Not Your Mother's Old Age: Baby Boomers at Age 65

The middle-aged and older Chinese adults' health using actigraphy in Taiwan (MOCHA-T): protocol for a multidimensional dataset of health and lifestyle

BACKGROUND AND OBJECTIVES

Older adults keep transforming with Baby Boomers and Gen Xers being the leading older population. Their lifestyle, however, is not well understood. The middle-aged and older Chinese adults' health using actigraphy in Taiwan (MOCHA-T) collected both objective and subjective data to depict the health and lifestyle of this population. The objectives, design, and measures of the MOCHA-T study are introduced, and the caveats and future directions related to the use of the data are presented.

METHODS

People aged 50 and over were recruited from the community, with a subset of women aged 45-49 invited to supplement data on menopause and aging. Four instruments (i.e., self-reported questionnaires, diary, wrist actigraphy recorder, and GPS) were used to collect measures of sociodemographic, health, psychosocial, behavioral, temporal, and spatial data.

RESULTS

A total of 242 participants who returned the informed consent and questionnaires were recruited in the MOCHA-T study. Among them, 94.6%, 95.0%, and 25.2% also completed the diary, actigraphy, and GPS data, respectively. There was almost no difference in sociodemographic characteristics between those with and without a completed diary, actigraphy, and GPS data, except for age group and educational level for those who returned completed actigraphy data.

CONCLUSION

The MOCHA-T study is a multidimensional dataset that allows researchers to describe the health, behaviors, and lifestyle patterns, and their interactions with the environment of the newer generation of middle-aged and older adults in Taiwan. It can be compared with other countries with actigraphy and GPS-based lifestyle data of middle-aged and older adults in the future.

A Narrative Inquiry Into the Lived Experiences of the Oldest-Old Caregivers and How These Are Shaped by Age and Aging

BACKGROUND AND OBJECTIVES

Oldest-old (80+) spousal caregivers of people with dementia are a fast-growing, highly vulnerable, and poorly understood population. As oldest-old individuals, these caregivers have a high likelihood of experiencing aging-related changes (e.g., frailty and multimorbidity) that result in unique caregiving experiences and support needs. Specialized interventions, sensitive to caregivers' age- and aging-related experiences and needs, may be required to provide adequate support to this group. To date, this group has received limited attention in the literature. Thus, the purpose of this study was to elucidate how age and aging shape the experiences of oldest-old spousal caregivers of people with dementia.

RESEARCH DESIGN AND METHODS

We used a narrative gerontology approach, with 2-3 semistructured interviews with 11 caregivers ages 80-89 (25 interviews in total). We analyzed narrative data thematically.

RESULTS

We identified 4 main themes representing caregivers' perceptions of age or aging: aging as decline, aging as life experience, doings in older age, and older age as perceived by others. Our results illustrate a breadth of age- and aging-related caregiving experiences stemming from each perception.

DISCUSSION AND IMPLICATIONS

This study provides insight into the particular experiences of oldest-old spousal caregivers of people with dementia and provides a foundation for critical future research that will continue to explore the experiences of this unique and fast-growing caregiving group. A more nuanced understanding of this caregiving subgroup is needed to develop age-sensitive health and social care services to meet their needs and, ultimately, improve their well-being and that of their spouses.

Global rural health disparities in Alzheimer's disease and related dementias: State of the science

INTRODUCTION

Individuals living in rural communities are at heightened risk for Alzheimer's disease and related dementias (ADRD), which parallels other persistent place-based health disparities. Identifying multiple potentially modifiable risk factors specific to rural areas that contribute to ADRD is an essential first step in understanding the complex interplay between various barriers and facilitators.

METHODS

An interdisciplinary, international group of ADRD researchers convened to address the overarching question of: "What can be done to begin minimizing the rural health disparities that contribute uniquely to ADRD?" In this state of the science appraisal, we explore what is known about the biological, behavioral, sociocultural, and environmental influences on ADRD disparities in rural settings.

RESULTS

A range of individual, interpersonal, and community factors were identified, including strengths of rural residents in facilitating healthy aging lifestyle interventions.

DISCUSSION

A location dynamics model and ADRD-focused future directions are offered for guiding rural practitioners, researchers, and policymakers in mitigating rural disparities.

HIGHLIGHTS

Rural residents face heightened Alzheimer's disease and related dementia (ADRD) risks and burdens due to health disparities. Defining the unique rural barriers and facilitators to cognitive health yields insight. The strengths and resilience of rural residents can mitigate ADRD-related challenges. A novel "location dynamics" model guides assessment of rural-specific ADRD issues.

A Cohort Comparison of Midlife Marital Quality: A Quarter Century of Change

Marital quality has been declining among recent cohorts, but whether this pattern characterizes middle-aged and older married adults is largely unknown. The doubling of the divorce rate among persons over the age of 50 years foretells poorer quality marriages for today's midlife adults than a generation ago. Combining data on married individuals aged 50-65 years from the 1987-88 National Survey of Families and Households (NSFH) and the 2013 Families and Relationships Study, we conduct a cohort comparison of five dimensions of midlife marital quality. Today's older adults report more marital disagreement and instability as well as less fairness and interaction with their spouses than their counterparts did a generation ago. The two cohorts report comparable levels of marital happiness. Consistent with the upward trend in divorce during the second half of life, the quality of midlife marriages appears to have declined over the past quarter century.

Identifying baby boomer service expectations for future aged care community services in Australia

Baby Boomers are ageing, yet little is known as to what their expectations are likely to be for the community health service sector or what the challenges this cohort might create. Interviews were conducted with 11 experienced Australian baby boomer carers to identify the key characteristics that might influence their future community aged care service expectations. Qualitative analysis of the data revealed five characteristics that could influence participant expectations for future services: Independent; Astute; Resourceful; Forthright and Exacting. As octogenarians this group plan to independently self-determine what support services they receive and from whom without any outside influence, using their well-developed skills and knowledge, by drawing on their own resourcefulness. They will most likely create significant pressure for industry change. To accommodate this group, a new service industry model will most likely be needed. One that empowers older people to completely self-manage and take control of their services as true consumers rather than a model, which designates older people as passive recipients of provider offered and driven services. For this to be achieved, a considerable philosophical shift is required on how ageing is viewed by society, including health professionals and government.

Couple processes of family economic hardship, depressive symptoms, and later-life subjective memory impairment: moderating role of relationship quality

OBJECTIVES

To examine a) processes through which family economic hardship (FEH) contributes to spouses' mental health and subsequent subjective memory impairment (SMI) in later years and b) the moderating effect of overall relationship quality on these associations.

METHODS

With prospective data over 27 years from a sample of 224 husbands and wives in enduring marriages, the present study utilized latent growth curves to identify how FEH trajectories are associated with both spouses' depressive symptoms trajectories across their mid-later years (average age 40-65 years) and subsequent SMI in later life (> 67 years). The moderating role of relationship quality between depressive symptoms and SMI was also examined.

RESULTS

FEH experiences across the mid-later years (1991-2015) explained variation in husbands' and wives' depressive symptoms trajectories (1994-2015). Change in depressive symptoms was associated with husbands' and wives' SMI in later life (2017) after taking the level of depressive symptoms into account. Spousal dependencies, including partner effects, existed among husbands' and wives' depressive symptoms trajectories and SMI outcomes. Some of these dependencies were moderated by couples' overall relationship quality.

CONCLUSION

FEH has a persistent influence on husbands' and wives' SMI in later years. Depressive symptoms mediated the influence of FEH on later wellbeing. The findings are discussed as they relate to family systems and life course stress process theories. Implications are addressed at multiple levels including national- and state-policies and clinical interventions.

Meaning Making in a Retirement Migrant Community: Religion, Spirituality, and Social Practices of Daily Lives

Meaning in life has also been seen as crucial to well-being, and especially, in later life. This study focused on the social complexity of meaning making processes and the role of religion and spirituality in them, by finding out the following: (1) How are meaning-making practices connected with religion and spirituality for Finnish retirement migrants of the boomer generation? (2) What does the role of religion and spirituality in meaning-making practices teach us about the relationship between individual and social aspects of meaning making? This was done by examining a particular group of older persons: Finnish retirement migrants aged 60 or over in Costa del Sol, Spain. The material for this study consists of 58 texts (written correspondence, dataset 1, year 2009), 10 semi-structured interviews (dataset 2, year 2011), and 30 completed online surveys with open-ended questions (dataset 3, year 2019). Key findings include that religion and spirituality are present in the lives of our informants in a variety of ways, playing a significant role in their meaning making, and that they appear as intertwined and not so easy to separate. A variety of religious and non-religious forms of spirituality exist in this population, and all of these forms can be relevant factors in meaning making. Also, the engagement in meaning making, contrary to what has been suggested in some of the literature about meaning in later life, not only occurs in response to confrontations with health issues, death, or other major life events. Instead, we found that meaning making occurs as a process that is often inherent to daily activities which may seem "trivial," but in fact turn out to be important sources of purpose, values, and connectedness. Contrary to the dominant modern ideal of the authentic, self-sufficient human agent, which is based on a problematically atomistic and individualistic anthropology, for our respondents, their authentic subject position is embedded in the social practices of their daily lives, which nourish their individual spirituality and are vital to making meaning.

Senior Center Service Utilization: Do Social Ties Affect Participation Patterns?

PURPOSE

A better understanding of service utilization patterns at senior service centers can improve program development and constituent usage.

THEORY

This research examines whether participation in senior center activities is a function of senior socialization that reinforces and supports existing social ties by selecting specific activities in senior centers.

METHODS

A total of 924 participants of senior centers in a municipality in the Southwest were surveyed.

RESULTS

We find that having closer friends influences participation in certain senior center services. We also find that gender, race, ethnicity, and income also explain different usage rates beyond age.

CONCLUSION

Opportunities to foster social interaction to grow and reduce barriers to participation and market to a broader range of current and potential participants are discussed.

A Scoping Review of Literature on Sex and Gender Differences Among Dementia Spousal Caregivers

BACKGROUND AND OBJECTIVES

Sex and gender differences among dementia spousal caregivers have been investigated, but never systematically reviewed or synthesized. A synthesis of findings can help facilitate specificity in practice and in health policy development. As a first step towards such a synthesis, this scoping review reports the available evidence, identifies research gaps, and suggests possible directions for future research.

RESEARCH DESIGN AND METHODS

A scoping review methodology was used to identify articles, and to chart and analyze data. Systematic searches for published, empirical studies, with an explicit goal or hypothesis related to sex or gender differences were conducted in seven databases.

RESULTS

Sixty-one studies met inclusion criteria. Most (n = 45) were quantitative, cross-sectional studies. Caregivers included in the studies were generally 61-70 years old, Caucasian, middle-class, and highly educated. The most extensively investigated differences are: depression, burden, objective physical health, and informal supports.

DISCUSSION AND IMPLICATIONS

This scoping review is the first to summarize and critique the research on sex and gender differences that are specific to dementia spousal caregivers. The review can be used by researchers to make decisions regarding future systematic reviews and primary studies. To further strengthen the evidence base, future studies may benefit from including more caregivers of ethnic minorities, using more qualitative, longitudinal, or experimental designs, and focusing on variables needed to inform caregiving models and theories. Overall, this scoping review contributes to furthering gender-sensitive practices and policies that are better tailored to the specific needs of this population.

What are the policy and program implications of individual budget style service models for low-income older renters?

OBJECTIVE

To explore the policy and program implications of the Australian aged care reforms for low-income older renters.

METHODS

Interviews and focus groups with low-income older renters and service providers of both housing and in-home aged care were undertaken.

RESULT

Analysis of the findings emphasised the complex world of aged care service provision, particularly for low-income renters and their service providers.

CONCLUSIONS

Societal, systemic and systematic change is required to ensure easier access to services. Policy and programming must be driven from both the bottom up and the top down, and not take a "market-making by government" approach.

Meaning of home and health dynamics among younger older people in Sweden

Research has shown that positive evaluations of home are important for very old people’s health, well-being and independence in daily life. The rationale for the present study derives from our survey study findings, confirming such associations also in a younger cohort (N = 371). The purpose of this study was to further increase the understanding of the dynamics of meaning of home and health among community-living healthy younger older people, in the present and in a projected future. Data were collected through semi-structured interviews with 13 persons aged 67–70 years living in ordinary housing in Sweden, followed by a qualitative content analysis. Findings suggest that the home becomes progressively important after retirement. Not only the immediate home environment but also local neighbourhoods influence perceptions about home. Home brings emotional and social benefits but also worries about how to cope with complex home ambivalence when reflecting upon future housing arrangements. The findings suggest that it is important to consider the role of perceived aspects of home for health and well-being in early phases of the ageing process. The findings could be used to raise awareness among policymakers, housing authorities and professionals involved in housing-related counselling.

The influence of family and professional lifecourse histories on economic activity among older French workers

This paper examines associations between early and mid-lifecourse events with economic activity in later life. These lifecourse trajectories are in turn examined for their impact on the pathways of men and women to retirement, including whether these pathways are perceived by individuals as been chosen or imposed. Data are from the three waves (2005, 2008 and 2011) of the French version of the Gender and Generations survey and comprise a sub-sample of 2,016 respondents in the birth cohort 1941–1960 who participated in all three waves. The analysis is undertaken within a gender perspective and in the context of the (de)standardisation of the lifecourse. The results show that mid-life and later-life work history, job category, employment sector and economic activity are influenced by early lifecourse events for both men and for women. Different pathways to retirement are observed according to institutional factors that determine access to pension rights. Women whose family formation occurred early, together with women who had an absence of family events (partnership or childlessness), were much more likely to be economically active in later life than men with the same characteristics. The results suggest that institutionalised (standardised) lifecourse patterns exist simultaneously with individualised (destandardised) patterns.

Providers' Perspectives on Palliative Care in a Neuromedicine-Intensive Care Unit: End-of-Life Expertise and Barriers to Referral

OBJECTIVE

This study identifies health care providers' perspectives on palliative care at end of life (EOL) in a neuromedicine-intensive care unit (Neuro-ICU) and barriers to providing palliative care.

BACKGROUND

Provider's EOL expertise is crucial in making timely referrals to palliative care as expectation of patient death can be high. Barriers to referral need to be clearly identified so as to engage quality initiatives that improve EOL care delivery.

DESIGN AND PARTICIPANTS

The study is a survey design using a mixed-methods approach. Providers at a large academic medical center, including doctors, nurses, and social workers, completed a quality improvement survey.

MEASUREMENTS

Forty-one providers responded to Likert-type scales assessing their perspectives on palliative care. Their EOL expertise was independently assessed. In addition, barriers to palliative care referral were collected using a checklist and open-ended responses. The latter were reliably content analyzed through a card-sort technique.

RESULTS

Three palliative care perspectives were identified: foundational perspective, comfort-care perspective, and holistic perspective. Regression analysis shows that providers' perspectives are differentially related to their EOL expertise. Frequencies of provider-reported barriers to referring patients to palliative care (e.g., lack of care coordination) were determined.

CONCLUSIONS

Health care providers hold multiple perspectives on what they consider palliative care. Their perspectives are related systematically to different aspects of their EOL expertise. In-house training and quality initiatives could focus on unifying providers' perspectives to create a common language for understanding palliative care. Eliminating individual, intergroup, and organizational barriers is necessary for creating an optimal environment for patients and their families who find themselves, often suddenly, in a Neuro-ICU.

The Unbearable Lightness of Being Retired

ABSTRACTIn this qualitative study, I followed an approach to examine perceptions about retirement, using an interview guide informed by the life course perspective, among 26 men and women who had retired from positions as chief executive officers. Three key themes emerged: (1) the importance of productivity and networking as participants rose up the corporate ladder; (2) the sense of having a "best before" date and experiencing societal pressures to retire; and (3) struggles with feeling insignificant in retirement while desiring personal fulfillment through continued engagement in paid work. These findings shed light on the value of using a life course perspective to examine retirement as both a personal experience and as a social phenomenon. Findings also contribute to theoretical understandings of productive aging by illustrating how preconceptions about productivity contrast with ideations of a leisure-filled retirement in ways that can foreshorten the employment contributions of some individuals.

Let me tell you about healthy ageing and about my quality of life: listening to the baby boomer voice

Purpose

The purpose of this paper is to determine how baby boomers define healthy ageing and quality of life, and if late life university study could have a beneficial impact for future health-promoting initiatives.

Design/methodology/approach

Qualitative data were collected from Australian baby boomers. Data were inductively categorised to identify and report emergent themes.

Findings

The majority of respondents believed healthy ageing meant being mentally and physically active, with later life university study contributing to mental health, which improves their quality of life.

Social implications

Later life university study can have positive health outcomes for baby boomers and may contribute to the quality of their life.

Originality/value

This study suggests that baby boomers are quite clear about how they define healthy ageing and quality of life: maintaining good health and retaining their independence. Some baby boomers stated that intellectual stimulation was critical for their overall health and wellbeing. Baby boomers identified as belonging to this group engagement in an educational (i.e. university) programme could be considered as a health-promoting intervention.

Retirement Transitions among Baby Boomers: Findings from an Online Qualitative Study

ABSTRACTCanadian baby boomers began turning 65 - traditional retirement age - in 2011. How this generation perceives and experiences retirement may differ from preceding generations. In this online, grounded-theory study, 25 baby boomers who were approaching retirement or had recently retired participated in a multi-author blog about their retirement experiences and processes. We collected additional data via subsequent focus groups and participant interviews. Participants retired in several ways, including ceasing work, adopting casual or part-time work, and adopting new types of work. Findings highlighted three phases of the retirement transition: pre-retirement, characterized by both apprehension about retirement and idealization of the perfect retirement; the initial transition, which participants compared to an extended vacation, but in which they also struggled to adjust to increased amounts of free time; and mid-transition, when participants learned to balance structure and flexibility. Findings suggest that despite retirement transition challenges, many people have positive experiences with this transition.

Boomer Matters: Responding to Emotional Health Needs in an Aging Society

This study explores baby boomer-aged adults' experiences accessing an emotional health program (EHP) in a community-based seniors' center, examining differences between it and an older cohort of users. Data generation includes client-based surveys (n=118), in-depth qualitative interviews (n=20) with client users and professionally-trained counselors (n=2), and a focus group with peer support service worker (n=14). Key findings suggest EHPs as a preventative strategy to address familial abuse, the need for education and support on sexual health and dating, and the need to combat ageism to improve access. Community-based seniors' centers as a cost-effective approach to health promotion is also highlighted.

Trajectories of Maintenance and Resilience in Healthful Eating and Exercise Behaviors in Older Adults

OBJECTIVE

Our objective was to describe behavioral change trajectories for healthful eating and exercise in a group of community-dwelling older adults. A secondary aim was to determine predictors of maintenance and resilience.

METHOD

Subjects were participants in the Study of Exercise and Nutrition in Older Rhode Islanders (SENIOR) I study who had achieved postaction stage of change for at least one behavior by its end. They were recruited for SENIOR II, a 48-month study with annual assessments on demographic, anthropometric, cognitive, psychosocial, and behavioral variables.

RESULTS

Maintainers generally had higher levels of healthy behaviors and better cognitive function. Resilient older adults were similar to maintainers but were older and had greater functional limitations.

DISCUSSION

Findings suggest that both physical health and psychological capital provide important resources upon which to draw as older adults grow even older. The trajectory model can provide useful information for developing resilience interventions for older adults.

Health Risk Appraisals With Aging Adults: An Integrative Review

Identification of risk factors unique to the aging experience is vital to support health promotion efforts and prevent loss of independence for the increasing aging population. Health risk appraisals are tools capable of identifying a broad range of factors that affect health; however, these tools were designed for use with predominantly healthy working-age adults. The purpose of this integrative review was to describe uses and adaptations of health risk appraisals with aging adults. A total of 43 articles met inclusion criteria, identifying multiple adaptations necessary to effectively identify the risks faced by aging adults, including those related to activities of daily living, pain, depression, social support/network, vision, hearing, and cognitive status. Uses included support for health promotion efforts and to determine risk for depression, falls, and loss of independence. Further research needs to be done to evaluate impact when used as a health promotion and prevention tool for aging adults.

Differences in Psychosocial and Behavioral Variables by Dietary Screening Tool Risk Category in Older Adults

BACKGROUND

The Dietary Screening Tool (DST) has been validated as a dietary screening instrument for older adults defining three categories of potential nutritional risk based on DST score cutoffs. Previous research has found that older adults classified as being "at risk" differed from those categorized as being "not at risk" for a limited number of health-related variables. The relationship between risk categories and a wide variety of variables has not yet been explored. This research will contribute to an increased understanding of clustering of multiple health concerns in this population.

OBJECTIVE

The aim of this study was to determine whether DST risk categories differed by demographic, anthropometric, cognitive, functional, psychosocial, or behavioral variables in older adults.

DESIGN

This study utilized a cross-sectional design with data collected from September 15, 2009 to July 31, 2012. Participants completed an interviewer-administered survey including the DST and other measures.

PARTICIPANTS/SETTING

Community-dwelling older adults (n=255) participating in the Study of Exercise and Nutrition in Older Rhode Islanders Project were included if they met study inclusion criteria (complete DST data with depression and cognitive status scores above cutoffs).

MAIN OUTCOME MEASURES

DST scores were used to classify participants' dietary risk (at risk, possible risk, and not at risk).

STATISTICAL ANALYSES PERFORMED

Multiple analysis of variance and χ² analyses examined whether DST risk categories differed by variables. Significant predictors were entered into a logistic regression equation predicting at-risk compared to other risk categories combined.

RESULTS

Participants' mean age was 82.5±4.9 years. Nearly half (49%, n=125) were classified as being at possible risk, with the remainder 26% (n=66) not at risk and at risk 25% (n=64). At-risk participants were less likely to be in the Action/Maintenance Stages of Change (P<0.01). There was a multivariate effect of risk category (P<0.01). At-risk participants had a lower intake of fruits and vegetables, fruit and vegetable self-efficacy, satisfaction with life, and resilience, as well as higher Geriatric Depression Scale scores, indicating greater negative affect than individuals not at risk (P<0.05). In a logistic regression predicting at risk, fruit and vegetable self-efficacy, Satisfaction with Life Scale score, and fruit and vegetable intake were independent predictors of risk (P<0.05).

CONCLUSIONS

Older adults classified as at risk indicated a greater degree of negative affect and reduced self-efficacy to consume fruits and vegetables. This study supports the use of the DST in assessment of older adults and suggests a clustering of health concerns among those classified as at risk.

Financial Care for Older Adults With Dementia

This article describes an examination of the sociodemographic characteristics of adult children, particularly Baby Boomer caregivers, who provide financial care to older parents with dementia. The sample including 1,011adult children dementia caregivers aged 50 to 64 years is selected from a nationally representative sample in the 2010 Health and Retirement Study. Exact logistic regression revealed that race, provision of financial assistance to caregiver children, and the number of their children are significantly associated with financial caregiving of parents. Non-White caregivers are more likely to provide financial care to their parents or parents-in-law with dementia; those who have more children and provide financial assistance to their children are less likely to provide financial care to parents with dementia. The current findings present valuable new information on the sociodemographic characteristics of adult children who provide financial assistance to parents with dementia and inform research, programs, and services on dementia caregiving.

The Best Exotic Marigold Hotel: international retirement migration on film

The two movies aboutThe Best Exotic Marigold Hotel(2012 and 2015) were directed by John Madden. Starring a cast of famous British older actors, the narratives are set in a faded hotel in India. These are individuals who have relocated because their retirement dreams cannot be realised in their home country. They reflect the growing phenomenon of international retirement migration (IRM): the quickly growing upsurge of financially independent individuals seeking an affordable old age. In India they can claim a position of relative comfort and privilege. For a generation that grew up in a consumerist culture, upward mobility in the senior life stage has become a purchasable commodity through exodus to a developing country. This generation of retirees is generally in better health compared with prior seniors, with a longer life expectancy. Many have a background of travel experience, and an ethos that places their own pleasures in life as pivotal. While global numbers are unavailable, it is estimated that there are millions of retirees relocating to less-developed countries for an affordable retirement. At retirement locations such as the Marigold Hotel, the discrepancies that continue between nations, and local poverty, enable this practice. The events in these movies might be read as a recapitulation of imperialism expressed through retirement migration.

Do baby boomers use more healthcare services than other generations? Longitudinal trajectories of physician service use across five birth cohorts

OBJECTIVE

In light of concerns for meeting the provision of healthcare services given the large numbers of ageing baby boomers, we compared the trajectories of primary care and specialist services use across the lifecourse of 5 birth cohorts and examined factors associated with birth cohort differences.

DESIGN

Longitudinal panel.

SETTING

Canadian National Population Health Survey (1994-2011).

POPULATION

Sample of 10 186 individuals aged 20-69 years in 1994-1995 and who were from 5 birth cohorts: Generation X (Gen X; born: 1965-1974), Younger Baby Boomers (born: 1955-1964), Older Baby Boomers (born: 1945-1954), World War II (born: 1935-1944) and pre-World War II (born: 1925-1934).

MAIN OUTCOMES

Use of primary care and specialist services.

RESULTS

Although the overall pattern suggested less use of physician services by each successive recent cohort, this blinded differences in primary and specialist care use by cohort. Multilevel analyses comparing cohorts showed that Gen Xers and younger boomers, particularly those with multimorbidity, were less likely to use primary care than earlier cohorts. In contrast, specialist use was higher in recent cohorts, with Gen Xers having the highest specialist use. These increases were explained by the increasing levels of multimorbidity. Education, income, having a regular source of care, sedentary lifestyle and obesity were significantly associated with physician services use, but only partially contributed to cohort differences.

CONCLUSIONS

The findings suggest a shift from primary care to specialist care among recent cohorts, particularly for those with multimorbidity. This is of concern given policies to promote primary care services to prevent and manage chronic conditions. There is a need for policies to address important generational differences in healthcare preferences and the balance between primary and specialty care to ensure integration and coordination of healthcare delivery.

Reflections on Women's Retirement

Popular literature often claims that baby boom women will "redefine" retirement, and there is some evidence in the gerontological literature that this may be true. However, considerably more research needs to be done on this generation of retirees. The author, a baby boomer herself, draws on recent research on retirement and her own experiences in early retirement to examine what a "good retirement" might mean, considering the diversity of baby boomers, the range of their experiences, and their relationship to work.

Participation in formal learning activities of older Europeans in poor and good health

Little attention has been given to the involvement in formal learning activities (FLA) in the older population when considering different health statuses. The aim of this study is to explore the extent to which possible predictors (derived from previous research as well as a conceptual model) of FLA differ for older people in poor and good health. Data are used from SHARE 2010/2011 for the 50+ populations in 16 European countries. Poor health is defined as self-report of having two or more chronic diseases assessed by a medical doctor, i.e. multimorbidity. Possible predictors of learning activities represent individual characteristics: functional limitations, demography (age, gender, marital status and household size), human capital (achieved level of education), employment, income and participation in other social activities. To assess the predictors of FLA, logistic regression models are used and average marginal estimates are compared across groups. In addition to multimorbidity, labour market activity is used as a grouping variable. The average participation of individuals in the group with multimorbidity was nearly 50 % lower than that in the group in good health (6.5 vs. 13.3 %). Regardless of multimorbidity, human capital proved to be significant predictors of FLA, especially in those active on the labour market. However, the associations were weaker in the multimorbidity group. Also, significant associations were observed of other types of social activities, in particular cultural and leisure activity and volunteering, with FLA. This study suggests that similar factors are predictors of FLA in older people with and without multimorbidity.

Power Relations and Health Care Communication in Older Adulthood: Educating Recipients and Providers

Unequal power relations lie just below the surface in much of today's discourse on health care communication with older adults. Focusing on pathologies or deficits tends to reinforce stereotypes of frailty and dependency, thus framing elders as a vulnerable group requiring special assistance. Implicit stereotyping frequently colors interactions of health care personnel with older clients and their families-interactions likely to affect elders' perceptions and health outcomes. Health care providers need to be attuned to the vast and growing diversity in today's older population, wherein many older adults are exemplars of what it takes to marshal resources and cope with multifaceted challenges. Thus, elders have the potential to teach medical personnel through narratives of resilience as well as tribulation. This potential can be fully realized, however, only in contexts where communication patterns characterized by paternalism, consumerism, and collaboration are mutually recognized and selectively challenged or implemented. Promising interventions to facilitate health care communication in older adulthood might well be directed toward (a) educating both recipients and providers to become more mindful of cues that evoke stereotypical thinking, (b) promoting an institutional culture that normalizes situationally appropriate assertive responses to stereotyping, and (c) formally ratifying older adults' life experience in the training of health care personnel.

Age-Appropriate Augmented Cognitive Behavior Therapy to Enhance Treatment Outcome for Late-Life Depression and Anxiety Disorders

We present an explanation of the benefits of using gerontological theory to augment treatment outcome in cognitive behavior therapy (CBT). Traditional formulations/conceptualizations of CBT may not always be the most optimal fit when working with older people, who may be experiencing different developmental life stages compared to adults of working age. In addressing how CBT may be different with older people, it is proposed that one may augment CBT outcome by applying gerontological theory as “vehicles for change.” This evidence-based scientist approach is consistent with standard practice in CBT. This paper outlines some examples of how gerontological theory can be useful to bring about an enhanced treatment outcome.

Car Licensing Trends of the Babyboomer Cohort (b. 1946-1965) Compared to Earlier Birth Cohorts: Effects on the Driving Population in the State of Victoria, Australia

OBJECTIVE

The objective of this article was to explore trends in licensing among babyboomer older drivers in the state of Victoria, Australia. The study aims were to (1) compare the car licensing trends of the babyboomer cohort to that of previous birth cohorts and (2) predict the number of babyboomers licensed to drive a car in 2021 when the babyboomer cohort reaches an average age of 65 years.

METHODS

The residential population of Victoria, Australia, for 2001-2013 was obtained from the Australian Bureau of Statistics; car licensing statistics were obtained from VicRoads. Birth cohorts from 1916 to 1975 were defined in 10-year birth-year intervals. Population size was modeled using logistic regression. License prevalence was modeled using a logit model.

RESULTS

The babyboomer cohort (1946-1965) in Victoria is 1.7 times larger than the cohort before them. At age 60 years, license prevalence among babyboomers was higher than in previous cohorts: 88% in the 1936-1945 cohort vs. 96% in the 1946-1955 cohort. When the babyboomers reach 65 years (average) in 2021, we estimate there to be over twice as many license holders among them than in the preceding cohort (n = 1,300,094 vs. 630,830, respectively).

CONCLUSIONS

Aging of the babyboomer cohort will have a greater impact on the driving population than on the general population, due to the multiplicative effect of cohort size and license prevalence. The impact of road user aging on burden of injury can be minimized by focusing prevention at crashes typical to older drivers, such as intersection crashes, and promoting car safety features among older drivers.

Baby boomer caregiver and dementia caregiving: findings from the National Study of Caregiving

BACKGROUND

Previous studies have well documented the characteristics of baby boomers but less is known about the experiences of boomer caregivers (CGs) of people with dementia.

OBJECTIVE

The purpose of this study was to compare the characteristics of boomer CGs of people with dementia with those of boomer CGs for people without dementia and to ascertain factors associated with outcomes.

DESIGN

We selected baby boomer CGs from the National Study of Caregiving (NSOC) with 650 primary boomer CGs (138 CGs of people with dementia and 512 CGs of people without dementia).

METHODS

The Stress Process Model (SPM) was used to examine the effects of resources (the use of paid help and informal support) and stressors (primary: level of CG care activities and interrupted sleep; secondary: strain of caregiving on work, other care and social activities) on CGs' down, depressed or hopeless feelings and self-perceived general health. T-tests and chi-square tests were used to compare SPM domain differences and ordinary least-square multiple regression analysis was used to investigate predictors of CGs' outcomes.

RESULTS

High blood pressure and arthritis were the most prevalent chronic diseases in both groups. Boomer CGs of people with dementia reported providing more help with daily activities, higher level of caregiving and social activity conflict, experiencing more interrupted sleep and more down, depressed or hopeless feelings than CGs of people without dementia. Different factors predicted boomer CGs' outcomes.

CONCLUSION

The current results yield important information about the considerable differences between two baby boomer CG groups within the caregiving experiences. The findings highlight the need to provide tailored interventions to boomer CGs to help them cope with caregiving stress to improve their physical and mental health.

Family Health Histories and Their Impact on Retirement Confidence

OBJECTIVE

Retirement confidence is a key social barometer. In this article, we examine how personal and parental health histories relate to working-age adults' feelings of optimism or pessimism about their overall retirement prospects.

METHOD

This study links survey data on retirement planning with information on respondents' own health histories and those of their parents. The multivariate models control for the respondents' socio-demographic and economic characteristics along with past retirement planning activities when estimating the relationships between family health histories and retirement confidence.

RESULTS

Retirement confidence is inversely related to parental history of cancer and cardiovascular disease but not to personal health history. In contrast, retirement confidence is positively associated with both parents being deceased.

DISCUSSION

As members of the public become increasingly aware of how genetics and other family factors affect intergenerational transmission of chronic diseases, it is likely that the link between family health histories and retirement confidence will intensify.

The Growing Costs and Burden of Family Caregiving of Older Adults: A Review of Paid Sick Leave and Family Leave Policies

Many family caregivers of older adults suffer from a high burden of care and struggle with the balance of jobs and caregiving tasks. However, the United States is the only developed country without paid sick leave policies for all workers and their families. The purpose of this article is to review the federal Family and Medical Leave Act (FMLA) and empirical studies about paid sick policy, propose policy recommendations, and provide a starting point for future research. The result has shown that the FMLA only applies to certain employees and the provided leave is unpaid under the act. Working women, Latinos, low-wage workers, and less-educated employees are less likely to access paid sick leave and family leave. Obviously, social injustice exists in the FMLA and paid sick leave policies. This article proposes that the Family and Medical Leave Act coverage should be expanded to protect all workers, especially for primary family caregivers of older adults, regardless of family relationships. Also, paid sick and family leave laws should be passed, and requirements to contribute to a family-friendly workplace added to relieve the growing burden of family caregiving of older adults. Policy recommendations including the exemplar of the San Francisco Paid Sick Leave Ordinance, and suggestions for more comprehensive policies are proposed for federal, state, or/and city legislation.

Infusing geropsychiatric nursing content into curricula: challenges and solutions

Nurses of the 21st century are unprepared to care for the increasing older adult population's mental health care needs. Nursing schools across the country struggle to identify and infuse geropsychiatric nursing content into curricula. In 2008, the John A. Hartford Foundation partnered with the American Academy of Nursing to fund a 4-year project, the Geropsychiatric Nursing Collaborative (GPNC). In 2011, four schools of nursing were selected to participate in the GPNC consultation project. This article describes two major challenges that schools currently face as they work to infuse geropsychiatric nursing content into nursing curricula and the solutions offered. Core geropsychiatric nursing competencies and content were identified to assist curriculum mapping, and examples of faculty resources for teaching about depression, dementia, and delirium were outlined. Incorporation of geropsychiatric nursing content is critical for preparing our future workforce to meet the increasing mental health care needs of older adults.

Challenges and Opportunities with Empowering Baby Boomers for Personal Health Information Management Using Consumer Health Information Technologies: an Ecological Perspective

"Baby Boomers" (adults born between the years of 1946 and 1964) make up the largest segment of the population in many countries, including the United States (about 78 million Americans) [1]. As Baby Boomers reach retirement age and beyond, many will have increasing medical needs and thus demand more health care resources that will challenge the healthcare system. Baby Boomers will likely accelerate the movement toward patient self-management and prevention efforts. Consumer Health Information Technologies (CHIT) hold promise for empowering health consumers to take an active role in health maintenance and disease management, and thus, have the potential to address Baby Boomers' health needs. Such innovations require changes in health care practice and processes that take into account Baby Boomers' personal health needs, preferences, health culture, and abilities to use these technologies. Without foundational knowledge of barriers and opportunities, Baby Boomers may not realize the potential of these innovations for improving self-management of health and health outcomes. However, research to date has not adequately explored the degree to which Baby Boomers are ready to embrace consumer health information technology and how their unique subcultures affect adoption and diffusion. This position paper describes an ecological conceptual framework for understanding and studying CHIT aimed at satisfying the personal health needs of Baby Boomers. We explore existing literature to provide a detailed depiction of our proposed conceptual framework, which focuses characteristics influencing Baby Boomers and their Personal Health Information Management (PHIM) and potential information problems. Using our ecological framework as a backdrop, we provide insight and implications for future research based on literature and underlying theories represented in our model.

"His" and "her" marriage? The role of positive and negative marital characteristics in global marital satisfaction among older adults

OBJECTIVES

We explore gender differences in older adults' appraisals of positive and negative aspects of their marriages, examine how these appraisals relate to global marital satisfaction, and identify distinctive marital profiles associated with global satisfaction in men and women.

METHOD

Data are from the Changing Lives of Older Couples Study (n = 1,110). We used a variant of principal components analysis to generate marital quality profiles, based on one's endorsement of positive and negative marital characteristics. OLS regression was used to detect associations between marital profiles and global marital satisfaction.

RESULTS

Men offered more positive marital assessments than women, particularly on items reflecting positive treatment by one's wife. Three marital quality profiles emerged: Positive, Positive-Negative, and Negative. Although marital satisfaction was best explained by positive appraisals in both genders, they were less important for men than for women. The negative profile showed a tendency for a stronger prediction in men.

DISCUSSION

Prior studies show small differences in men's and women's global marital satisfaction. Our work provides evidence that the presence and magnitude of such gender differences may vary based on the specific marital component considered. We discuss ways that gender shapes marital interactions, expectations, and perceptions, and the implications of our results for the well-being of married older adults.

Cumulative exposure to traumatic events in older adults

OBJECTIVES

The present study examined the impact of cumulative trauma exposure on current posttraumatic stress disorder (PTSD) symptom severity in a nonclinical sample of adults in their 60s. The predictive utility of cumulative trauma exposure was compared to other known predictors of PTSD, including trauma severity, personality traits, social support, and event centrality.

METHOD

Community-dwelling adults (n = 2515) from the crest of the Baby Boom generation completed the Traumatic Life Events Questionnaire, the PTSD Checklist, the NEO Personality Inventory, the Centrality of Event Scale, and rated their current social support.

RESULTS

Cumulative trauma exposure predicted greater PTSD symptom severity in hierarchical regression analyses consistent with a dose-response model. Neuroticism and event centrality also emerged as robust predictors of PTSD symptom severity. In contrast, the severity of individuals' single most distressing life event, as measured by self-report ratings of the A1 PTSD diagnostic criterion, did not add explanatory variance to the model. Analyses concerning event categories revealed that cumulative exposure to childhood violence and adulthood physical assaults were most strongly associated with PTSD symptom severity in older adulthood. Moreover, cumulative self-oriented events accounted for a larger percentage of variance in symptom severity compared to events directed at others.

CONCLUSION

Our findings suggest that the cumulative impact of exposure to traumatic events throughout the life course contributes significantly to posttraumatic stress in older adulthood above and beyond other known predictors of PTSD.

Cancer prevention among adults aged 45-64 years: setting the stage

As part of setting the stage for this supplement to the American Journal of Preventive Medicine, a life-course perspective is presented to assist in understanding the importance of cancer prevention for adults in midlife, a period roughly spanning 20 years between ages 45 and 64 years. Drawing on disciplinary perspectives from the social sciences and public health, several life-course themes are delineated in this article: how specific life transitions present unique opportunities for interventions to inform policy and practice that can improve population health outcomes; how interventions can be focused on those at particular life stages or on the entire life course; and how the onset and progression of chronic conditions such as cancer are dependent on a complex interplay of critical and sensitive periods, and trajectory and accumulation processes. A translational research framework is applied to help promote the movement of applied public health interventions for cancer prevention into practice. Also explored are differences that can affect people at midlife relative to other age cohorts. Specifically, cancer-related risks and care networks are examined, with examples of public health strategies that can be applied to cancer prevention and control. As a conclusion, select methodologic issues and next steps for advancing research and practice are identified.

Generating sensor data summaries to communicate change in elders' health status

BACKGROUND

Sensor systems detect critical health changes of frail residents in the community. However, sensor systems alone may not allow users to identify data trends fast enough. Linguistic summaries of sensor data describing elder activity in their apartment provide a useful solution so clinicians can respond quicker.

OBJECTIVES

This paper describes two case studies of independent elders living with sensors in their assisted living apartment. Residents experienced declining health status and activity level over a period of approximately 24 months. Linguistic summaries were assessed iteratively by engineers and nurses working with the sensor system.

METHODS

We created summaries of activity data collected from sensors located in resident apartments during a period of health status change. Engineers distilled information from heterogeneous data sources including bedroom motion and bed restlessness sensors during the summarization process. Engineers used fuzzy measures to compare two different periods of nighttime activity. Using iterative approaches a registered nurse worked with the team to develop algorithms and short phrases that appropriately capture and describe changes in activity levels.

RESULTS

Total activity levels captured by sensors were graphed for two elderly residents experiencing health problems over a period of months. In the first case study (resident 3004), an elderly resident had knee surgery and onset of backspasms postoperatively. Graphed dissimilar measures show changes from baseline when backspasms occur. In the second case study (resident 3003), there were increased periods of bed restlessness before and after a resident had a major surgical procedure. During these periods, graphs of dissimilarity measures indicate that there were changes from usual baseline periods of restlessness postoperatively indicating the health problems were persisting. Nurse care coordination notes indicate these episodes were related to poor pain control.

CONCLUSIONS

Summaries of activity change are useful for care coordinators to detect resident health status for community dwelling residents.

Associations Between Secondary Caregivers' Supportive Behavior and Psychological Distress of Primary Spousal Caregivers of Cognitively Intact and Impaired Elders

PURPOSE OF THE STUDY

This study examined associations between the availability and types of supportive behavior provided by secondary caregivers and the psychological distress of primary spousal caregivers of cognitively intact and impaired elders.

DESIGN AND METHODS

A sample of 8,087 assessments using the validated Chinese version of the Minimum Data Set-Home Care of individuals applying for government-subsidized long-term care services from 2006 to 2009 in Hong Kong were selected based on inclusion criteria.

RESULTS

More than 70% of primary caregivers had secondary caregivers; the rate was slightly lower for those caring for moderately or severely cognitively impaired spouses. More than half of the primary spousal caregivers had secondary caregivers who provided both emotional and instrumental support. Emotional support provided by secondary caregivers had a negative association with primary caregivers' psychological distress when their care recipients were cognitively intact. When secondary caregivers provided both instrumental and emotional support, primary caregivers had a higher likelihood of psychological distress when care recipients had greater negative mood symptoms as compared to those who had less negative mood symptoms.

IMPLICATIONS

This is the first study that examined the association between availability and types of supportive behavior provided by secondary caregivers and the psychological distress of primary spousal caregivers of cognitively intact and impaired elders. The findings suggest a need to provide services that enhance the provision of emotional support from both secondary and primary caregivers to cognitively intact elders and support primary spousal caregivers to seek appropriate help according to the mood of care recipients.

Long-term supports and services planning for the future: implications from a statewide survey of Baby Boomers and older adults

PURPOSE OF THE STUDY

Little is known about adults' future planning for long-term supports and services (LTSS), and no studies have examined how LTSS planning compares between Baby Boomers and their parents' generation. The primary aim of this study is to examine the potential influences of birth cohort and gender on LTSS planning. Drawing on Andersen's Behavioral Model of Health Services Use, birth cohort and gender are viewed as predisposing characteristics, and several additional predisposing, enabling, and need characteristics are included as independent variables.

DESIGN AND METHODS

Cross-sectional design; data obtained from a statewide survey of 2,522 randomly selected Baby Boomers (born between 1946 and 1964) and older adults (born before 1946).

RESULTS

Two thirds of respondents expected to need LTSS, but few reported saving for such services. Controlling for other independent variables, compared with older adults, Baby Boomers were significantly more likely to plan to move to an apartment, live in a retirement community or assisted living, and live with an adult child. Conversely, women were more likely than men to report planning to use specific LTSS such as homecare, but specific LTSS plans did not vary by birth cohort.

IMPLICATIONS

Policymakers and providers should prepare for a shift in community planning to accommodate the changing plans and expectations of Baby Boomers, large numbers of whom plan to age in existing homes and retirement communities, or live with adult children, with increasing demand for informal family support. The LTSS industry should also adapt to meet the need for formal services, which will likely continue to grow.

Comparing the Future Concerns of Early Wave Baby Boomers With the Concerns of Young-Old Adults

Using data from a statewide needs assessment survey, this study examines and compares the self-reported future concerns of two age groups in Mississippi: Early wave Baby Boomers (age 55 to 64; n = 383) and the young-old (age 65 to 75; n = 349). Items under analysis focus on issues related to future concerns surrounding financial resources, health, and employment. Results from multivariate analyses of variance (MANOVA) indicate that Early wave Baby Boomers have higher levels of future concern than the young-old group in all three areas. Hierarchical regression analyses showed that the financial and employment concerns of the Baby Boomers were higher than the concerns of the older group even after subjective well-being and income were taken into account. However, age differences in health concerns disappeared after controlling for current health and well-being. These findings suggest that the financial concerns of the Baby Boomers extend to the whole cohort and not just to the most financially stressed.