The Effects of Residential Mobility on ADL and IADL Limitations Among the Very Old Living in the Community

Expecting Relocation to a Nursing Home: Longitudinal Links with Functional Limitations, Self-Rated Health, and Life Satisfaction

INTRODUCTION

Developing realistic expectations of future old age constitutes an adaptational process which facilitates the anticipation of and adjustment to challenges, such as relocation to a nursing home. Developing such expectations might minimize the negative impacts of relocation. This pre-registered study examined (1) to which extent lower levels and declines in health (i.e., functional limitations and self-rated health) and life satisfaction before relocation were associated with higher levels and increases in expectations to relocate and (2) to which extent higher expectations to relocate were associated with more positive changes in health and life satisfaction after relocation.

METHODS

Using data from the Health and Retirement Study (HRS; 2006-2018), we selected older adults (aged 65 years and older) who relocated to a nursing home. We used latent growth curve models to assess the longitudinal links between self-reported measures of health, life satisfaction, and expectations to relocate to a nursing home from up to 7 years before (n = 1,048) until up to 5 years after relocation (n = 307).

RESULTS

As hypothesized, more functional limitations and lower self-rated health were related to higher expectations of relocation. Surprisingly, changes in expectations to relocate were not related to changes in health and life satisfaction before relocation. Moreover, expectations to relocate were not associated with changes in health and life satisfaction after relocation.

CONCLUSION

The absence of a link between expectations to relocate to a nursing home with changes in health and well-being suggests that these expectations did not constitute adaptational processes before or after this transition.

Migration status, physical limitations and associated self-rated health: a study of older Indian adults

BACKGROUND

Migrant status with mobility impairment becomes a double burden for health and wellbeing of older adults. This study examined the independent relationships and multitude effects between migrant status, functional and mobility impairments and poor self-rated health (SRH) among older Indian adults.

METHODS

This study utilised nationally representative Longitudinal Ageing Study in India wave-1 (LASI) data, including a sample of 30,736 individuals aged 60 years and above. The main explanatory variables were migrant status, difficulty in activities of daily living (ADL), difficulty in instrumental activities of daily living (IADL) and mobility impairments; and the outcome variable was poor-SRH. Multivariable logistic regression and stratified analyses were used to fulfil the study objectives.

RESULTS

Overall, about 23% of older adults reported poor-SRH. Reporting poor-SRH was more prevalent (28.03%) among recent migrants (less than ten years). The prevalence of reporting poor-SRH was significantly higher among older adults who had mobility impairment (28.65%), difficulty in ADL or IADL (40.82% & 32.57%). Migrant older adults (regardless of duration) who had mobility impairment had significantly greater odds of reporting poor-SRH compared with non-migrant older adults who did not have mobility impairment. Similarly, older respondents who had problems in ADL and IADL with migration status had higher odds of reporting poor-SRH than their non-migrant counterparts with no such problems.

CONCLUSIONS

The study revealed the vulnerability of migrant older adults with functional and mobility disability, as well as those with limited socioeconomic resources and suffering from multimorbidity on rating their perceived health. The findings can be utilised to target outreach programmes and provision of services for migrating older individuals with mobility impairments and enhance their perceived health and ensure active ageing.

Oral health problems and risk of incident disability in two studies of older adults in the United Kingdom and the United States

BACKGROUND

Preventing oral health problems can be crucial for maintaining physical independence in older adults. We aimed to examine the associations of a range of oral health problems with incidence of disability in older adults.

METHODS

We used prospective data from the British Regional Health Study (BRHS) (N = 2147, 71-92 years), and the Health, Aging and Body Composition (HABC) study (USA) (N = 3075, 71-80 years). Oral health measures included tooth loss, periodontal disease, self-rated oral health, and self-reported dry mouth. Participants were followed for onset of disability over a follow-up period of 3 years. Onset of disability was assessed through new cases of mobility limitations, activities of daily living (ADL), and instrumental activities of daily living (IADL). Logistic regression was performed to calculate the odds of incident disability.

RESULTS

In the BRHS, tooth loss was associated with greater odds of mobility limitations and ADL difficulties. Periodontal disease was associated with greater incidence of mobility limitations. Self-report of ≥3 dry mouth symptoms was associated with increased odds of incident mobility limitations and ADL difficulties (OR = 2.08, 95% CI 1.27-3.42; OR = 1.73, 95% CI 1.03-2.90). Fair/poor self-rated oral health was associated with greater incidence of IADL difficulties. In the HABC study, complete tooth loss was associated with greater incidence of mobility limitations (OR = 1.86, 95% CI 1.13-3.06), and fair/poor self-rated oral health was associated with increased odds of incident ADL difficulties (OR = 1.42, 95% CI 1.04-1.94).

CONCLUSIONS

Oral health problems in older adults, particularly tooth loss, self-reported dry mouth and self-rated oral health were associated with greater incidence of disability. Poor oral health plays a potentially important role in the development of disability in older populations, which in turn is an essential part of quality of life and healthy aging.

Characteristics of movers and predictors of residential mobility in the Atherosclerosis Risk in Communities (ARIC) cohort

Current efforts to characterize movers and identify predictors of moving have been limited. We used the ARIC cohort to characterize non-movers, short-distance movers, and long-distance movers, and employed best subset algorithms to identify important predictors of moving, including interactions between characteristics. Short- and long-distance movers were notably different from non-movers, and important predictors of moving differed based on the distance of the residential move. Importantly, systematic inclusion of interaction terms enhanced model fit and was substantively meaningful. This work has important implications for epidemiologic studies of contextual exposures and those treating residential mobility as an exposure.

The Role of Optimism on the Relationship Between Activity Limitations and Life Satisfaction Among Middle-Aged and Older Adults in the United States: A Growth Curve Model of Changes Over Time

Activity limitations can diminish life satisfaction. This study explored the role of optimism on the relationship between changes in activities of daily living and instrumental activities of daily living (ADL/IADL) limitations and life satisfaction over time among middle-aged and older adults. Growth curve modeling accounting for intra- and inter-individual changes in life satisfaction was applied to the 2008-2018 waves of the Health and Retirement Study Leave Behind Survey subsample (n = 39,122 person-years). After controlling for sociodemographic factors, physical functioning decline adversely affected life satisfaction (β_ADL = -0.12, β_IADL = -0.13, p < 0.001), but the negative consequences reduced slightly through optimism (β_ADL = -0.11, β_IADL = -0.12, β_optimism = 0.47, p < 0.001). Increasing optimism could reduce the negative consequences of ADL/IADL limitations on life satisfaction among middle-aged to older adults.

The Relationship among Community Environment, Behavior, Activity Ability, and Self-Rated Health of Older Adults: A Hierarchical and Multi-Dimensional Comparative Study

Although the community environment is a known determinant of older adults’ health, it is unclear about the logical relationships among the community environment, behavior, activity ability, and health of older adults, and the differences between the different age groups. This study used a two-stage sampling method to conduct a household survey of people over 60 years old living in Xinhua Street, Shanghai, China. In total, 2783 valid samples were obtained. Of these, 1256 were males and 1627 were females, with an average age of 71.1 years. The statistical method used in this study was the structural equation modeling method. The effects of the community environment and behavior on the activity ability and self-rated health of older adults are different, and the path of health influence of older adults is different in different age groups. Community environment has more wider effects on older adults’ self-rated health, while behavior, including walking behavior and neighbor contacts, have a more intensive effect on the activity ability of older adults. The community environment has a significant positive effect on the activity ability of the younger group but not on that of the older group, which instead was significantly affected by the neighbor contacts. Therefore, refined environmental governance and targeted improvement and resolution of different types of health problems among different groups of older persons will contribute to the overall health of older adults.

Learning as an Important Privilege: A Life Span Perspective with Implications for Successful Aging

Research has demonstrated the cognitive and mental health benefits of learning new skills and content across the life span, enhancing knowledge as well as cognitive performance. We argue that the importance of this learning – which is not available equally to all – goes beyond the cognitive and mental health benefits. Learning is important for not only the maintenance, but also enhancement of functional independence in a dynamic environment, such as changes induced by the COVID-19 pandemic and technological advances. Learning difficult skills and content is a privilege because the opportunities for learning are neither guaranteed nor universal, and it requires personal and social engagement, time, motivation, and societal support. This paper highlights the importance of considering learning new skills and content as an <i>important privilege</i> across the life span and argues that this privilege becomes increasingly exclusionary as individuals age, when social and infrastructural support for learning decreases. We highlight research on the potential positive and negative impacts of retirement, when accessibility to learning opportunities may vary, and research on learning barriers due to low expectations and limited resources from poverty. We conclude that addressing barriers to lifelong learning would advance theories on life span cognitive development and raise the bar for successful aging. In doing so, our society might imagine and achieve previously unrealized gains in life span cognitive development, through late adulthood.

The Enigma of Gender Differences in an Environment-Behavior-Health Model of Elderly People: The Choice Between Individually and Sociality

Gender difference in the health of elderly people has become an important perspective to consider when studying their health. However, the gender differences in terms of “environment–behavior–health” from the social ecology perspective remain unknown. On the basis of survey data from Shanghai, China, including 2839 samples, this study explored the gender differences of outdoor environment–behavior–activity ability in elderly people from two aspects of the mean value of variables and the path relationship, utilizing the structural equation model analysis method combined with social ecology theory. The results showed that, at the level of the mean of variables, the elderly males had significantly higher mean values than the females in terms of individual behaviors, but had significantly lower values in terms of social behaviors. At the level of path relationships, there were similarities in that the health of elderly males was more likely to be affected by individual factors, whereas that of the females was more effected by social factors. Through the great positive effect of the high-level social behaviors, the health of the elderly females was progressively promoted. The study provided some useful insights for future research, aiming at promoting gender-sensitive urban design.

Repensando as migrações a partir de um arcabouço processual multiescalar

Resumo As modificações recentes nos padrões migratórios exibidos por diversas populações forçam-nos a buscar novos enfoques analíticos que possibilitem apreender teórico-conceitualmente esses processos. Acredita-se que as migrações podem ser melhor compreendidas se direcionarmos nossa atenção, simultaneamente, para as transições por que passam os indivíduos, as famílias e as populações como um todo. O objetivo deste trabalho é apresentar um arcabouço conceitual que condense os aspectos teórico-explicativos da relação da migração com as transições ocorridas ao longo do ciclo de vida individual, domiciliar e populacional. Busca-se integrar os pressupostos desenvolvidos por abordagens uniescalares em um mesmo arcabouço conceitual.

Mental Well-Being of Older People in Finland during the First Year in Senior Housing and Its Association with Physical Performance

Growing numbers of older people relocate to senior housing, when their physical or mental performance declines. The relocation is known to be one of the most stressful events in the life of older people and affect their mental and physical well-being. More information about the relationships between mental and physical parameters is required. We examined self-reported mental well-being of 81 older people (aged 59⁻93, living in northern Finland), and changes in it 3 and 12 months after relocation to senior housing. The first measurement was 3 months and the second measurement 12 months after relocation. Most participants were female (70%). Their physical performance was also measured, and associations between these two were analyzed. After 12 months, mental capability was very good or quite good in 38% of participants, however 22% of participants felt depressive symptoms daily or weekly. Moreover, 39% of participants reported daily or weekly loneliness. After 12 months participants reported a significant increase in forgetting appointments, losing items and difficulties in learn new things. They felt that opportunities to make decisions concerning their own life significantly decreased. Furthermore, their instrumental activities of daily living (IADL), dominant hand’s grip strength and walking speed decreased significantly. Opportunities to make decisions concerning their life, feeling safe, loneliness, sleeping problems, negative thoughts as well as fear of falling or having an accident outdoors were associated with these physical parameters. In addition to assessing physical performance and regular exercise, the various components of mental well-being and their interactions with physical performance should be considered during adjustment to senior housing.

Social Environment of Older People during the First Year in Senior Housing and Its Association with Physical Performance

Increasing numbers of older people relocate into senior housing when their physical performance declines. The change in social environment is known to affect their wellbeing, providing both challenges and opportunities, but more information on the relations between social and physical parameters is required. Thus, we elicited perceptions of the social environment of 81 older people (aged 59-93 years, living in northern Finland) and changes in it 3 and 12 months after relocation to senior housing. We also measured their physical performance, then analysed associations between the social and physical variables. Participants reported that they had freedom to do whatever they liked and generally had enough contact with close people (which have recognized importance for older people's wellbeing), but changes in their physical condition limited their social activity. Moreover, their usual walking speed, dominant hand's grip strength and instrumental activities of daily living (IADL) significantly decreased. The pleasantness of the residential community, peer support, constraints on social activity imposed by changes in physical condition, meaningful activity at home and meeting close people all affected these physical performance parameters. Clearly, in addition to assessing physical performance and encouraging regular exercise, the complex interactions among social factors, physical performance and wellbeing should be considered when addressing individuals' needs.

Community Relocation in Very Old Age: Changes in Housing Accessibility

OBJECTIVE

The objective of this study was to compare environmental barriers, housing accessibility, and usability before and after relocation of very old, single-living people in the community. It also examined whether accessibility improved after relocation compared with a simulated scenario in which participants would have remained in their former dwellings.

METHOD

Data from the Swedish part of the longitudinal Enabling Autonomy, Participation, and Well-Being in Old Age: The Home Environment as a Determinant for Healthy Ageing database were analyzed with a before-and-after design (N = 29). Mean time from before to after data collection was 2.6 yr.

RESULTS

The number of environmental barriers was significantly reduced after relocation, especially barriers at entrances and in bathrooms. In addition, usability was stable and accessibility improved compared with the simulated scenario of remaining in the former dwelling.

CONCLUSION

Community-based moves to new dwellings may lead to fewer environmental barriers and stable levels of usability and accessibility. This relocation is a positive outcome, considering the expected functional decline in old age.

Consideration of Age-Related Changes in Behavior Trends in Older Adults in Assessing Risks of Environmental Exposures

Objectives: To explore age-related behavior differences between older and younger adults, and to review how older adult activity patterns are considered in evaluating the potential risk of exposure to environmental pollutants. Methods: Activity pattern data and their use in risk assessments were analyzed using the U.S. EPA Exposure Factors Handbook (EFH), U.S. EPA Consolidated Human Activity Pattern Database (CHAD), and peer-reviewed literature describing human health risk assessments. Results: The characterization by age of some factors likely to impact older adults’ exposures remains limited. We demonstrate that age-related behavior trends vary between younger and older adults, and these differences are rarely explicitly considered in environmental health risk assessment for older adults. Discussion: Incorporating older adult exposure factors into risk assessments may be challenging because of data gaps and difficulty in defining and appropriately binning older adults. Additional data related to older adult exposure factors are warranted for evaluating risk among this susceptible population.

Physical impairment is associated with nursing home admission for older adults in disadvantaged but not other neighborhoods: results from the UAB study of aging

OBJECTIVES

Aging adults face an increased risk of adverse health events as well as risk for a decrease in personal competencies across multiple domains. These factors may inhibit the ability of an older adult to age in place and may result in a nursing home admission (NHA). This study combines insights from Lawton's environmental press theory with the neighborhood disadvantage (ND) literature to examine the interaction of the neighborhood environment and individual characteristics on NHA.

METHODS

Characteristics associated with the likelihood of NHA for community-dwelling older adults were examined using data collected for 8.5 years from the UAB Study of Aging. Logistic regression models were used to test direct effects of ND on NHA for all participants. The sample was then stratified into 3 tiers of ND to examine differences in individual-level factors by level of ND.

RESULTS

There was no direct link between living in a disadvantaged neighborhood environment and likelihood of NHA, but physical impairment was associated with NHA for older adults living highly disadvantaged neighborhood environments in contrast to older adults living in less disadvantaged neighborhood environments, where no association was observed.

DISCUSSION

These outcomes highlight (a) the usefulness of linking Lawton's theories of the environment with the ND literature to assess health-related outcomes and (b) the importance of neighborhood environment for older adults' ability to age in place.

Moving Considerations

Residential proximity is an important indicator of family members’ availability to provide assistance to each other. We investigate proximity-enhancing moves by older parents and their children and the reasons for such moves. Using the 2000–2004 waves of the Health and Retirement Study, we fit multinomial logit models examining 2-year residential transitions for parents and children living 10 or more miles apart at baseline. Our results show that family members collectively adjust intergenerational proximity to facilitate mutual support. Despite the common assumption that older parents move closer to their children to receive assistance, more than two thirds of all proximity-enhancing moves are made by adult children. While greater anticipated longevity raises the probability that older parents will move closer to their children, parents’ anticipated longevity does not influence children’s moving decisions. Including individual variability in anticipated longevity in the life course framework helps account for relocation that precedes declines in health or increases in the need for support.

I Want to Move, But Cannot

Objectives: The purpose of this study was to investigate characteristics of seniors in the Canadian population who are involuntary stayers and to assess associations with health. Method: Data come from the 1994 Canadian National Population Health Survey, with the sample restricted to those 65 and older ( N = 2,551). Results: Nearly 1 in 10 seniors identified as an involuntary stayer. Seniors with few socioeconomic resources, poor health, greater need for assistance, and low social involvement were more likely to identify as an involuntary stayer. Furthermore, seniors who were involuntary stayers report significantly more distress and greater odds of low self-rated health than other seniors. Discussion: This study brings into visibility an understudied segment of the elderly population: seniors who are unable to move from their present location despite their desire to do so. Further research and policy responses assisting seniors to age in a setting of their own choosing are needed.

Health Trajectories Among Older Movers

Objective: To examine health trajectories among older migrants by reason for move. Method: Data from the 1992 to 2006 Health and Retirement Study (HRS) are used to model trajectories of self-rated health and activity of daily living (ADL) limitations that occurred prior seven types of moves. Results: There are substantial differences across the reason-for-move groups in initial levels of self-rated health. Declines in self-rated health among nursing home movers are more than two times steeper than the other reason-for-move groups. Employment, comfort, economic security, life crisis, and affiliation movers have low initial levels of ADL limitations and slow increases in ADL limitations. Health and nursing home movers have higher initial ADL limitations and increases in ADL limitations that are three and seven times higher respectively than the other groups. Discussion: The results are consistent with the predictions of Litwak and Longino’s (1987) typology of later-life migration and the extant literature on later-life migration. Implications for communities are considered.

Older Adults’ Participation in Nursing Home Placement Decisions

African American ( n = 7) and European American ( n = 9) older adults newly relocated to a nursing home described the extent of their relocation decision-making participation via semistructured interviews. Additionally, the study identified whether sense of coherence, functional ability, and physical functioning were related to decision participation. Two themes emerged, “They put me in here” and “I/we made the decision (together with others).” Older adults whose decisions were in the “They” category were younger, were African American, had more children, had lower Mini Mental State Examination scores, and had less education than those in the “I/we” category. Findings suggest older adults’ participation in nursing home relocation decisions may be determined more by informal support than ability to participate. No significant differences were found in sense of coherence, functional ability, or physical functioning across decision-making categories. Decision-making participation approached significance in a positive association with social support.

Migration and psychological well-being among older adults: a growth curve analysis based on panel data from the Health and Retirement Study, 1996-2006

PURPOSE

A vibrant body of research examines migration among older adults. Existing research, however, grants scarce attention to the implications of later-life migration for the migrants themselves. Our research focuses on the impacts of migration on depressive symptomatology among older U.S. adults.

METHODS

Our analysis employs six waves of panel data from the Health and Retirement Study, 1996-2006. Growth curve modeling techniques are employed.

RESULTS

Net of other stressful life events, migration effects appear to vary significantly across persons. Findings highlight the particularly depressive impact of moves motivated by negative life events or circumstances. Results further suggest that later life moves may be especially stressful for women and as individuals age.

DISCUSSION

The stress of moving late in life may depend on social integration at destination. Further research should pursue this issue. Study limitations and additional directions for further research are delineated.

Older adults' expectations to move: do they predict actual community-based or nursing facility moves within 2 years?

OBJECTIVE

This study examined the relationship between older adults' expectations to move and actual residential relocation in the community or to a nursing facility within 2 years.

METHOD

Two waves of data (2000, 2002) from the Health and Retirement Study were used to compare expectations with subsequent moves. Logistic regression techniques were used to analyze the association between decision outcomes and expectations to move, health and functioning, physical environment, informal supports, and formal services.

RESULTS

Findings indicated that expectations to move did predict community-based moves but did not predict moves to nursing facilities. Additional factors had significant effects but did not diminish relationships between expectations and actual moves.

DISCUSSION

Results support the residential decision process as a dynamic one based on the cumulative effect of factors from an ecological model. Findings will inform policy makers and practitioners as they work to support older adults' preferences to remain living in their homes.

Sooner or later? A study of institutionalization in late life

BACKGROUND AND AIMS

Existing information about institutionalization of elderly individuals is mainly based on cross-sectional data and does not address the cumulative risk of institutionalization. The purpose of the present study was to analyze longitudinal data prospectively and estimate the risk of placement in an elder care institution for individuals aged 70 years or older.

METHODS

The study was based on a longitudinal investigation (the H70 study) of a random sample of 70- year-olds living in Gothenburg, Sweden, in 1971. Individuals were followed from age 70-100 years. Three different analyses were performed: a descriptive prospective analysis, cross-sectional analyses at ages 70, 79 and 85 years, and a longitudinal analysis of predictors for institutionalization.

RESULTS

The prospective analysis indicated that 50% of the individuals eventually moved to an elder care institution. Significantly more women than men were institutionalized, although for women the move occurred later in life. Cross-sectional analyses demonstrated that various factors were important to institutionalization at different ages. The Cox regression model with time-varying covariates indicated that gender, socio-economic situation, marital status, number of symptoms, having children living nearby, and activities in daily life were related to institutionalization.

CONCLUSIONS

The proportion of elderly persons relocating to institutions was significantly higher than that generally found in cross-sectional studies. It was possible to identify variables that predict institutionalization during a subsequent 30-year period, but different analyses revealed different effects from the factors evaluated.

Negotiating and effectuating relocation to sheltered housing in old age: a Swedish study over 11 years

The aim of this study was to explore how very old people consider and arrive at decisions on relocation, with specific attention to housing and health relationships during the process of ageing. The sample included 13 very old participants of an 11-year longitudinal study of relationships between housing and health. Applying a mixed-methods approach, data from qualitative interviews and quantitative survey data from three data collection waves were utilised. The quantitative data were interwoven with the qualitative findings into a coherent body of text. The core theme "Negotiating and effectuating relocation is a long process" indicates a non-linear process consisting of five phases constituting the main categories of our findings. In the first phase, some informants considered relocation while others avoided thinking about it. Next, relations between health and home changed and led to turning points triggering relocation, i.e. when dependence in everyday activities reached critical points or when sudden illness forced an involuntary move. In the third phase, once the decision to relocate was made it was set in stone by the individual, but often questioned by the authorities, leading to a situation causing much frustration. While waiting for the relocation, doubts as well as expectations about the new home were expressed. Finally, even though the actual move caused different feelings, it was most often a positive experience and resulted in subjective health improvement and increased social contacts. The results can be used for the development of positive, proactive strategies for improved housing provision along the ageing process.

LONGITUDINAL RELATIONSHIPS BETWEEN NEIGHBORING BEHAVIOR AND DEPRESSIVE SYMPTOMS IN HISPANIC OLDER ADULTS IN MIAMI, FLORIDA

This study examines the relationship between neighboring behavior and depressive symptoms across 3 years in a prospective study of 273 community-dwelling, Hispanic older adults in Miami, Florida. The analyses extend the literature by testing for a bidirectional or reciprocal relationship between neighboring behavior and depressive symptoms over time and examining the relationship between these variables in Hispanic older adults, a group at risk of developing depressive symptoms. Structural Equation Modeling with a cross-lagged panel design showed that depressive symptoms were unrelated to subsequent neighboring behavior. However, neighboring behavior was related to subsequent depressive symptoms at every time point, such that higher levels of neighboring behavior were related to lower levels of depressive symptoms. Findings suggest that neighboring behavior may be a protective factor against depressive symptoms in community-dwelling Hispanic older adults.

Do Older Adults Anticipate Relocating?

The relationship between the occurrence of falls and the expectations older adults have about making future residential moves is examined in this research. Data from the 2002 Health and Retirement Study (HRS) are used to analyze self-reported probabilities of moving among a nationally representative sample of noninstitutionalized adults aged 65 and older. The results show that falls were predictive of anticipation of housing relocation as indicated by more than 50% reported probability of moving within the next 2 years. The results suggest that consideration of housing relocation is greater among older adults who experience tangible events indicative of a trajectory of deteriorating health.

Structural relationships between social activities and longitudinal trajectories of depression among older adults

PURPOSE

This study examines the structural relationships between social activities and trajectories of late-life depression.

DESIGN AND METHODS

Latent class analysis was used with a nationally representative sample of older adults (N = 5,294) from the Longitudinal Study on Aging II to classify patterns of social activities. A latent growth curve model captured longitudinal changes in depression and tested the impact of social activities while controlling for residential relocation, health status, insurance, and sociodemographics.

RESULTS

We found 3 different patterns of participation across 8 social activities. Specific activities of volunteering and exercise, self-perception of social activity level as "enough," and a higher participation level pattern were associated with lower initial status and longitudinal changes in depression.

IMPLICATIONS

Assessing involvement in multiple social activities is important when using social activities to prevent and treat depression. Future work with improved measures can further clarify how specific activities may reduce risk for depression.

A first step in the development of an international self-report instrument for physical functioning in palliative cancer care: a systematic literature review and an expert opinion evaluation study

Decline in physical functioning (PF) in progressive cancer increases risk of psychological problems, dependence, and distress, and it considerably affects quality of life. Despite this, assessment of PF has received little attention. Standardized, internationally endorsed assessment tools are needed that assess activities of relevance to palliative cancer patients from very low to high levels of PF. This study was done in cooperation with the European Association for Palliative Care Research Network. It was initiated to develop a computer-based symptom-assessment tool and aimed to 1) identify relevant existing PF-assessment instruments, 2) extract relevant items and classify them into meaningful subdimensions, and 3) construct unidimensional scales of selected PF domains. A systematic literature review was performed to detect relevant PF items from existing instruments. The International Classification of Functioning and Health was used to decide relevant subdimensions of PF, and expert panels within palliative cancer care were consulted to make decisions on activities to be included. One hundred and thirty-five instruments containing 743 items were included from the literature review. Two relevant PF subdimensions were revealed: Mobility (386 items representing 65 different activities) and Self-Care (143 items representing 30 different activities). The final PF tool consisted of two unidimensional scales: 24 hierarchically ranked Mobility items ranging from turning in bed to running, and 16 non-hierarchically ranked Self-Care items. Further testing of the instrument in a palliative cancer population is needed to develop the final PF instrument.

Contribution of residential relocation and lifestyle to the structure of health trajectories

OBJECTIVE

Underlining ecological theories of aging, we assessed the impact of relocation, residential type, and individual lifestyle factors on the structure of health status overtime.

METHODS

From the data of Longitudinal Study on Aging II, we included older adults aged 70 and older (N = 5,294). To analyze individual longitudinal trajectories of health outcomes, Latent Growth Curve Modeling (LGCM) was employed.

RESULTS

LGCMs supported that older adults' residential relocation and health-related lifestyles were important in preserving better health outcomes. Multiple structural equations corroborated the causal chains in the multidimensionality of health structure.

DISCUSSION

These findings suggest a necessity to design policies for older adults to create a synergy between housing and health care and to translate meaningful health-related lifestyles into diverse long-term care settings.

Motives for residential mobility in later life: post-move perspectives of elders and family members

This qualitative study delineates motives for residential mobility, describes dynamics between the elder and family members during the move decision process, and locates the move decision within ecological layers of the aging context. Interviews were conducted with 30 individuals and couples (ages 60-87) who experienced a community-based move within the past year, and with 14 extended family members. Reasons for moving (from perspectives of both elders who moved and their family members) were grouped into four themes and eleven issues that influenced the move decision. These themes parallel the ecological context of individual health and functioning, beliefs and attitudes, physical environment, and social pressures. Late-life mobility is a significant life transition that is the outcome of an ongoing appraisal and reappraisal of housing fit with individual functioning, needs, and aspirations. Family members are an integral part of these decision and residential mobility processes.

Health and motivation of elderly relocating to a suburban area in Japan

In Japan, few studies have investigated the effects of moving residence among the elderly, despite the fact that Japanese elderly will be increasingly required to switch residence in the future. Here, we used representative sampling to examine the characteristics of elderly persons who had moved residence to a Tokyo suburb and compared results with those of non-moving residents of the suburb. Movers aged 65 years old or older who had relocated within the previous 2 years (movers) and residents aged 65 years old or older and had lived in the area longer than 5 years (non-movers) were surveyed by mail in 2004, with a focus on health and psychosocial measures. Compared with non-movers (N=117), movers (N=97) were more depressed, socially isolated, and fulfilled less active social roles among family members. The majority of movers had moved to find affordable housing or to live with or near family. Two factors preceded co-residence with family, namely retirement and imminent loss of functional independence. Our findings suggest that movers require community support to prevent social isolation, dependency and health declines.

Health, functional capacity, formal care, and survival in the oldest old: a longitudinal study

There are surprisingly few longitudinal studies of the oldest old, but these studies are of high importance because the number of oldest old continues to increase in most countries and because of the uniqueness in this population. The aims of this study were to investigate how health, activities of daily living (ADL), and use of care change over time in the oldest old and to seek how differences in health and ADL affect survival of the oldest old. The study was longitudinal in design, and the participants were interviewed by trained nurses. A group of 300 persons was randomly selected from three age-groups; 86, 90, and 94. For the first phase, in 1999, 157 persons could and wanted to participate; from these 98 persons continued to participate in the second phase and 62 in the third. Repeated measures (general linear model=GLM) from the oldest old showed a decline in objective health and ADL with increasing age, but subjective health remained positive and stable. The use of formal help increased with age, and once the oldest old entered the old-age care system, it was rare that they returned to independent living. Analysis using a Cox regression model showed that health and ADL significantly predicted survival, but age did not.

Causal inference for non-mortality outcomes in the presence of death

Evaluation of the causal effect of a baseline exposure on a morbidity outcome at a fixed time point is often complicated when study participants die before morbidity outcomes are measured. In this setting, the causal effect is only well defined for the principal stratum of subjects who would live regardless of the exposure. Motivated by gerontologic researchers interested in understanding the causal effect of vision loss on emotional distress in a population with a high mortality rate, we investigate the effect among those who would live both with and without vision loss. Since this subpopulation is not readily identifiable from the data and vision loss is not randomized, we introduce a set of scientifically driven assumptions to identify the causal effect. Since these assumptions are not empirically verifiable, we embed our methodology within a sensitivity analysis framework. We apply our method using the first three rounds of survey data from the Salisbury Eye Evaluation, a population-based cohort study of older adults. We also present a simulation study that validates our method.

Supplemental private health insurance and depressive symptoms in older married couples

Stress process theory is applied to examine lack of supplemental private health insurance as a risk factor for depressive symptomatology among older married couples covered by Medicare. Dyadic data from 130 African-American couples and 1,429 White couples in the 1993 Asset and Health Dynamics Among the Oldest-Old Survey were analyzed using hierarchical generalized linear modeling. Lack of supplemental insurance is operationalized at the household level in terms of neither spouse covered, one spouse covered, or both spouses covered. Controlling for covariates at both individual and couple levels, supplemental insurance has significant impact on depression, but the pattern differs by race. White couples report the highest depression when neither spouse is covered by private health insurance; African-American couples report the highest depression when only one spouse is covered. Results suggest lack of supplemental private health insurance coverage is a stressor that significantly affects depressive symptoms.

Living Arrangement Decisions at Discharge and Later: Differences in Criteria and Outcomes

This study examined the pattern of post rehabilitation living arrangements over 18 months of 172 adults discharged from a geriatric rehabilitation unit at a large urban medical center, all of whom were living alone prior to admission. Results showed the diminishing importance of physical function and cognition as factors in decisions to return home as the length of time after hospital discharge increased. Patients who returned home to live alone after a period of time living in more supported environments had significantly lower assessment scores on physical function (p < 0.001) and cognition (p < 0.001) compared to patients who went home to live alone immediately upon discharge. As well, patients who returned home to live alone later than three months post discharge were significantly more likely to move to more supported environments by 18 months after discharge (p = 0.043) and to experience re-hospitalizations (p = 0.008), which raises questions about the appropriateness of these later decisions.