Impairment Severity and Evaluative and Experienced Well-being Among Older Adults: Assessing the Role of Daily Activities

Demographic and Audiological Characteristics of Candidates for Over-the-Counter Hearing Aids in the United States

OBJECTIVES

This report presents descriptive data on the demographic and audiological characteristics of US adults with perceived mild-to-moderate hearing loss, the primary candidates for over-the-counter (OTC) hearing aids.

DESIGN

The analyses are descriptive and present population-weighted responses for various self-reported demographic and audiological variables for adults with mild or moderate perceived hearing trouble. Results of pure-tone audiometry and immittance measures are also presented. Nationally representative datasets from the National Health and Nutrition Examination Surveys (NHANES) for 2011 to 2012, 2015 to 2016, and 2017 to 2020, the three most recent NHANES datasets with audiological information, were used.

RESULTS

The NHANES datasets indicated that there are 49.5 million adults in the United States with perceived mild-to-moderate hearing trouble. Results indicated that OTC hearing-aid candidates are most frequently 50 to 69 years of age, married, and identify as non-Hispanic White race/ethnicity. Most of these individuals graduated from high school, had several risk factors for hearing loss, had not had a hearing test in the past 5 years, and had never used hearing aids or assistive listening devices previously. The typical audiometric profile was a bilaterally symmetrical sloping hearing loss with slight to mild hearing loss above 2000 Hz. Group data showed normal immittance measures and absence of otoscopic abnormalities except for the presence of excessive (not impacted) cerumen in about 13% of the OTC hearing-aid candidates.

CONCLUSIONS

Tens of millions of US adults have perceived mild-to-moderate hearing trouble but have not pursued assistance, either through obtaining a hearing test or acquiring prescription hearing aids.

Psychosocial Well-Being Differences Between the Young Old, Old-Old, and Oldest Old: A Global Comparison

OBJECTIVES

We investigate global differences in psychosocial well-being between older adult age groups.

METHODS

Using multinomial logistic regression, we analyzed 2018 data (n = 93,663) from 9 countries/regions in the Health and Retirement Study international family of studies to compare age group differences in depression, loneliness, and happiness.

RESULTS

Compared to the young old, the old-old reported more depression in Southern Europe, while the oldest old had higher risk in India and Southern Europe but lower risk in the United States. The old-old reported less loneliness in the United States but more in Southern Europe, while the oldest old had greater risk in Southern Europe. The old-old reported less happiness in Korea, while the oldest old had lower reports in Korea but higher reports in the United States.

DISCUSSION

The psychosocial well-being of the oldest old is exceptionally good in the United States but exceptionally poor in Southern Europe.

Disability and Patterns of Leisure Participation Across the Life Course

OBJECTIVES

Patterns of healthy leisure are dependent upon age, but people with disabilities are particularly susceptible to passive and disengaged types of activities. This study evaluates how individuals with disabilities spend their time in passive, active, social, and isolated forms of leisure over the life course, and how these patterns vary by age.

METHOD

I analyze nationally representative data from 70,165 respondents ages 15 and older in the 2008, 2010, and 2012-2016 American Time Use Survey. Linear regression models estimate the association between disability and leisure time, net of self-rated health and sociodemographic controls. Interactions between age and disability are also evaluated, as well as the robustness of results by sensory, cognitive, physical, and multiple disability status.

RESULTS

People with disabilities report significantly more, and poorer quality, leisure than people without disabilities. This includes more than 2 hr more time in passive leisure as well as a disproportionate amount of isolated leisure spent at home, alone. These differences are not fully explained by health and sociodemographic controls. The isolated leisure time of people with disabilities is most different from people without disabilities in later life-whereas differences in total and passive leisure time, by disability status, are greatest in midlife.

DISCUSSION

People with disabilities spend less time in health-promoting forms of leisure at all ages, but these patterns are unique across midlife and older age.

Cognitively Intact and Happy Life Expectancy in the United States

OBJECTIVES

We examined the number of years to be lived with and without cognitive impairment and with high self-assessed quality of life (i.e., happiness) among a nationally representative sample of Americans aged 65 years and older. Two key questions are addressed: Can people have a high quality of life despite being cognitively impaired? Which is longer: happy life expectancy or cognitively intact life expectancy?

METHOD

Data from nine waves of the Health and Retirement Study (1998-2014) were used to estimate transition probabilities into and out of cognitively intact/impaired-un/happy states, as well as to death. Recently extended Bayesian multistate life table methods were used to estimate age-specific cognitively intact and happy life expectancy net of sex, race/ethnicity, education, and birth cohort.

RESULTS

Happiness and cognitive impairment were shown to coexist in both the gross cross-tabulated data and in the life tables. Happy life expectancy is approximately 25% longer than cognitively intact life expectancy at age 65 years, and by age 85, happy life expectancy is roughly double cognitively intact life expectancy, on average.

DISCUSSION

Lack of cognitive impairment is not a necessary condition for happiness. In other words, people can have a high quality of life despite being cognitively impaired.

Disability in Community-Dwelling Older Adults: Exploring the Role of Stroke and Dementia

Objectives: We sought to determine the relative contributions of stroke, dementia, and their combination to disability and racial differences in disability among community-dwelling older adults. Methods: We performed a cross-sectional study of 6848 community-dwelling older adults. We evaluated the associations of stroke, dementia, and their combination with activities of daily living (ADL) limitations (range 0-7). We then explored the impact of stroke and dementia on race differences in ADL limitations using Poisson regression after accounting for sociodemographics and comorbidities. Results: After full adjustment, ADL limitations differed among older adults with stroke and dementia. Older adults without stroke or dementia had 0.32 (95% CI 0.29-0.35) ADL limitations compared to 0.64 (95% CI 0.54-0.73) with stroke, 1.36 (95% CI 1.20-1.53) with dementia and 1.84 (95% CI 1.54-2.15) with stroke and dementia. Overall, blacks had 0.27 (95%CI 0.19-0.36) more ADL limitations than whites. Models accounting for stroke led to a 3.7% (95%CI 2.98%-4.43%) reduction in race differences, while those for dementia led to a 29.26% (95%CI 28.53%-29.99%) reduction and the stroke-dementia combination -1.48% (95%CI -2.21% to -0.76) had little impact. Discussion: Older adults with stroke and dementia have greater disability than older adults with either of these conditions alone. However, the amount of disability experienced by older adults with stroke and dementia is less than the sum of the contributions from stroke and dementia. Dementia is likely a key contributor to race differences in disability.

The Psychological Consequences of Disability over the Life Course: Assessing the Mediating Role of Perceived Interpersonal Discrimination

We examine whether perceived interpersonal discrimination mediates the association between disability and psychological well-being (depression, negative and positive affect) and how these processes differ across the life course. Data are from two waves (2004-2006; 2013-2014) of the Midlife in the United States (MIDUS; N = 2,503). Perceived discrimination accounts for 5% to 8% of the association between disability and the three mental health outcomes. Moderated mediation analyses reveal significant age differences; perceived discrimination is a stronger explanatory mechanism among midlife (ages 40-64) relative to older (age 65+) adults. Disability stigma takes a heightened psychological toll at midlife, a life stage when adults are expected to be able-bodied and interact with a diverse social network, which may be a source of interpersonal mistreatment. Among older adults, for whom impairment is expected and common, the psychological impact of disability may operate through other pathways. We discuss implications for research and practice.

Late life disability and experienced wellbeing: Are economic resources a buffer?

BACKGROUND

Disablement has been linked to compromised wellbeing in later life, but whether material resources buffer these negative effects is unclear.

OBJECTIVE

Drawing upon conceptual models of stress and coping, we analyze experienced wellbeing data from time diary interviews with adults ages 60 and older. We expect that experienced wellbeing will be influenced by each stage of the disablement process and that higher income and wealth will buffer the negative effects of disability on experienced wellbeing. Because income is a better reflection of one's liquid resources while assets reflect lifetime accumulation, we expect income to be a more substantial buffer than assets.

METHODS

We use the Disability and Use of Time Supplement to the Panel Study of Income Dynamics (N = 1607). We consider several measures of the disablement process (activity limitations, impairment severity, duration of limiting condition) and history of work limitation and evaluate both pre-tax income and net worth quartiles. We estimate a series of multi-level regression models that account for clustering of individuals within couples. We calculate the marginal effects of disability on wellbeing at different quartiles of economic resources.

RESULTS

We find that impairment severity is associated with worse experienced wellbeing before and after adjusting for covariates, and income buffers these negative effects for those in the middle-income quartiles.

CONCLUSIONS

Future research should further explore the mechanisms through which income buffers the negative effects of impairment severity and specify the accommodations that enable economically disadvantaged and advantaged older adults alike to withstand physical declines while maintaining wellbeing.

Experienced Subjective Well-Being During Physically Active and Passive Leisure Time Activities Among Adults Aged 65 Years and Older

Background and Objectives

The encore years, or later life stages when adults enjoy health and free time, are the prime opportunity for leisure to maximize the overall quality of life. Physically active leisure is widely known to be linked to overall subjective well-being (SWB). However, experienced SWB or momentary emotion during active leisure as well as passive leisure has yet to be examined.

Research Design and Methods

Data were derived from the 2012/2013 American Time Use Survey Well-being modules. Propensity score matching (PSM) was used to identify comparable matched samples of older adults.

Results

The PSM identified 211 older adults who reported a series of emotions (i.e., happy, meaningful, tired, sad, stressed, pain) during active leisure, and the comparable counterpart (n = 211) during passive leisure. Results from the Wilcoxon Rank Sum tests showed that active leisure was associated with greater levels of experienced happiness and meaningfulness, as well as with lower levels of sadness (p < .05).

Discussion and Implications

Physically active leisure is linked to greater levels of experienced SWB among older adults. Although more detailed roles of active and passive leisure for experienced SWB are yet to be verified, choices that older adults make in their free time may significantly impact their experienced SWB and, in turn, their overall quality of life. Aging and public health policies should enhance accessibility to active leisure to promote older adults’ SWB.