance than friends, neighbors, and informal organizations. Those requiring more care received more care from their children, but also these women who remained at home seemed able to organize some kind of care arrangement. Financial resources, such as income and Medicaid eligibility, strongly affect living arrangements, but become less important as the need for care increases. Blacks were much more likely to be living with relatives than were whites. Before national policies and priorities can be set, or housing for the elderly built, the needs and preferences of the elderly must be taken into account. (Consumer Summary produced by Reliance Medical Information, Inc.)

Although the prevalence of late-life disability has been declining, how best to promote further reductions remains unclear. This article develops and then demonstrates an approach for comparing the effects of interventions on the prevalence of late-life disability. We review evidence for three potentially high-impact strategies: physical activity, depression screening and treatment, and fall prevention. Because of the large population at risk for falling, the demonstrated efficacy of multi-component interventions in preventing falls, and the strong links between falls and disability, we conclude that, in the short run, multi-component fall-prevention efforts would likely have a higher impact than either physical activity or depression screening and treatment. However, longer-term comparisons cannot be made based on the current literature and may differ from short-run conclusions, since increases in longevity may temper the influences of these interventions on prevalence. Additional research is needed to evaluate longer-term outcomes of interventions, including effects on length and quality of life.

A decline has been found in the prevalence of disability among the older U.S. population during the 1980s and 1990s. One source of evidence for this decline is data from the National Long-Term Care Survey (NLTCS). This article investigates possible ambiguities in measuring disability using large-scale household surveys, illustrating the consequences of such problems with new analyses of NLTCS data. The reanalysis suggests a more gradual decline in disability than that found in prior research. The article also discusses three societal trends in areas other than health or functioning that might contribute to declines in disability levels: a reduced supply of informal care, changes in the technology of self-care, and changes in the definition and perception of both 'ability' and 'disability.'

Caregiving for family members is often described as a 36-hour day. Previous literature has suggested that family caregivers have little time to attend to their own health needs, such as participating in leisure-time physical activity. Using data from the Health and Retirement Study, we analyze whether time-allocation decisions reflect a conflict between time devoted to informal care and time devoted to self-health promotion through physical activity. The empirical model is a system of four correlated equations, wherein the dependent variables are hours spent caregiving, frequency of moderate and vigorous physical activity, and hours spent in paid work. Results from joint estimation of the four equations indicate limited evidence of a competition between time spent in caregiving and frequency of physical activity. Parental factors that increase allocation of care time to parents do not comprehensively induce reductions in the frequency of any type of physical activity, or in hours of work, among either men or women. [ABSTRACT FROM AUTHOR]

Focuses on how the methodology for calculating health expectancy is developed. Background on the researches on active life expectancy; Data and methods of the study; Discussion on the microsimulation of active life expectancy.

The article focuses on the current state of pathology peer reviews of non-clinical toxicology studies as of December 2010. It explains the crucial role of the pathology peer review in ensuring the quality of the data gathered from animal studies that provide the basis for determining the risk posed by certain compounds to human health. It also describes how peer review pathologist could provide study pathologists with additional insights in interpreting unfamiliar lesions, techniques, and animal models used in toxicity studies.

Growing disparities in adult mortality across U.S. states point to the importance of assessing disparities in other domains of health. Here, we estimate state-level differences in disability, and draw on the WHO socio-ecological framework to assess the role of ecological factors in explaining these differences. Our study is based on data from 5.5 million adults aged 25–94 years in the 2010–2014 waves of the American Community Survey. Disability is defined as difficulty with mobility, independent living, self-care, vision, hearing, or cognition. We first provide estimates of age-standardized and age-specific disability prevalence by state. We then estimate multilevel models to assess how states' socioeconomic and policy contexts shape the probability of having a disability. Age-standardized disability prevalence differs markedly by state, from 12.9% in North Dakota and Minnesota to 23.5% in West Virginia. Disability was lower in states with stronger economic output, more income equality, longer histories of tax credits for low-income workers, and higher cigarette taxes (for middle-age women), net of individuals' socio-demographic characteristics. States' socioeconomic and policy contexts appear particularly important for older adults. Findings underscore the importance of socio-ecological influences on disability. [ABSTRACT FROM AUTHOR]