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Background and Objectives Meeting individual preferences for long-term services and supports (LTSS) is a policy priority that has implications for quality of care. Evidence regarding preferences is sparse. In addition, little is known regarding whether preferences and care arrangements match for those receiving care, and implications for quality of life. Research Design and Methods A random sample (n = 1,783 in 2012) of National Health and Aging Trends Study participants were asked the best care option for someone 80+ who needs help with personal care and mobility. Analyses examine variations in care preferences, the relationship of preferences to care arrangements, and the association of matched preference and care arrangements to quality of life indicators. Results Care preferences vary by demographics. Equal proportions (3 in 10) of older adults chose assisted living or continuing care retirement communities (CCRC), care in own home with family help, and care in own home with paid help, as the best options. Persons in assisted living/CCRC settings were significantly more likely to choose this option as best. Only 1 in 3 older persons receiving care are in arrangements that match preferences. No association with quality of life indicators was found. Discussion and Implications Aging in place remains the care preference of a majority, but close to one-third chose assisted living/CCRC, suggesting preferences are evolving. Aligning care preferences and arrangements is a policy goal, but many do not achieve a match and there remain gaps in understanding trajectories in preferences and care arrangements and implications for quality of life. [ABSTRACT FROM AUTHOR]

Objectives Studies have reported decreasing dementia prevalence in recent decades in the United States. We explore with a new national data source whether declines have occurred since 2011, whether trends are attributable to shifts in dementia incidence or mortality, and whether trends are related to shifts in population composition or subgroup prevalence. Methods We use the 2011–2015 National Health and Aging Trends Study (N = 27,547) to examine prevalence of probable dementia among the 70 and older population. To minimize the influence of potential learning effects on prevalence rates, we require individuals to meet probable dementia criteria at two consecutive rounds. Results: Prevalence of probable dementia declines over this period by 1.4% to 2.6% per year. Declines are concentrated among women, non-Hispanic white and black groups, and those with no vascular conditions or risk factors. The latter group also has experienced declines in dementia incidence. Declines in prevalence are largely attributable to age- and education-related shifts in population composition. Discussion Given the role of age and educational composition in short-term declines, the United States is likely to continue to experience short-term declines in dementia prevalence. However, persistently high rates among minority groups, especially of Hispanic origin, are concerning, and, barring new treatments, long-run trends may reverse course. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to develop and assess a composite measure of physical capacity using self-report and physical performance items. Method: Item response theory (IRT) is used to evaluate measurement properties of self-report and performance items and to develop a composite measure for 7,609 participants in the National Health and Aging Trends Study. Results: Self-reports distinguish differences at the lower end of physical capacity but not at mid-to-high levels. Performance-based measures discriminate across a fuller spectrum. An IRT-based composite score, drawing on both, provides increased measurement precision across the physical capacity spectrum and detects age group differences if either self-report or performance does so—suggesting it is better suited for studying age-related changes than either measure alone. Discussion: Self-report and performance measures have different strengths on the physical capacity spectrum. IRT provides a means of combining these different measurement approaches for analyses of physical capacity across a broad range of functioning in later life. [ABSTRACT FROM AUTHOR]

Objectives: To provide a profile of older adults who successfully accommodate declines in capacity by using assistive devices. Method: Using the National Health and Aging Trends Study, we provide national estimates of prevalent, incident, and persistent successful accommodation of mobility and self-care activity limitations. For incident and persistent accommodation groups, we describe their subjective wellbeing and participation restrictions, health and functioning, demographic and socioeconomic characteristics, and acquisition of assistive devices and environmental features. We estimate regression models predicting incident and persistent successful accommodation and the extent of wellbeing and participation restrictions for incident and persistent groups (vs. those who are fully able). Results: Nearly one-quarter of older adults have put in place accommodations that allow them to carry out daily activities with no assistance or difficulty. In adjusted models, incident and persistent successful accommodation is more common for those ages 80-89, those with more children, and those living in homes with environmental features already installed; well-being levels for these groups are similar and participation restrictions only slightly below those who are fully able. Discussion: A focus on facilitating successful accommodation among those who experience declines in capacity may be an effective means of promoting participation and wellbeing in later life. [ABSTRACT FROM AUTHOR]

The number of US adults ages sixty-five and older who are living with dementia is substantial and expected to grow, raising concerns about the demands that will be placed on family members and other unpaid caregivers. We used data from the 2011 National Health and Aging Trends Study and its companion study, the National Study of Caregiving, to investigate the role of dementia in caregiving. We found that among family and unpaid caregivers to older noninstitutionalized adults, one-third of caregivers, and 41 percent of the hours of help they provide, help people with dementia, who account for about 10 percent of older noninstitutionalized adults. Among older adults who receive help, the vast majority in both community and residential care settings other than nursing homes rely on family or unpaid caregivers (more than 90 percent and more than 80 percent, respectively), regardless of their dementia status. Caregiving is most intense, however, to older adults with dementia in community settings and from caregivers who are spouses or daughters or who live with the care recipient. [ABSTRACT FROM AUTHOR]

Objectives. To inform public health efforts to promote independent functioning among older adults, we have provided new national estimates of late-life disability that explicitly recognize behavioral adaptations. Methods. We analyzed the 2011 National Health and Aging Trends Study, a study of Medicare enrollees aged 65 years and older (n = 8077). For 7 mobility and self-care activities we identified 5 hierarchical stages-fully able, successful accommodation with devices, activity reduction, difficulty despite accommodations, and receipt of help-and explored disparities and associations with quality of life measures. Results. Among older adults, 31% were fully able to complete self-care and mobility activities. The remaining groups successfully accommodated with devices (25%), reduced their activities (6%), reported difficulty despite accommodations (18%), or received help (21%). With successive stages, physical and cognitive capacity decreased and symptoms and multimorbidity increased. Successful accommodation was associated with maintaining participation in valued activities and high well-being, but substantial disparities by race, ethnicity, and income existed. Conclusions. Increased public health attention to behavioral adaptations to functional change can promote independence for older adults and may enhance quality of life. [ABSTRACT FROM AUTHOR]

Objective. To examine the measurement equivalence of items on disability across three international surveys of aging. Method. Data for persons aged 65 and older were drawn from the Health and Retirement Survey (HRS, n = 10,905), English Longitudinal Study of Aging (ELSA, n = 5,437), and Survey of Health, Ageing and Retirement in Europe (SHARE, n = 13,408). Differential item functioning (DIF) was assessed using item response theory (IRT) methods for activities of daily living (ADL) and instrumental activities of daily living (IADL) items. Results. HRS and SHARE exhibited measurement equivalence, but 6 of 11 items in ELSA demonstrated meaningful DIF. At the scale level, this item-level DIF affected scores reflecting greater disability. IRT methods also spread out score distributions and shifted scores higher (toward greater disability). Results for mean disability differences by demographic characteristics, using original and DIF-adjusted scores, were the same overall but differed for some subgroup comparisons involving ELSA. Discussion. Testing and adjusting for DIF is one means of minimizing measurement error in cross-national survey comparisons. IRT methods were used to evaluate potential measurement bias in disability comparisons across three international surveys of aging. The analysis also suggested DIF was mitigated for scales including both ADL and IADL and that summary indexes (counts of limitations) likely underestimate mean disability in these international populations. [ABSTRACT FROM PUBLISHER]

Background. Measurement gaps continue to hamper fuller understanding of late-life disability trends and dynamics. This article reports findings that validate the self-reported components of the disability protocol to be used in the new National Health and Aging Trends Study. The protocol was designed to redress existing measures by attending to environmental aspects of disability, capturing a broader range of capacity to perform tasks and including participation restriction items. Methods. We undertook an in-person validation study to determine the reliability, validity, and initial measurement properties of the National Health and Aging Trends Study self-reported disability protocol (n = 326). A random subset (n = 111) was readministered the protocol within 2–4 weeks. The interview and reinterview included new self-reported measures of physical capacity, activity limitations, and participation restrictions, as well as established performance and cognitive tests. We calculated percent agreement and kappa between interviews for all self-reported items and summary measures. We also assessed the construct validity of summary measures through correlations with demographic characteristics, frailty, memory, and performance-based mobility and confirmed whether activity limitations and participation restrictions were distinct domains. Results. New items and derived summary measures demonstrate robustness over a short time period, with kappas for retained/recommended items in the .60–.80 range. The summary measures correlate as expected with age, sex, residential status, and established performance-based constructs. Two factors, representing activity limitations and participation restrictions, were confirmed. Conclusions. The National Health and Aging Trends Study protocol preserves the ability to examine more traditional measures of functioning while offering new insights into how activities are performed and preserving key conceptual distinctions. [ABSTRACT FROM PUBLISHER]

Objectives. To examine whether stability of living arrangements and changes in household composition—both types and frequency—influence nursing home placement or timing to entry among older people. Methods. Data from the first 5 waves of the Assets and Health Dynamics of the Elderly (1993–2002) on 8,093 persons aged 70 years or older at baseline are used in probit and hazard models to predict nursing home entry and time to entry. Results. Stable living arrangements carry different risks of institutionalization. Those living continuously alone or with others were at highest risk; at lowest risk were those living continuously with a spouse or the same child (lowest overall). Changes in household composition were protective against nursing home entry and slowed time to entry; types of change were not influential when number of changes was taken into account. Discussion. Results suggest that stability of living arrangements in and of itself is not protective against institutionalization. Having options that allow one to change living arrangements over time in response to changing needs for assistance is of importance if the goal is to avoid institutional care or extend community residence prior to entry. [ABSTRACT FROM PUBLISHER]

Objectives: To propose a theoretical construct of family caregiver skills in effective medication management for home hospice patients. [ABSTRACT FROM PUBLISHER]

Objectives. The purpose of this study was to investigate the cumulative effects of poverty and family stressors to the later life functional status of African American women. Methods. We used longitudinal data covering a 30-year period for a cohort of 553 African American women with common life experiences. Interviews were conducted with these women as young mothers, as mothers of adolescents, and in early old age (two thirds aged 60+). We classified women as high, usual, or low functioning by using physical and mental health indicators. We examined both timing and duration of poverty and family stressors. Results. Initially these women were largely healthy, but health declines were steeper and occurred earlier for those who were low functioning in later life. Persistent poverty was detrimental to functioning at older ages, as was persistent family stress. Women who left poverty early did not differ in later life functioning from women who were never poor. Discussion. Despite similar earlier life circumstances and health, there was substantial heterogeneity in functioning in early old age. Long-term poverty and family stress were strongly associated with being low functioning. Early poverty and transient family problems did not have lasting health effects, underscoring the plasticity of human development and the importance of interventions that can alter life course trajectories. [ABSTRACT FROM AUTHOR]

Abstract: Race- and poverty-related disparities in physical function are well documented, though little is known about effects of race and poverty on functional decline and the progression of disability. We examined cross-sectional and longitudinal relationships between race, poverty and lower extremity function using data from moderately to severely disabled women in the U.S. Women''s Health and Aging Study. Severity of lower extremity functional limitation was determined from scaled responses of reported difficulty walking ¼ mile, walking across a room, climbing stairs, and stooping, crouching or kneeling. Usual walking speed assessed over 4m was our objective measure of function. Of the 996 women who described themselves as black or white, 284 (29%) were black and 367 (37%) were living at or below 100% of the federal poverty level. Independent of demographic and health-related factors, among white women, the poor exhibited consistently worse lower extremity function than the non-poor; this association, however, was not observed in black women. Among the non-poor, black women had slower walking speeds, and reported more limitation in lower extremity function than their non-poor white counterparts, even after adjusting for demographic variables and health-related characteristics. After 3 years, accounting for baseline function, demographic and health-related factors, race and poverty status were unrelated to functional decline. Thus, while race and poverty status were associated with functional deficits in old age, they do not appear to impact the rate of functional decline or progression of disability over 3 years. [Copyright &y& Elsevier]

Little is known about the prevalence and correlates of psychotropic drug use in community-dwelling elders with dementia. Baseline data from 285 community-dwelling elders with a research classification of dementia enrolled in the observational Memory and Medical Care Study were analyzed. Of these, 33.3% with a research classification of dementia were clinically diagnosed, 28.8% used at least 1 psychotropic drug, and 61.8% had at least 1 behavioral or psychologic symptom of dementia. Presence of a behavioral or psychologic symptom of dementia was associated with a higher likelihood of a clinical diagnosis of dementia. A clinical diagnosis of dementia, not a behavioral or psychologic symptom of dementia, was associated with psychotropics use. Clinical recognition of dementia appears to be an intermediate step between presence of symptoms of dementia and the prescription of psychotropics. Most community-dwelling elders meeting the research criteria for dementia were not clinically diagnosed, despite contact with a physician (89%) in the previous year. [ABSTRACT FROM AUTHOR]

Little is known about the prevalence and correlates of psychotropic use in community-dwelling elders with dementia. Baseline data from 285 community-dwelling elders with a research classification of dementia (based on a neuropsychological battery of 4 tests) and their knowledgeable informants enrolled in the observational Memory and Medical Care Study were analyzed. A total of 33.3% of subjects with a research classification of dementia were clinically diagnosed, 28.8% used at least 1 psychotropic drug, and 61.8% had at least 1 behavioral or psychological symptom of dementia (BPSD). Presence of BPSD was associated with a higher likelihood of a clinical diagnosis of dementia. Multivariate logistic regression showed a clinical diagnosis of dementia, not BPSD, was associated with psychotropic use; clinical recognition of dementia appears to be an intermediate step between presence of BPSD and prescription of psychotropics. In addition, most community-dwelling elders meeting the research criteria for dementia were not clinically diagnosed, despite contact with a physician (89%) in the previous year. [ABSTRACT FROM AUTHOR]

Purpose: Family caregivers comprise the backbone of long-term-care provision in the United States, yet little is known about how the composition and experience of Family caregiving has changed over time. Design and Methods: Data are drawn from the 1989 and 1999 National Long-Term Care Survey and Informal Caregiver Survey to develop nationally representative profiles of disabled older adults and their primary informal caregivers at two points in time. Results: The proportion of chronically disabled community-dwelling older adults who were receiving informal assistance from family or friends declined over the period of interest, whereas the proportion receiving no human help increased. On average, recipients of informal care were older and more disabled in 1999 than in 1989. Primary caregivers were children (41.3%), spouses (38.4%), and other family or friends (20.4%); children were more likely and others less likely to serve as primary caregivers in 1999 relative to 1989. Primary caregivers provided frequent and high levels of help at both points in time. A striking increase was found (from 34.9% to 52.8%) in the proportion of primary caregivers working alone, without secondary caregiver involvement. Implications: In the context of projected demographic trends and budgetary constraints to public health insurance programs, these data underscore the importance of identifying viable strategies to monitor and support family caregivers in the coming years. [ABSTRACT FROM AUTHOR]

The comprehensive insurance coverage afforded low-income elders with both Medicare and Medicaid coverage (dual enrollees) has substantially reduced financial barriers to care. However, other studies show reduced and less appropriate utilization patterns among dual enrollees compared to Medicare beneficiaries with private supplemental insurance, suggesting access barriers remain. This study found that 59 percent of elderly dual enrollees needed an ambulatory medical or long-term care service in a 1-year period. One third of these individuals experienced barriers to access; organizational and geographic barriers were more prevalent than financial barriers. African American race, trouble paying basic living expenses, fair or poor health status, and an unfavorable assessment of physician information giving were significantly associated with an increased likelihood of organizational and geographic access barriers among elderly dual enrollees. [ABSTRACT FROM AUTHOR]

Background This study examines the association of potentially inappropriate medication prescribing (PIRx) with hospitalization and death among elderly long-stay nursing home residents. Methods We defined PIRx using the combined version of the Beers criteria. Data were from the 1996 Medical Expenditure Panel Survey Nursing Home Component. The study sample included 3372 residents, 65 years and older, who had nursing home stays of 3 consecutive months or longer in 1996. We performed multivariate logistic regression analyses of longitudinal data using generalized estimating equations. Results Residents who received any PIRx had greater odds (odds ratio [OR], 1.27; P = .002) of being hospitalized in the following month than those receiving no PIRx. Residents with PIRx exposure for 2 consecutive months were at increased risk (OR, 1.27; P = .004) of hospitalization, as were those receiving PIRx in the second month only (OR, 1.80; P = .001), compared with those receiving no PIRx. Residents who received PIRx were at greater risk of death (OR, 1.28; P = .01) that month or the next. Residents with intermittent PIRx exposures were at greater odds of death (OR, 1.89; P<.001), compared with those with no PIRx exposure. Conclusions The association of PIRx with subsequent adverse outcomes (hospitalization and death) provides new evidence of the importance of improving prescribing practices in the nursing home setting. [ABSTRACT FROM AUTHOR]

To estimate the scope of potentially inappropriate medication prescriptions (PIRx) among elderly residents in U.S. nursing homes (NHs), and to examine associated resident and facility characteristics. The 1996 Medical Expenditure Panel Survey Nursing Home Component (MEPS NHC), a survey of a nationally representative sample of NHs and residents. The PIRx, defined by Beers's consensus criteria (1991, 1997), was identified using up to a year's worth of NH prescribed medicine data for each resident. The study sample represented 1.6 million NH residents ( n=3,372). At a minimum, 50 percent of all residents aged 65 or older, with an NH stay of three months or longer received at least one PIRx in 1996. The most common PIRx involved propoxyphene, diphenhydramine, hydroxyzine, oxybutynin, amitriptyline, cyproheptadine, iron supplements, and ranitidine. Resident factors associated with greater odds of PIRx were Medicaid coverage, no high school diploma, and nondementia mental disorders. Facility factors were more beds and lower RN-to-resident ratio. Factors associated with lower odds of PIRx were fewer medications, residents with communication problems, and being in an accredited NH. Onsite availability of pharmacists or mental health providers was not related. With quality of care and patient safety as major public health concerns, effective policies are needed to avoid PIRx occurrences and improve the quality of prescribing among elderly residents in NHs. Additional studies are needed to determine the impact of PIRx on this NH population. [ABSTRACT FROM AUTHOR]

Examines the use of mental health services and correlates of receiving services among the community-dwelling children with disabilities ages six to seven. Analysis of data from the 1994 and 1995 National Health Interview Survey Disability Supplements; Mental health services for children with poor psychosocial adjustment; Differences by age, race, and insurance coverage.

Background: The role of behavioral and psychological symptoms as an independent risk factor of nursing home placement (NHP) in cognitively impaired elders has been controversial.Methods: A community sample of 449 cognitively impaired elders and their knowledgeable informants (KIs) was followed for 1 year. Subjects were classified as having dementia (n=330) or mild cognitive impairment (MCI) (n=119) using a neuropsychiatric battery of 4 tests. Subject characteristics (behavioral and psychological symptoms, demographic, health related, and health services use) and KI characteristics were entered into the Cox proportional hazard regression analysis.Results: The incidence rate of NHP was 8.9%. At baseline, 57.7% of subjects had at least 1 behavioral and psychological symptom. Presence of these symptoms was associated with shorter time to NHP only in a univariate analysis. Other factors significant in the multivariate Cox modeling were being white (hazard ratio [HR] = 2.17), having fair or poor physical health rating (HR= 2.12), having greater numbers of difficulties with activities of daily living (HR = 1.46), and having a physician's diagnosis of dementia (HR = 6.76). An interaction was found between the last 2 variables (HR = 0.59), indicating that among those with a diagnosis of dementia, a greater number of difficulties with activities of daily living delayed time to NHP. KI characteristics were not associated with NHP.Conclusions: Behavioral and psychological symptoms were common, but having these symptoms was not an independent risk factor of NHP. Caregiver characteristics may not play as important a role in determining NHP as subject characteristics. Interventions aimed at improving or maintaining physical or cognitive functioning may have better chances of delaying NHP. [ABSTRACT FROM AUTHOR]

Examines the factors that affect time to nursing home placement (NHP) in a sample of community-dwelling cognitively impaired elders. Features of behavioral and psychological symptoms of dementia; Characteristics associated with shorter time to NHP; Description of the participants of the study.

BackgroundLittle is known about the prevalence and correlates of behavioral and psychiatric symptoms of dementia in community-dwelling elders with dementia or mild cognitive impairment (MCI). Methods512 people with Mini-Mental State Examination (MMSE) scores < 24 or a decline of at least 4 points over two administrations, and their knowledgeable informants (KI) were enrolled in the MMCS. The classification of subjects as having dementia or MCI was based on a neuropsychological battery of four tests, not a clinical diagnostic evaluation. The sample for this study included 454 subjects (dementia n = 333; MCI n = 121) and their KIs. Demographic and health-related characteristics of subjects and KIs were obtained during KI interviews. Multivariate logistic regression was used in statistical analysis. ResultsCompared to dementia subjects, those classified as MCI had a lower prevalence (47.1% vs 66.1%) of any symptoms (psychosis, depression, or agitation), and of agitation (24.8% vs 45.1%). Symptoms of psychosis and depression also were less prevalent, even though differences did not reach statistical significance. In the dementia group symptoms were associated with a report of a physician's diagnosis of dementia, greater functional impairment, and a KI who was a child/child-in-law. In those with MCI, symptoms were correlated with being white, greater functional impairment, and a younger, less educated, KI. ConclusionsPsychiatric and behavioral symptoms were common in community-residing elders with cognitive impairment, but their prevalence and correlates differed by study classification as having dementia or MCI. Identifying and treating these symptoms may benefit patients with cognitive impairment and their families. Longitudinal studies on the predictors, changes in prevalence, and effectiveness of treatments for psychopathology of dementia are needed. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: To better understand factors associated with Medicaid enrollment among low-income, community-dwelling elderly persons and to examine the effect of Medicaid enrollment on the use of health care services by elderly persons, taking into account selection in program participation.Data Sources: 1996 Medicare Current Beneficiary Survey (MCBS) Access to Care and Cost and Use files.Methods: Individual-level predictions of the probability of dual enrollment are obtained from equations that estimate jointly the residential status of Medicare beneficiaries (community versus institution) and the probability of Medicaid enrollment among community-dwelling eligible beneficiaries. Predicted values are then substituted into the service use equations, which are estimated via two-part models.Principal Findings: Less than half of all community-dwelling elderly persons with incomes at or below 100 percent of the Federal Poverty Level (FPL) were enrolled in Medicaid in 1996. Once selective enrollment was accounted for, there was limited evidence of a dual enrollment effect on service use. Although there were no effects of state Medicaid policy variables on the probability that beneficiaries lived in the community (as opposed to nursing homes), the effects of state's Medicaid generosity in home and community-based services had a sizeable and statistically significant effect on influencing the likelihood that eligible elderly persons enrolled in Medicaid.Conclusions: Our results provide compelling evidence that Medicaid participation can be influenced by state policy. The observation that "policy matters" provides new insights into how existing programs might reach a larger proportion of potentially eligible beneficiaries. [ABSTRACT FROM AUTHOR]

Examines the validity of scales quantifying severity of upper and lower extremity functional limitation in Maryland. Comments on the development of the scale; Importance of the scale for screening persons at risk of disability.

This study uses longitudinal data to examine the consequences of losing and gaining health insurance coverage for access to care and health. For both Medicaid and privately insured persons, compared with those who remained insured, persons losing coverage over a 2-year period were more likely to lack a usual source of care, encounter difficulty in obtaining medical care, be very dissatisfied with ability to obtain needed care, and report no physician visits in the previous 12 months. Uninsured people who gained coverage showed improvement across all indicators of access, in contrast to those who remained without insurance. The effects of changes in coverage on health were in the same direction as those for access, but did not reach statistical significance. This study strengthens the evidence that health insurance coverage has a substantial impact on ability to gain access to medical care and may affect health status. [ABSTRACT FROM AUTHOR]

Focuses on the challenges in healthcare surveys in evaluating access. Classification of access indicators used in surveys; What surveys need in order to provide efficient information on access; Conclusion that surveys have not included questions about the structure of the delivery system in healthcare.

Reports on a study which focused on the factors relating to why people with primary responsibility for providing care to activities of daily living (ADL)-impaired persons ended their caregiving roles. Sources of data used; What the variables of the study reflect.

Provides information on a study examining the association of disability and social interaction in disabled older women with non-household members and home confinement. Methodology used to conduct the study; Characteristics of the persons used in the study; Importance of social contact and interaction in morbidity and mortality in older populations; Information on the measures of social interaction; Findings of the study.

Presents information on a study pertaining to elderly people's satisfaction with medical care while identifying the personal characteristics and factors related to health and patterns of healthcare. Collection of data from the 1991 Medicare Current Beneficiary Survey (MCBS); Amount of participants in the study; Age range of the participants; Purpose of the study; What were the principal findings; Conclusion reached based on the findings.

This article reflects on the role of sociological concepts and of sociologists in a series of national surveys that have proved important to national health policy in financing and access to health care. The development of the early surveys in a university setting and their migration to the government is discussed, as is the relative influence of sociologists and economists. The changing focus of health policy from access to care through expanded government programs, to cost containment and utilization control, provides an important context for understanding these developments. Areas are identified where sociologists can make significant contributions to health policy in financing and access to care. [ABSTRACT FROM AUTHOR]

Objectives To understand changes during the coronavirus disease 2019 (COVID-19) pandemic in weekly contact with nonresident family and friends for U.S. adults aged 70 and older in residential care and community settings. Methods Participants in the National Health and Aging Trends Study COVID-19 mail supplement (N = 3,098) reported frequency of phone, electronic, video, and in-person contact with nonresident family and friends in a typical week before and during the pandemic. We examined less than weekly contact by mode for those in residential care settings and community residents with and without limitations. We estimated multinomial logit models to examine predictors of change to less than weekly contact (vs. maintaining weekly or more contact) by mode, overall, and stratified by setting. Results Weekly in-person contact fell substantially (from 61% to 39%) and more so in residential care (from 56% to 22%), where nearly 4 in 10 transitioned to less than weekly in-person contact (doubling to 8 out of 10). Weekly or more contact was largely stable for electronic and telephone modes across settings. Weekly or more video contact increased mainly for community residents without limitations. Compared to community residents without limitations, those in assisted living or nursing homes had more than 5 times the odds (adjusted odds ratio [AOR] = 5.3; p =.01) of changing to less than weekly in-person contact; those in independent living also had higher odds of changing to less than weekly in-person (AOR = 2.6; p =.01) and video (AOR = 3.4; p =.01) contact. Discussion The pandemic revealed the importance of ensuring that communication technologies to maintain social ties are available to and usable by older adults, particularly for those living in residential care settings. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Hospitalization is common among older adults with disability, many of whom receive help from a caregiver and have dementia. Our objective was to evaluate the association between caregiver factors and risk of hospitalization and whether associations differ by dementia status. DESIGN: Longitudinal observational study. SETTING: The 1999 and 2004 National Long‐Term Care Survey and the 2011 and 2015 National Health and Aging Trends Study, linked caregiver surveys, and Medicare claims. PARTICIPANTS: A total of 2,589 community‐living Medicare fee‐for‐service beneficiaries, aged 65 years or older (mean age = 79 years; 63% women; 31% with dementia), with self‐care or mobility disability and their primary family or unpaid caregiver. MEASUREMENTS: Self‐reported characteristics of older adults and their caregivers were assessed from older adult and caregiver survey interviews. Older adult hospitalization over the subsequent 12 months was identified in Medicare claims. Multivariable Cox proportional hazards models adjusted for older adult characteristics and were stratified by dementia status. RESULTS: In this nationally representative cohort, 38% of older adults with disabilities were hospitalized over 12 months following interview. Increased hospitalization risk was associated with having a primary caregiver who helped with healthcare tasks (adjusted hazard ratio (aHR) = 1.22; 95% confidence interval (CI) = 1.05–1.40), reported physical strain (aHR = 1.21; 95% CI = 1.04–1.42), and provided more than 40 hours of care weekly (aHR = 1.26; 95% CI = 1.04–1.54 vs ≤20 hours). Having a caregiver who had helped for 4 years or longer (vs <1 year) was associated with 38% lower risk of hospitalization (aHR = 0.62; 95% CI = 0.49–0.79). Older adults with and without dementia had similar rates of hospitalization (39.5% vs 37.3%; P =.4), and caregiving factors were similarly associated with hospitalization regardless of older adults' dementia status. CONCLUSION: Select caregiving characteristics are associated with hospitalization risk among older adults with disability. Hospitalization risk reduction strategies may benefit from understanding and addressing caregiving circumstances. [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]

Objectives We provide national estimates of caregiving networks for older adults with and without dementia and examine how these networks develop over time. Most prior research has focused on primary caregivers and rarely on change over time. Method We identify a cohort of older adults continuously followed in the National Health and Aging Trends Study between 2011 and 2015 and receiving help from family members or unpaid caregivers in 2015 (n = 1,288). We examine differences by dementia status in network size, types of assistance and task sharing, and composition—differentiating between "specialist" and "generalist" caregivers helping in one versus multiple activity domains. Multinomial regression is used to estimate change over time in network task sharing and composition. Results In 2015, older adults with dementia had larger caregiving networks involving more task sharing than those without dementia and more often relied on generalist caregivers, especially the subset assisting with medical, household, and mobility or self-care activities. Uniformly greater reliance over time on these more intensely engaged generalist caregivers chiefly accounts for larger dementia networks. Discussion Findings lend support to the need for caregiver training on managing multiple task domains and—for dementia caregivers in particular—task-sharing skills. More generally, the design of new approaches to better support older adults and their caregivers should consider the complexity, heterogeneity, and change over time in caregiving networks. [ABSTRACT FROM AUTHOR]

Objectives: To assess two models for the prediction of health utilization and functions using standardized in-person assessments of frailty and administrative claims-based geriatric risk measures among Medicare fee-for-service beneficiaries aged 65 years and above. Methods: Outcomes of hospitalizations, death, and functional help were investigated for participants in the 2011 National Health and Aging Trends Study. For each outcome, multivariable logistic regression model was used to investigate claims-based geriatric risk and survey-based frailty. Results: Both claims-based and survey-based models showed moderate discrimination. The c-statistic of the standardized frailty models ranged from 0.67 (for any hospitalization) to 0.84 (for any IADL [instrumental activities of daily living] help). Models using administrative data ranged from 0.71 (for any hospitalization) to 0.81 (for any IADL help). Discussion: Models based on existing administrative data appear to be as discriminate as survey-based models. Health care providers and insurance plans can effectively apply existing data resources to help identify high-risk individuals for potential care management interventions. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including national health, aging, and post-stroke disability management.

Background: Striking changes occurred in health care in the United States between 2000 and 2013, including growth of hospice and hospital-based palliative care teams, and changes in Medicare payment policies. Objective: The aim of this study was to compare informants' reports and ratings of the quality of end-of-life care for decedents between 2000 and 2011-2013. Methods: The study design comprised retrospective national surveys. Subjects were decedents age 65 years and older residing in the community from two time periods. Similar survey questions were asked at the two time periods. Bivariate and multivariate analyses were conducted, using appropriate survey weights to examine response differences between time periods, after adjusting for the decedent's age, race, pattern of functional decline, and the presence of a cancer diagnosis, as well as the respondent's relationship to the decedent. Results: A total of 1208 informants were interviewed; 622 in 2000 and 586 in 2011-2013. Respondents from deaths in 2011-2013 were more likely to state that their loved ones experienced an unmet need for pain management (25.2% versus 15.5% in 2000, adjusted odds ratio [AOR] 1.9, 95% confidence interval [CI] 1.1-3.3). More respondents reported that religion and spirituality were addressed in the later time period (72.4% not addressed compared with 58.3%, AOR 1.4, 95% CI 1.1-1.9). High rates of unmet need for palliation of dyspnea and anxiety/depression remained. The overall rating of quality did not improve but decreased (with 56.7% stating care was excellent in 2000 and 47.0% in the later survey, AOR 0.70, 95% CI 0.52-0.95). Conclusions: Substantial unmet needs in end-of-life care remain. Continued efforts are needed to improve the quality of end-of-life care. [ABSTRACT FROM AUTHOR]

Objective Despite cross-sectional evidence that persons living with dementia receive disproportionate hours of care, studies of how care intensity progresses over time and differs for those living with and without dementia have been lacking. Method We used the 2011–2018 National Health and Aging Trends Study to estimate growth mixture models to identify incident care hour trajectories ("classes") among older adults (N = 1,780). Results We identified 4 incident care hour classes: "Low, stable," "High, increasing," "24/7 then high, stable," and "Low then resolved." The high-intensity classes had the highest proportions of care recipients with dementia and accounted for nearly half of that group. Older adults with dementia were 3–4 times as likely as other older adults to experience one of the 2 high-intensity trajectories. A substantial proportion of the 4 in 10 older adults with dementia who were predicted to be in the "Low, stable" class lived in residential care settings. Discussion Information on how family caregiving is likely to evolve over time in terms of care hours may help older adults with and without dementia, the family members, friends, and paid individuals who care for them, as well as their health care providers assess and plan for future care needs. [ABSTRACT FROM AUTHOR]

Background: Physical frailty and cognitive impairment have been separately associated with falls. The purpose of the study is to examine the associations of physical frailty and cognitive impairment separately and jointly with incident recurrent falls among older adults.Methods: The analysis included 6000 older adults in community or non-nursing home residential care settings who were at least 65 years old and participated in the National Health and Aging Trends Study. Frailty was assessed using the physical frailty phenotype; cognitive impairment was defined by bottom quintile of the clock-drawing test or immediate and delayed 10-word recall, or self/proxy-report of diagnosis of dementia, or AD8 score at least 2. The marginal means/rates models were used to analyze the associations of frailty and cognitive impairment with recurrent falls over 6 years of follow-up between 2011 and 2017.Results: Of the 6000 older adults, 1787 (29.8%) had cognitive impairment only, 334 (5.6%) had frailty only, 615 (10.3%) had both, and 3264 (54.4%) had neither. After adjusting for age, sex, race, education, living alone, obesity, disease burden, and mobility disability, those with frailty (with or without cognitive impairment) at baseline had higher rates of recurrent falls than those without cognitive impairment and frailty (frailty only: rate ratio [RR] = 1.31, 95% confidence interval [CI] = 1.18-1.44; both: RR = 1.28, 95% CI = 1.17-1.40). The association was marginally significant for those with cognitive impairment only (RR = 1.07, 95% CI = 1.00-1.13).Conclusions: Frailty and cognitive impairment were independently associated with recurrent falls in noninstitutionalized older adults. There was a lack of synergistic effect between frailty and cognitive impairment. [ABSTRACT FROM AUTHOR]

Medicare's role in the distribution of mobility-related assistive technology has not been well documented, yet rapid growth and regional variation in spending, and concerns over "in-the-home" coverage criteria, highlight the need for facts. Using the 2001 Medicare Current Beneficiary Survey, we find that 6.2 percent percent of beneficiaries obtained mobility assistive technology under the Medicare durable medical equipment (DME) benefit. These beneficiaries were disproportionately poor, disabled, and users of both acute and postacute services. Average per item spending ranged from $52 for canes to $6,208 for power wheelchairs. Among beneficiaries who acquired such technology through the DME benefit, these devices comprised just 2 percent of overall Medicare spending. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates health outcomes of older individuals who reported on their level of satisfaction with support given to family, friends, or community organizations. Methods: A 3-year prospective cohort study of women aged 65 and older. Results: Higher scores on the giving support scale predicted better lower-body function (Β= .06; SE .02; p= .02) and less ADL difficulty (Β= -.18; SE .04; p= .0001). The scale was also significantly associated with future hospitalization and death. Women in the lowest quartile were 28%more likely to be hospitalized (relative risk [RR] 1.28; 95%CI 1.00 - 1.65; p= .05) and 52%more likely to die (RR 1.52; 95% CI 1.03 - 2.26; p= .03) compared with those who scored in the highest quartile. Conclusions: Our results demonstrate that level of satisfaction with support given to family or friends or the community is associated with future health of the older person. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the rate and patterns of accumulation of frailty manifestations in relationship to all‐cause mortality and whether there is a point in the progression of frailty beyond which the process becomes irreversible and death becomes imminent (a.k.a. point of no return). Design Longitudinal observational study. Setting: Community or a non‐nursing home residential care setting. Participants: Two thousand five hundred and fifty seven robust older adults identified at baseline in 2011 with follow‐up for all‐cause mortality between 2011 and 2018. Measurements Frailty was measured by the physical frailty phenotype. Cox models were used to study the relationships of the number of frailty criteria (0–5) at each point in time and its accumulation patterns with all‐cause mortality. Markov state‐transition models were used to study annual transitions between health states (i.e., frailty, recovery, and death) after becoming frail among those with frailty onset (n = 373). Results: There was a nonlinear association between greater number of frailty criteria and increasing risk of mortality, with a notable risk acceleration after having accumulated all five criteria (hazard ratio (HR) = 32.6 vs none, 95% confidence interval (CI) = 15.7–67.5). In addition, the risk of one‐year mortality tripled, and the likelihood of recovery (i.e., reverting to be robust or pre‐frail) halved among those with five frailty criteria compared to those with three or four criteria. A 50% increase in mortality risk was also associated with frailty onset without (vs with) a prior history of pre‐frailty (HR = 1.51, 95% CI = 1.20–1.90). Conclusion: Both the number and rate of accumulation of frailty criteria were associated with mortality risk. Although there was insufficient evidence to declare a point of no return, having all five‐frailty criteria signals the beginning of a transition toward a point of no return. Ongoing monitoring of frailty progression could aid clinical and personal decision‐making regarding timing of intervention and eventual transition from curative to palliative care. [ABSTRACT FROM AUTHOR]

Maintenance of visual and auditory function is important for preventing the onset of activity limitations and preserving quality of life in later life. To date, national panel studies focused on health and aging have mostly collected subjective (self-reported) measures of visual and auditory function. The National Health and Aging Trends Study (NHATS), a study of Medicare beneficiaries ages sixty-five and older, recently developed a protocol for measuring objective visual and auditory function for its annual, in-home data collection conducted by trained interviewers. The protocol includes three vision tests—distance and near acuity and contrast sensitivity—and one hearing test—pure-tone audiometry—conducted using a tablet platform with results recorded in a scannable booklet. To identify operational issues and evaluate data quality for the proposed set of vision and hearing tests, NHATS incorporated a pilot study into its 2019 round (N  = 417 participants and N  = 9 interviewers). Using these pilot study data, the objectives of this paper are to: (1) describe the NHATS protocols to collect objective measures of visual and auditory function; (2) evaluate the quality of the data collected; and (3) assess whether results are influenced by interviewers. We found that respondents were highly likely to participate, with cooperation rates for each test about 90 percent. Data were high quality, with low rates of missingness, test results significantly associated with age and self-reported items, and percentages with poor vision or hearing consistent with prior population-based studies. Objective measures were more likely than self-reports to classify participants as having visual and auditory impairments and had stronger relationships with demographic correlates. Interviewer effects were small and not statistically significant in this small sample. Results of this study have demonstrated that objective visual and auditory functioning can be successfully incorporated into an interviewer-administered home-based protocol. [ABSTRACT FROM AUTHOR]

Background: Racial/ethnic frailty prevalence disparities have been documented. Better elucidating how these operate may inform interventions to eliminate them. We aimed to determine whether physical frailty phenotype (PFP) prevalence disparities (i) are explained by health aspects, (ii) vary by income, or (iii) differ in degree across individual PFP criteria.Methods: Data came from the 2011 National Health and Aging Trends Study baseline evaluation. The study sample (n = 7,439) included persons in all residential settings except nursing homes. Logistic regression was used to achieve aims (i)-(iii) listed above. In (i), health aspects considered were body mass index (BMI) status and number of chronic diseases. Analyses incorporated sampling weights and adjusted for sociodemographic factors.Results: Comparisons are versus non-Hispanic whites: Non-Hispanic blacks (odds ratio [OR] = 1.46, 95% confidence interval [CI]: 1.21-1.76) and Hispanics (1.56, 1.20-2.03) continued to have higher odds of frailty after accounting for BMI status and number of chronic diseases. Non-Hispanic blacks had elevated odds of frailty in all income quartiles, including the highest (OR = 2.19, 1.24-3.397). Racial/ethnic disparities differed considerably across frailty criteria, ranging from a twofold increase in odds of slowness to a 25%-30% decrease in odds of self-reported exhaustion.Conclusions: BMI and disease burden do not explain racial/ethnic frailty disparities. Black-white disparities are not restricted to low-income groups. Racial/ethnic differences vary considerably by NHATS PFP criteria. Our findings support the need to better understand mechanisms underlying elevated frailty burden in older non-Hispanic black and Hispanic Americans, how phenotypic measures capture frailty in racial/ethnic subgroups and, potentially, how to create assessments more comparable by race/ethnicity. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: To obtain national and regional estimates of prevalence of frailty with or without cognitive impairment, and cognitive impairment with or without frailty among older adults in the United States, and to identify profiles of characteristics that distinguish their joint versus separate occurrence. DESIGN: Cross‐sectional. SETTING: Community or non–nursing home residential care settings. PARTICIPANTS: A U.S. nationally representative sample of 7,497 older adults aged 65 and older from the National Health and Aging Trends Study. MEASUREMENTS: Frailty was measured by the physical frailty phenotype. Cognitive impairment was assessed by cognitive performance testing of executive function and memory or by proxy reports. Multinomial logistic regression was used to identify profiles of demographic, socioeconomic, health, behavioral, and psychosocial characteristics that distinguish four subgroups: not‐frail and cognitively intact ("neither"), not‐frail and cognitively impaired ("Cog. only"), frail and cognitively intact ("frailty only"), and frail and cognitively impaired ("both"). RESULTS: The prevalence of "Cog. only," "frailty only," and "both" was 25.5%, 5.6%, and 8.7%, respectively. Individuals with"frailty only" had the highest prevalence of obesity, current smoking, comorbidity, lung disease, and history of surgery. The "both" group had the highest prevalence of dementia, depression, cardiovascular diseases, and disability. No significant differences were found between the "Cog. only" group and the "neither" group with respect to history of surgery and comorbidity burden. The prevalence of dementia in the "Cog. only" was less than half of that in the "both" group. CONCLUSION: The finding of sizable subgroups having physical frailty but not cognitive impairment, and vice versa, suggests that the two cannot be considered necessarily as antecedent or sequela of one another. The study provided empirical data supporting the prioritization of comorbidity, obesity, surgery history, and smoking status in clinical screening of frailty and cognitive impairment before formal diagnostic assessments. [ABSTRACT FROM AUTHOR]

A correction to the article "Change OverTime in Caregiving Networks for Older Adults With and Without Dementia," by Brenda C. Spillman, Vicki A. Freedman, Judith D. Kasper, and Jennifer L. Wolff, which was published in a 2019 issue of the journal is presented.