Social Relationships, Gender, and Recovery From Mobility Limitation Among Older Americans

A Care Paradox: The Relationship Between Older Adults' Caregiving Arrangements and Institutionalization and Mortality

We investigate how the type of caregiving arrangement is associated with older Americans' outcomes. We use the Health and Retirement Study (2004-2018) and discrete-time event history analysis to assess the odds of institutionalization or death over a 14-year period among older adults with limitations in Activities of Daily Living (ADLs; e.g., bathing). We consider caregiving arrangements as conventional (i.e., spouse or adult child), unconventional (e.g., extended family, employee, friend), or self-directed (i.e., no caregiver). We find a "care paradox" in that self-directing one's own care was associated with a lower risk of institutionalization or death compared with having conventional care (spouse/adult caregiver) and unconventional care (employee). Relative to conventional care, having an employee caregiver was associated with increased risk of institutionalization. Findings are still observed when controlling for level of impairment and various health-related factors. More research is needed to understand older adults who self-direct their own care.

Who Gets Help? A National Longitudinal Study of Personal Networks and Pandemic Support Among Older Adults

OBJECTIVES

Personal networks provide social support for older adults, perhaps especially during the coronavirus disease 2019 (COVID-19) pandemic when traditional avenues may be disrupted. We provide one of the first population-based studies on how prepandemic personal networks predict support during the pandemic among older adults, with attention to gender and race variation.

METHOD

We analyzed longitudinal data from the National Social Life, Health, and Aging Project Round 3 (2015/2016) and COVID-19 Round (2020; N = 2622, 55.68% female, 78.75% White, aged 50-99), a nationally representative survey of community-dwelling older Americans. We considered structure (i.e., size, density) and composition (i.e., proportion female and kin) of prepandemic personal networks, estimating multinomial logistic models to predict self-reported need and receipt of instrumental help and emotional support during the pandemic.

RESULTS

Larger prepandemic confidant networks predicted higher risk of receiving needed pandemic help and support, higher risk of receiving help and support more often than prepandemic, and lower risk of being unable to get help. Denser prepandemic networks also predicted higher risk of receiving pandemic help and support. Furthermore, how network size and density related to support differed with respondent race and a greater proportion of kin in prepandemic networks predicted higher risk of receiving help for non-White older adults only.

DISCUSSION

Older adults' prepandemic confidant network structure and composition can provide underlying conditions for receiving pandemic social support. Findings speak to policies and programs that aim to foster social support or identify vulnerable groups that suffer the greatest unmet need for support during a global crisis.

Does gender matter to promote mental health through community engagement among older adults?

Objectives: Community engagement is critical for healthy aging. However, how gender plays a role in mental health promotion of late life is less understood. The study objectives were to examine the association between community engagement and mental health and the effect of gender on this association in older adults.Methods: A door-to-door interviewer-administered survey was conducted with 497 older adults in a public housing town in Singapore. The survey used measures of General Health Questionnaire (GHQ-12), Community Integration Measure (CIM), FRAIL Index, Lubben Social Network, and community participation. Multiple regressions were conducted for psychological distress and social dysfunction, assessed by GHQ-12. After testing the main effects, the moderating effects of gender were explored in the regression models.Results: None of the demographic characteristics, except gender, was associated with psychological distress; men reported poorer mental health than women. In regressions, female, community attachment (assessed by CIM), and participation were associated with decreased psychological distress; social networks and community participation were associated with decreased social dysfunction. Interaction effects of gender and community participation were found in psychological distress, not social dysfunction. The reduction of psychological distress by community engagement was higher among males than females.Conclusions: The findings suggest that, besides the importance of community engagement on mental health among older adults, greater efforts should be placed on the development of gender-tailored community interventions for older adults to maximize its benefits.

Neighborhood Social Cohesion and Mobility Limitations Among Community-dwelling Older Americans: The Mediating Roles of Depressive Symptoms and Mastery

Neighborhood environment plays an important role in late-life health; yet, the social aspect of neighborhood environment and its impact on mobility limitations have rarely been examined. This nonexperimental, cross-sectional study examines the relationship between neighborhood social cohesion and mobility limitations and the potential mediators (i.e., depressive symptoms, mastery) of this relationship. A total of 8,317 Americans aged 65 years and older were selected from the Health and Retirement Study. Using ordinary least squares regressions, this study shows that neighborhood social cohesion was negatively associated with mobility limitations (B  =  -0.04, p < .01). A Sobel test of mediation indicated that this relationship was significantly mediated by depressive symptoms (z  =  -9.10, p < .001) and mastery (z  =  -8.86, p < .001). Findings suggest that neighborhood cohesion can reduce mobility limitations through mitigating depressive symptoms and increasing mastery. Future research should disentangle the temporal ordering of the mediators.

Change in Mobility: Consistency of Estimates and Predictors Across Studies of Older Adults

OBJECTIVES

This study compares estimates and determinants of within-individual changes in mobility across surveys of older U.S. adults.

METHODS

Data come from the Health and Retirement Study (HRS) and the Midlife in the United States (MIDUS) study. Measures of mobility comprise self-reported level of difficulty with walking several blocks, going up several flights of stairs, lifting and carrying 10 pounds, and stooping. Predictors include sociodemographic characteristics and indicators of health and health behaviors. We pool the datasets and estimate weighted lagged dependent variable logistic regression models for each activity, assessing cross-study differences using interaction terms between a survey indicator and relevant variables.

RESULTS

Estimates of declines in mobility differ substantially across surveys for walking, lifting and carrying, and stooping, but there are no between-survey differences in the probability of (not) recovering from a limitation. With the exception of age, determinants of change are similar between studies. For lifting/carrying and stooping, the age-related increase in developing limitations is less steep at younger ages for HRS respondents than MIDUS respondents, but steeper at older ages.

DISCUSSION

To compare estimates of mobility change across surveys, mobility measures would need to be harmonized. Determinants of mobility change, however, are more comparable.

"They don't know who they have in here": Sense of community in budget hotels

The purpose of this study was to understand older residents descriptions of socio-spatial guest interactions and sense of community in budget hotels. Due to financial vulnerability, some people move into budget hotels when other housing options are unavailable. Little is known about how older residents perceive other hotel guests who frequent the commercial establishment and how a mix of various consumer interactions can potentially influence health. Theoretically framing this inquiry with sense of community constructs, we conducted a secondary data analysis of 20 interviews with residents aged 50 and older. Through thematic analysis strategies, we identified temporal and socio-spatial interactions of hotel guests, then discussed sense of community based on these insider/outsider relationships. We conclude with research, policy, and practice implications of our findings.

Physical functioning and survival: Is the link weaker among Latino and black older adults?

Measures of physical functioning are among the strongest predictors of mortality, but no previous study has assessed whether the predictive value of such measures varies by race/ethnicity, as has been done for the simple self-rated health question. The current study tests whether the relationship between two measures of physical functioning (the number of self-reported functional limitations and measured walking speed) and mortality is weaker (has a lower hazard ratio) for Latinos and blacks than for whites. Data were drawn from the 1998-2014 waves of the Health and Retirement Study, with mortality follow-up through 2016. We used Cox hazard models with household random effects to test for interactions between race/ethnicity and these measures of physical functioning and verified earlier findings for self-rated health. The number of self-reported functional limitations is significantly related to mortality for all racial/ethnic groups, but has a substantially lower hazard ratio for blacks and Latinos than for whites, as hypothesized. This hazard ratio remains lower for blacks and Latinos after adjustment for sociodemographic characteristics and health conditions. These findings suggest that the higher rates of functional limitations observed among Latinos and blacks compared with whites may reflect a history of strenuous physical work, inadequately controlled pain, lower leisure-time physical activity, or untreated/under-treated mobility problems that can lead to reduced physical performance without necessarily having a substantial effect on mortality risk. On the other hand, we do not detect significant racial/ethnic differences in the association between measured walking speed and subsequent mortality. This may be the result of the smaller sample size for the walking speed tests, the more nuanced nature of the continuous walking speed measure, or the fact that the walking speed test captures only a subset of the limitations included in the self-reports.

Profile of social self-management practices in daily life with Parkinson's disease is associated with symptom severity and health quality of life

Purpose: Social participation is a key determinant of healthy aging, yet little is known about how people with Parkinson's disease manage social living. This study describes individual differences in social self-management practices and their association with symptom severity and health quality of life.Methods: People with Parkinson's disease (N = 90) completed measures of healthy routines, activities and relationships, symptom severity, and health related quality of life. Cluster analysis identified profiles of social self-management practices. Analysis of variance tested differences between profiles in symptom severity and health quality of life.Results: Participants clustered into one of seven groups according to different combinations of three practices: health resources utilization, activities in home and community, and social support relationships. The healthiest cluster engaged equally in all three practices at above sample average degree of engagement. Four clusters that engaged at or above sample average in activities in home and community experienced less health problems than three clusters that engaged below average. Variation in aspects of social lifestyle unrelated to health appeared also to contribute to profile diversity.Conclusion: Findings provide insight into similarity and variation in how people with Parkinson's disease engage with social self-management resources and point to person-centered interventions.Implications for RehabilitationSocial self-management is a biopsychosocial construct to identify and describe self-care practices that engage one's social resources for managing healthful daily living.People with Parkinson's disease vary in their profiles of engaging in social self-management practices in daily living, and this variability relates to severity of symptoms and health quality of life.Learning how to identify health-centered social self-management practices may help people with Parkinson's disease to focus on the healthfulness of their own practices.Learning how to strategically engage one's social resources as part of self-care may help people with Parkinson's disease to master managing their health and well-being in daily life.

Exploring Racial and Ethnic Differences in Recovery Maintenance From Mobility Limitation

Objective: This research examines whether racial and ethnic minorities experience less recovery maintenance (i.e., maintaining their recovery status 2 years later). Method: Using Waves 4-12 (1998-2014) of Health and Retirement Study (HRS), this research examines recovery maintenance among a group of older adults who have previously recovered from mobility limitation. Outcomes included newly acquired mobility limitation (reference), recovery maintenance, and death/attrition. Additional analyses examined whether recovery maintenance predicted disability onset. Results: Analyses used multinomial logistic regression to estimate the odds of recovery maintenance 2 years later. After adjusting for socioeconomic status, there were no significant differences in recovery maintenance among older White and minority adults. Recovery maintenance was a robust predictor of subsequent disability onset; there was suggestive evidence that the effect of recovery maintenance on disability onset varied by race. Discussion: This research provides evidence that the higher rates of recovery among minorities is a form of physical resilience.

Life-space mobility in older persons with cognitive impairment after discharge from geriatric rehabilitation

OBJECTIVES

To describe life-space mobility and identify its determinants in older persons with cognitive impairment after discharge from geriatric rehabilitation.

METHODS

A cross-sectional study in older community-dwelling persons with mild to moderate cognitive impairment (Mini-Mental State Examination, MMSE: 17-26) following geriatric rehabilitation was conducted. Life-space mobility (LSM) was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment (LSA-CI). Bivariate analyses and multivariate regression analyses were used to investigate associations between LSM and physical, cognitive, psychosocial, environmental, financial and demographic characteristics, and physical activity behavior.

RESULTS

LSM in 118 older, multimorbid participants (age: 82.3 ± 6.0 years) with cognitive impairment (MMSE score: 23.3 ± 2.4 points) was substantially limited, depending on availability of personal support and equipment. More than 30% of participants were confined to the neighborhood and half of all patients could not leave the bedroom without equipment or assistance. Motor performance, social activities, physical activity, and gender were identified as independent determinants of LSM and explained 42.4% (adjusted R²) of the LSA-CI variance in the regression model.

CONCLUSION

The study documents the highly restricted LSM in older persons with CI following geriatric rehabilitation. The identified modifiable determinants of LSM show potential for future interventions to increase LSM in such a vulnerable population at high risk for restrictions in LSM by targeting motor performance, social activities, and physical activity. A gender-specific approach may help to address more advanced restrictions in women.

"Taking a Turn for the Better": Does Self-reported Recovery From Walking Limitation Improve Disability and Mortality Outcomes?

Objectives

Recovery from self-reported walking limitation may be a turning point in an individual's health trajectory and may lead to better physical and mental health in the future. This research examines whether recovery from walking limitation is associated with onset of mobility disability, activities of daily living (ADLs) disability, or mortality among a national sample of older Americans.

Data and Methods

Using Waves 4 through 11 (1998-2012) of the Health and Retirement Study (HRS), discrete-time event history models (N = 12,579 person-intervals) with multiple competing events were estimated using multinomial logistic regression. The risk group was defined as respondents with walking limitation, but free of disability. A lagged measure of recovery was created using 2 adjacent waves, and disability and mortality outcomes were assessed in the subsequent wave (i.e., 2 years later).

Results

Recovery from walking limitation (i.e., difficulty walking one or several blocks) was associated with lower odds of mobility disability (i.e., difficulty walking across the room) onset, ADL with mobility disability onset, ADL without mobility disability onset, and mortality. Recovery from walking limitation was not only predictive of mobility-related outcomes, but also nonmobility-related ADLs and mortality-suggesting that the predictive capacity of recovery extends to multiple physical health outcomes.

Discussion

This research suggests that self-reported recovery from walking limitation may be a turning point in the disabling process and signals a meaningful change in an older adult's functional health trajectory.

Factors That Contribute to Recovery of Community Mobility After Hospitalization Among Community-Dwelling Older Adults

This study aimed to determine the proportion of older adults who recovered community mobility after hospitalization and identify factors associated with recovery. Using a random sample of 1,000 Medicare beneficiaries ≥65 years of age, we identified individuals with at least one hospitalization over 8.5 years of follow-up. Data were collected at baseline and every 6 months, including demographics, function, social support, community mobility measured by the UAB Life-Space Assessment (LSA), and overnight hospital admissions. Recovery was defined as a LSA score no more than five points lower than the prehospitalization LSA score at last follow-up. Overall, 339 participants (M age = 75.4 [SD = 6.6] years, 44% African American, 48% female) had at least one hospitalization. In the full logistic regression model, younger age (p = .007) and religious service attendance (p = .001) remained independently associated with recovery. An understanding of factors associated with recovery after hospitalization may provide a target for future interventions.

(Where) Is Functional Decline Isolating? Disordered Environments and the Onset of Disability

The onset of disability is believed to undermine social connectedness and raise the risk of social isolation, yet spatial environments are seldom considered in this process. This study examines whether unruly home and neighborhood conditions intensify the association between disability onset and several dimensions of social connectedness. I incorporate longitudinal data from the National Social Life, Health, and Aging Project, which contains environmental evaluations conducted by trained observers ( N = 1,558). Results from Poisson, ordinal logistic, and linear regression models reveal heterogeneous consequences of disablement: disability onset was associated with reduced core network size, fewer friends, lower likelihood of social interaction, and less overall social connectedness-though mainly when accompanied by higher levels of household disorder. There was limited evidence that neighborhood disorder moderated consequences of disability. Findings point to the importance of the home as an environmental resource and underscore important contextual contingencies in the isolating consequences of disability.

Childhood Disadvantage, Psychosocial Resiliency, and Later Life Functioning: Linking Early-Life Circumstances to Recovery From Mobility Limitation

Objective: There is limited knowledge about whether childhood disadvantage, defined as economic and health disadvantage, influences recovery from functional impairment. Method: Using data from the Health and Retirement Study (2008-2010), this research explores whether childhood disadvantage shapes recovery from mobility limitation. In addition, this research examines whether measures of psychosocial resiliency such as mastery, optimism, and religiosity moderate the relationship between childhood disadvantage and recovery. Results: Childhood disadvantage appeared to shape recovery from mobility limitation in later life. Greater number of chronic childhood conditions and low maternal education decreased the odds of recovery. Mastery was a robust predictor of recovery and also a moderator of childhood disadvantage (i.e., moving for financial reasons) and recovery. Discussion: Findings suggest that mastery may be able to diminish the negative effects of financial hardship in childhood on recovery outcomes in later life.

Disability Measurement in the Health and Retirement Study

The Health and Retirement Study (HRS) has provided extensive and detailed national data on disability since it began in 1992, and has been used extensively in studies of disability trends and trajectories. We summarize conceptual frameworks used to characterize disability and review the HRS measures of functioning, work disability, and employer accommodations. HRS survey questions have experienced changes in wording, skip logic, or other design features over the life of the study, and we comment on the analytic challenges posed by those changes. Among our conclusions are (1) work disability and benefit eligibility are important concepts that should be considered for redesign to better reflect current concepts and policy issues; (2) methodological studies of changes in wording or skip logic should be undertaken; and (3) minor additions to survey content in areas such as temporal reference periods or changes in social-participation activities would improve measurement.

Age Trajectories of Physical Health Among Older Adults of Mexican Descent: Implications of Immigrant Status, Age at Immigration, and Gender

OBJECTIVE

This study examines consequences of immigrant status, age at immigration, and gender on age trajectories of activities of daily living (ADL) limitations and chronic conditions among older adults of Mexican descent.

METHOD

This research draws on 7 waves of the Hispanic Established Populations for the Epidemiologic Study of the Elderly and employs growth curve models.

RESULTS

All men had similar age trajectories of ADL limitations, regardless of immigrant status and age at immigration. All women experienced steeper increases in ADL limitations, although U.S.-born women and those who immigrated by age 19 had lower initial levels. Men who immigrated between ages 20 and 49 had steeper increases in chronic conditions, despite lower initial levels. U.S.-born women and those women who immigrated by age 50 had more chronic conditions at age 65.

DISCUSSION

This study highlights the multidimensional nature of physical health by demonstrating that immigrant status-gender disparities can vary by the health outcome examined.

Effect of Physical Activity on Self-Reported Disability in Older Adults: Results from the LIFE Study

BACKGROUND/OBJECTIVES

To test the hypothesis that a long-term structured, moderate intensity physical activity (PA) program is more effective than a health education (HE) program in reducing the risk of s elf-reported dependency and disability in basic activities of daily living (BADLs), disability in instrumental ADLs (IADL), and mobility disability.

DESIGN

The Lifestyle Interventions and Independence for Elders (LIFE) study was a multicenter, single-blinded randomized trial.

SETTING

University-based research clinic.

PARTICIPANTS

Thousand six hundred and thirty five sedentary men and women aged 70-89 years, who had functional limitations, defined as a score ≤9 on the Short Physical Performance Battery.

INTERVENTION

Participants were randomized to a structured, moderate intensity PA program (n = 818) that included aerobic, resistance, and flexibility exercises or to a HE program (n = 817).

MEASUREMENTS

All outcomes were derived by self-report using periodic interviews that asked about the degree of difficulty and receipt of help during the past month. Dependency was defined as "receiving assistance" or "unable" to do ≥1 activities. Disability was defined as having "a lot of difficulty" or "unable" doing ≥1 activities. Severe disability was defined as reporting difficulty or being unable to perform ≥3 activities.

RESULTS

Over an average follow-up of 2.6 years, the cumulative incidence of BADL dependency was 15.2% among PA and 15.1% among HE participants (HR = 1.0, 95% CI = 0.78-0.1.3). Intervention groups had similar rates of incident BADL disability, IADL disability and reported mobility disability. Reporting severe mobility disability (HR = 0.78, 95% CI = 0.64-0.96) and ratings of difficulty on mobility tasks were reduced in the PA group.

CONCLUSION

A structured physical activity intervention reduces reported severe mobility disability and difficulty on mobility tasks, but not BADL and IADL disability in older adults with functional limitations.

Social network types among older Korean adults: Associations with subjective health

With population aging now a global phenomenon, the health of older adults is becoming an increasingly important issue. Because the Korean population is aging at an unprecedented rate, preparing for public health problems associated with old age is particularly salient in this country. As the physical and mental health of older adults is related to their social relationships, investigating the social networks of older adults and their relationship to health status is important for establishing public health policies. The aims of this study were to identify social network types among older adults in South Korea and to examine the relationship of these social network types with self-rated health and depression. Data from the Korean Social Life, Health, and Aging Project were analyzed. Model-based clustering using finite normal mixture modeling was conducted to identify the social network types based on ten criterion variables of social relationships and activities: marital status, number of children, number of close relatives, number of friends, frequency of attendance at religious services, attendance at organized group meetings, in-degree centrality, out-degree centrality, closeness centrality, and betweenness centrality. Multivariate regression analysis was conducted to examine associations between the identified social network types and self-rated health and depression. The model-based clustering analysis revealed that social networks clustered into five types: diverse, family, congregant, congregant-restricted, and restricted. Diverse or family social network types were significantly associated with more favorable subjective mental health, whereas the restricted network type was significantly associated with poorer ratings of mental and physical health. In addition, our analysis identified unique social network types related to religious activities. In summary, we developed a comprehensive social network typology for older Korean adults.

The effect of an enriched environment on activity levels in people with stroke in an acute stroke unit: protocol for a before-after pilot study

BACKGROUND

Clinical practice guidelines advocate engaging stroke survivors in as much activity as possible early after stroke. One approach found to increase activity levels during inpatient rehabilitation incorporated an enriched environment (EE), whereby physical, cognitive, and social activity was enhanced. The effect of an EE in an acute stroke unit (ASU) has yet not been explored.

METHODS/DESIGN

We will perform a prospective non-randomized before-after intervention study. The primary aim is to determine if an EE can increase physical, social, and cognitive activity levels of people with stroke in an ASU compared to usual care. Secondary aims are to determine if fewer secondary complications and improved functional outcomes occur within an EE. We will recruit 30 people with stroke to the usual care block and subsequently 30 to the EE block. Participants will be recruited within 24-72 h after onset of stroke, and each block is estimated to last for 12 weeks. In the usual care block current management and rehabilitation within an ASU will occur. In the EE block, the ASU environment will be adapted to promote greater physical, social, and cognitive activity. Three months after the EE block, another 30 participants will be recruited to determine sustainability of this intervention. The primary outcome is change in activity levels measured using behavioral mapping over 12 h (7.30 am to 7.30 pm) across two weekdays and one weekend day within the first 10 days of admission. Secondary outcomes include functional outcome measures, adverse and serious adverse events, stroke survivor, and clinical staff experience.

DISCUSSION

There is a need for effective interventions that starts directly in the ASU. The EE is an innovative intervention that could increase activity levels in stroke survivors across all domains and promote early recovery of stroke survivors in the acute setting.

TRIAL REGISTRATION

Australian New Zealand Clinical Trial Registry, ANZCTN12614000679684.

Trajectories of limitations in activities of daily living among older adults in Mexico, 2001-2012

BACKGROUND

Trajectories of disability are an essential component to understand the burden of disability at the societal level. Longitudinal studies, compared to cross-national studies, enable a better analysis of the progression of physical limitations among the elderly. However, information on disability dynamics in developing countries is limited.

OBJECTIVES

This paper examines the changes in activities of daily living (ADLs) in an 11-yr. period in the Mexican elderly population aged 60 or older and identifies how sociodemographic variables alter these trajectories.

METHODS

The data come from the Mexican Health and Aging Study (MHAS), a national sample of adults born in 1951 or earlier, including a baseline survey in 2001 and follow-ups in 2003 and 2012.

RESULTS

The ADL score increased on average by 0.03 for every year respondents aged after 60. In contrast, the ADL score was reduced by 0.06 for every additional year of education.

CONCLUSIONS

Age, gender, and years of education were confirmed to influence the trajectories of ADL limitations. Understanding the patterns of deterioration of functional limitations will help public health policies to better serve the population.