Population Aging and Heat Exposure in the 21st Century: Which U.S. Regions Are at Greatest Risk and Why?

BACKGROUND AND OBJECTIVES

The co-occurring trends of population aging and climate change mean that rising numbers of U.S. older adults are at risk of intensifying heat exposure. We estimate county-level variations in older populations' heat exposure in the early (1995-2014) and mid (2050) 21st century. We identify the extent to which rising exposures are attributable to climate change versus population aging.

RESEARCH DESIGN AND METHODS

We estimate older adults' heat exposure in 3,109 counties in the 48 contiguous U.S. states. Analyses use NASA NEX Global Daily Downscaled Product (NEX-GDDP-CMIP6) climate data and county-level projections for the size and distribution of the U.S. age 69+ population.

RESULTS

Population aging and rising temperatures are documented throughout the United States, with particular "hotspots" in the Deep South, Florida, and parts of the rural Midwest. Increases in heat exposure by 2050 will be especially steep in historically colder regions with large older populations in New England, the upper Midwest, and rural Mountain regions. Rising temperatures are driving exposure in historically colder regions, whereas population aging is driving exposure in historically warm southern regions.

DISCUSSION AND IMPLICATIONS

Interventions to address the impacts of temperature extremes on older adult well-being should consider the geographic distribution and drivers of this exposure. In historically cooler areas where climate change is driving exposures, investments in warning systems may be productive, whereas investments in health care and social services infrastructures are essential in historically hot regions where exposures are driven by population aging.

Telehealth Use Among Older Adults With Sensory, Cognitive, and Physical Impairments: A Substitute or Supplement to Traditional Care?

OBJECTIVES

Telehealth use flourished during the COVID-19 pandemic, as older patients faced obstacles to seeking in-person care. Heavy reliance on telehealth may continue postpandemic, due to increased Medicare investments in its use. However, it is unclear if older adults with disabilities face obstacles to effective telehealth use. We evaluate (a) how sensory, physical, and cognitive impairments affect older adults' use of telehealth only, traditional in-person care only, neither, or both (i.e., combined care); and (b) whether these patterns differ on the basis of socioeconomic and social resources that may facilitate telehealth use.

METHOD

Data are from the Self-Administered Questionnaire in the 2020 wave of the Health and Retirement Study (n = 4,453). We estimated multinomial logistic regression models to evaluate associations between impairments and health care service use and tested 2-way interaction terms to evaluate moderation effects.

RESULTS

Persons without impairments were most likely to use combined care, considered the optimal form of care. Persons with vision or cognitive impairment were more likely to use telehealth or traditional care only, whereas persons with 3 or more physical limitations were least likely to use telehealth alone, relative to combined care. Patterns did not differ significantly on the basis of any of the potential moderators.

DISCUSSION

We discuss implications for health care policy and practice, in light of reimbursement changes proposed by the Centers for Medicare and Medicaid Services for telehealth services. These proposals include the elimination of voice-only services which may be particularly beneficial to vision-impaired older adults.

To Tell or Not: Chinese Older Adults' Preferences for Disclosing or Concealing Serious Illness Diagnoses

BACKGROUND AND OBJECTIVES

Knowledge of one's medical diagnosis is critical for end-of-life decision making. However, a patient's right to know their diagnosis is neither guaranteed nor protected by law in China. Doctors typically inform family members of the patient's illness diagnosis and prognosis and let the family decide whether to disclose this information to the patient. This study examines midlife and older Chinese adults' preferences for disclosure of their own and significant others' diagnoses, and the sociodemographic, economic, and cultural factors associated with these preferences.

RESEARCH DESIGN AND METHODS

We surveyed 571 adults ages 50+ in Shanghai from 2021 to 2022. Our outcome measures are preferences for diagnosis disclosures, including whether and to whom diagnoses should be disclosed. We characterize preference types using latent class analysis, and estimate multinomial logistic regression to identify the covariates associated with each preference type.

RESULTS

Three latent classes were identified. The transparent group (34%) believed patients, whether self or a significant other, should be informed of their own diagnoses. The contradictory group (50%) held conflicting attitudes; they preferred to know their own diagnosis but preferred that significant others not be informed of their diagnoses. The avoidant group (16%) preferred not to know their own diagnosis and similarly preferred not to disclose significant others' diagnoses to them. Familism attitudes were positively associated with holding contradictory views. Experiences with hospitalization and medical decision making for family members were associated with holding transparent views.

DISCUSSION AND IMPLICATIONS

We discuss the importance of illness disclosure for honoring patients' autonomous decision making.

Estimating Prevalence of Bereavement, Its Contribution to Risk for Binge Drinking, and Other High-Risk Health States in a State Population Survey, 2019 Georgia Behavioral Risk Factor Surveillance Survey

BACKGROUND

Binge drinking is a pattern of alcohol abuse. Its prevalence and associated risk factors are not well documented. Heavy drinking, on the other hand, has a well-documented association with bereavement. This report uses a cross-sectional, population-based survey to estimate prevalence of bingeing and its association with new bereavement. Bingeing is defined as 4 or more drinks (women) or 5 or more drinks (men) in a 2-4-h setting. For the first time in 2019, the Georgia Behavioral Risk Factor Surveillance Survey (BRFSS) included a bereavement item: 'Have you experienced the death of a family member or close friend in the years 2018 or 2019?'

METHODS

Georgia BRFSS is a complex sampling survey administered annually. It is designed to represent the 8.1 million people aged 18 years and older in the U.S. state of Georgia. Alcohol consumption patterns are routinely measured in the common core. In 2019, the state added a new item probing for bereavement in the prior 24 months predating the COVID-19 pandemic. Imputation and weighting techniques were applied to yield the population prevalence rates of new bereavement, bingeing, and their co-occurrence with other high-risk health behaviors and outcomes. Multivariate models, adjusted for age, gender, and race, were used to estimate the risk for other unhealthy behaviors posed by the co-occurrence of bereavement and bingeing.

RESULTS

In Georgia, bereavement (45.8%), and alcohol consumption (48.8%) are common. Bereavement and alcohol use co-occurred among 1,796,817 people (45% of all drinkers) with a subset of 608,282 persons reporting bereavement combined with bingeing. The most common types of bereavement were death of a friend/neighbor (30.7%) or three plus deaths (31.8%).

CONCLUSIONS

While bingeing is a known risk to public health, its co-occurrence with recent bereavement is a new observation. Public health surveillance systems need to monitor this co-occurrence to protect both individual and societal health. In a time of global bereavement, documenting its influence on binge drinking can support the work towards Sustainable Development Goal #3-Good health and Well-Being.

Ageism and late-life mortality: How community matters

AGEISM: the deeply entrenched biases that people hold about old age-is a persistent social problem that intensified during the COVID-19 pandemic. The harmful physical, emotional, and cognitive health consequences of individual-level age bias are well-documented, with most studies operationalizing ageism as an older adult's personal encounters with age discrimination, self-perceptions of their own aging, and internalized negative beliefs about old age. However, the impacts of community-level age bias on older adults' well-being have received less attention. This commentary reviews recent evidence (Kellogg et al.,) showing that county-level explicit age bias is associated with lower mortality rates among older adults, with effects limited to older adults residing in counties with relatively younger populations. Effects were not detected in counties with relatively older populations, or for implicit age bias. These counterintuitive findings require further exploration, including the use of more fine-grained measures of community-level ageism, attention to the role of gentrification in communities, and the development of new measures of structural ageism, drawing on approaches used to study the impacts of structural racism. Data science approaches, including the use of social media data in tandem with mortality data, may reveal how age bias affects older adults. Communities are especially important to older adults, who spend much of their time in areas immediately proximate to their homes. As more individuals age in place, and as federal funding for home-based and community services (HCBS) increases, researchers should identify which community-level characteristics, including age bias, undermine or enhance late-life well-being.

Urban endoliths: incidental microbial communities occurring inside concrete

<abstract> <p>Concrete is now a prevalent type of synthetic rock, and its production and usage have major environmental implications. Yet, assessments of ordinary concrete have rarely considered that concrete itself is potential habitat for a globally important microbial guild, the endolithic microbes, which live inside rocks and other mineralized substrates. We sought evidence that many common concrete structures harbor endolithic microbial communities and that these communities vary widely depending on the conditions imposed by the concrete. In Summer 2022, we obtained samples from various concrete structures found throughout Lubbock, Texas, USA and subjected the internal (non-surface) portions of each sample to controlled microbial life detection tests including culture tests, DNA quantifications, DNA amplification tests, and ATP assays. The great preponderance of positive life detection results from our concrete samples suggests that most modern concrete hosts cryptic endolith communities composed of bacteria, sometimes co-occurring with fungi and/or archaea. Moreover, many of these microbes are viable, culturable, and identifiable via genetic analysis. Endolith signatures varied widely across concrete samples; some samples only yielded trace evidence of possibly dormant microbes while other samples contained much more microbial biomass and diversity, on par with some low-biomass soils. Pre-cast masonry units and fragments of poured concrete found underwater generally had the most endolith signatures, suggesting that concrete forms and environmental positioning affect endolithy. Endolith biosignatures were generally greater in less dense and less alkaline concrete samples. So, concrete endolith communities may be as ubiquitous and diverse as the concrete structures they inhabit. We propose further research of concrete endoliths to help clarify the role of modern concrete in our rapidly urbanizing biosphere.</p> </abstract>

LIFE AFTER LOSS: EMERGING INSIGHTS ON GRIEF ADJUSTMENT AND HEALTH IN LATE LIFE

Recent scholarship recognizes that grief adjustment is not a staged, linear process. In late life, the loss of close others is common and dynamic. However, little is known about the ‘ripple effects’ from loss experiences. As people are living longer, it is important to gain insight regarding how loss is processed, carried, and used for self-direction. This symposium responds to GSA’s 2022 meeting theme of “Reimagining Aging” by presenting emerging research which reimagines grief adjustment across diverse populations. To begin, Sara Hackett, PhD will share her work on the continuing bonds of older conjugally bereaved women and how they shape perceptions about repartnering. Following, Emily Mroz, PhD will present on affective sequences in final memories from past spousal loss and demonstrate how sequences predict future caregiving confidence in these widowed older adults. Danielle McDuffie, MA will add to this rich discussion by shedding light on predictors of bereavement and grief outcomes specific to Black adults. Last, Holly Prigerson, PhD will outline unmet psychological needs of family caregivers of patients who die in ICU settings and present her work on EMPOWER, an intervention aimed to reduce psychological distress and foster caregiver adjustment across the loss experience in this setting. Stephanie Wladkowski, PhD, our discussant, will tie these perspectives together, facilitating an important dialogue regarding classic and newly-considered impacts of grief in late life. Further, she will discuss how through more closely examining peoples’ experiences during and after loss, we can recognize late-life bereavement as shaping self-perceptions, relationships, and mental health.

GIVING AND GETTING ACROSS THE GENERATIONS: NEW INSIGHTS INTO INTERGENERATIONAL TIES

Population aging raises debates about who will care and provide for older adults, while shifting economic and family patterns suggest that young adults may require ongoing support from their (grand)parents. These five papers use diverse methods and data to shed new light on upward and downward intergenerational exchanges. Fingerman and colleagues use data from a small racially diverse sample of young adults (ages 18 to 29) providing care to grandparents. They document psychological benefits yet potentially harmful life course disruptions (e.g., education). Wiemers and co-authors use the Health and Retirement Study Core and COVID-19 Module to document how adult children’s transfers of time, money, and coresidence changed in response to the COVID-19 pandemic. Minoritized and lower SES older adults were less likely to receive help from family members, due to children’s constraints. Whitworth documents disparities in the types of support college students receive from midlife parents, using the Panel Study of Income Dynamics Transition to Adulthood Supplement. Higher SES parents tend to provide financial support, whereas lower SES parents provide coresidence. Silverstein et al. use multigenerational data from Longitudinal Study of Generations. They find religiosity of parents during the offspring’s adolescence affects their cognitive and behavioral religiosity in later life. Avni uses cross-national attitudinal data from the International Social Survey Programme (ISSP) and finds that Americans believe family should be responsible elder care, whereas Israelis and Germans believe the government should provide care. The discussant highlights implications of the study results for research and policies regarding intergenerational relations.

Paternal Occupation and Delirium Risk in Older Adults: A Potential Marker of Early-Life Exposures

Background and Objectives

Delirium is a common disorder among older adults following hospitalization or major surgery. Whereas many studies examine the risk of proximate exposures and comorbidities, little is known about pathways linking childhood exposures to later-life delirium. In this study, we explored the association between paternal occupation and delirium risk.

Research Design and Methods

A prospective observational cohort study of 528 older adults undergoing elective surgery at two academic medical centers. Paternal occupation group (white collar vs. blue collar) served as our independent variable. Delirium incidence was assessed using the Confusion Assessment Method (CAM) supplemented by medical chart review. Delirium severity was measured using the peak CAM-Severity score (CAM-S Peak), the highest value of CAM-S observed throughout the hospital stay.

Results

Blue-collar paternal occupation was significantly associated with a higher rate of incident delirium (91/234, 39%) compared with white-collar paternal occupation (84/294, 29%), adjusted odds ratio OR (95% confidence interval [CI]) = 1.6 (1.1, 2.3). All analyses were adjusted for participant age, race, gender, and Charlson Comorbidity Index. Blue-collar paternal occupation was also associated with greater delirium severity, with a mean score (SD) of 4.4 (3.3), compared with white-collar paternal occupation with a mean score (SD) of 3.5 (2.8). Among participants reporting blue-collar paternal occupation, we observed an adjusted mean difference of 0.86 (95% CI = 0.4, 1.4) additional severity units.

Discussion and Implications

Blue-collar paternal occupation is associated with greater delirium incidence and severity, after adjustment for covariates. These findings support the application of a life-course framework to evaluate the risk of later-life delirium and delirium severity. Our results also demonstrate the importance of considering childhood exposures, which may be consequential even decades later.

The Effect of Physical Limitations on Depressive Symptoms over the Life Course: Is Optimism a Protective Buffer?

OBJECTIVES

We examined the extent to which optimism buffers the effects of physical limitations on depressive symptoms, across four mid- and later-life age groups (ages 40-49, 50-64, 65-74, 75+ at baseline). Analyses are motivated by stress theories, which hold that the protective effects of coping resources are evidenced only at high levels of stress. We further explore whether these purportedly protective effects diminish with age, as health-related stressor(s) intensify and become irreversible.

METHODS

We use data from two waves (2004-06 and 2013-14) of the Health and Retirement Study (HRS, n = 4,515) and Midlife in the United States (MIDUS, n = 2,138). We estimate OLS regression models with three-way interaction terms to examine prospectively the benefits of optimism as a coping resource for persons with physical limitations across four age groups. Physical limitations are assessed with a composite measure encompassing mobility and activity of daily living (ADL) limitations.

RESULTS

In HRS and MIDUS, persons with 3+ limitations reported significantly more depressive symptoms than persons with 0-2 limitations, yet these disparities diminished at higher levels of optimism. Buffering effects of optimism vary by age. For midlife and young-old persons with 3+ limitations, optimism is strongly and inversely related to depressive symptoms at follow-up. Comparable protective effects are not evident among oldest sample members.

DISCUSSION

Stress and coping models should consider more fully factors that limit older adults' capacity to deploy purportedly protective personal resources. Investments in structural or institutional supports may be more effective than interventions to enhance positive thinking.

Lessons Learned From a Centers for Disease Control and Prevention Virtual Partner Services Technical Assistance Pilot Project to Respond to a Local Syphilis Outbreak

ABSTRACT

A virtual partner services technical assistance (TA) project was piloted with the Minnesota Department of Health to address an ongoing syphilis outbreak. The TA reduced the health department's disease intervention specialist workload, achieved partner services outcomes comparable with in-person methods, and identified lessons learned to replicate with other jurisdictions.

Racial and Ethnic Disparities in Advance Care Planning: Assessing the Role of Subjective Life Expectancy

OBJECTIVES

Persistent race disparities in advance care planning (ACP) are troubling, given Black and Hispanic older adults' elevated risk of disease, some dementias, and receipt of care that may not align with their preferences. A potentially important yet underexplored explanation for these disparities is subjective life expectancy (SLE), or beliefs about one's future survival which may impel or impede ACP.

METHODS

Data are from the Health and Retirement Study (HRS; n=8,912). We examined the extent to which perceived chances of living another 10 years are associated with three components of ACP (living will, durable power of attorney for health care [DPAHC], and informal discussions). We used multilevel logistic regression models to evaluate the extent to which SLE mediates the association between race and ACP, adjusting for demographic, socioeconomic, psychosocial, and health characteristics.

RESULTS

Black and Hispanic older adults have significantly lower rates of ACP relative to whites. These disparities persist even when SLE is controlled. Blacks report especially optimistic whereas Hispanics report pessimistic survival expectations, although these differences do not explain racial disparities in ACP. SLE has direct effects on ACP, such that persons who report an "uncertain" SLE are less likely to have a living will or a DPAHC, whereas those who perceive a 50 percent chance of survival have significantly greater odds of discussions, relative to those who perceive a 0 percent chance of survival.

DISCUSSION

Doctor-patient conversations about the likely course of one's illness may inform patients' knowledge of their SLE, which may motivate timely ACP.

Marital Histories and Late-Life Economic Security: Do Social Security Benefits Rules Perpetuate Disparities?

Disparities in late-life economic security persist along the lines of gender, marital status, race, and educational attainment. We propose that these disparities are partly due to the fact that Social Security benefits are structured such that never-married, divorced, and cohabiting persons, those who were widowed prematurely, or were in a dual-earner couple face benefit penalties. Drawing on data from the Wisconsin Longitudinal Study (WLS), a study that has followed men and women from age 18 (in 1957) through age 72 (in 2011), we examine disparities in Social Security earnings and poverty risk on the basis of gender and marital histories. Our results reveal a large disadvantage for divorced and never-married persons (relative to their married counterparts), with women and those divorced two or more times experiencing the largest toll. We discuss the implications of our results for revamping Social Security to better meet the needs of 21st century families.

Older Americans With Disability Are Vulnerable to Economic and Food Insecurity During COVID-19

This study investigated whether older Americans with physical disability were vulnerable to three types of economic insecurity (difficulty paying regular bills, difficulty paying medical bills, income loss) and two types of food insecurity (economic obstacles, logistical obstacles) during the early months of the COVID-19 pandemic. We evaluated the extent to which associations are moderated by three personal characteristics (age, sex, race/ethnicity) and two pandemic-specific risk factors (job loss, COVID-19 diagnosis). Data were from a random 25 percent subsample of the Health and Retirement Study participants who completed a COVID-19 module administered in 2020. Our analytic sample included 3,166 adults aged 51 and older. We estimated logistic regression models to document the odds of experiencing each hardship. Persons with three or more functional limitations reported significantly higher odds of both types of food insecurity, and difficulty paying regular and medical bills, relative to those with no limitations. After controlling for health conditions, effects were no longer significant for paying medical bills, and attenuated yet remained statistically significant for other outcomes. Patterns did not differ significantly on the basis of the moderator variables. Older adults with more functional limitations are vulnerable to economic and food insecurity during the pandemic, potentially exacerbating the physical and emotional health threats imposed by the pandemic. Our findings reveal an urgent need to promote policies and procedures to protect older adults with disability from economic and food insecurity. Supports for older adults with disability should focus on logistical as well as financial support for ensuring food security.

Physical Disability at Work: How Functional Limitation Affects Perceived Discrimination and Interpersonal Relationships in the Workplace

Adults with disability have significantly lower rates of labor force participation relative to persons without disability, although it is unclear whether this disparity extends to subjective workplace experiences. Using data from the 2004 to 2006 wave of the National Survey of Midlife Development in the United States (n =2,030), we evaluate: (1) whether U.S. workers with physical disability report higher levels of perceived job discrimination and unequal workplace opportunities and lower levels of supervisor and coworker support and (2) whether these patterns differ by sex, age, and occupation group. We find that workers with physical disability fare significantly worse on all four outcomes net of covariates. Disability takes a particularly large toll on men's perceived workplace opportunities and white-collar employees' relationships with coworkers. Young adult workers (ages 30-39) with disability report significantly more support from their supervisor relative to their counterparts without disability. We discuss implications for research and policy.

Physical Disability and Older Adults' Perceived Food and Economic Insecurity During the COVID-19 Pandemic

OBJECTIVES

We examined whether older adults with physical disability were vulnerable to three types of perceived economic insecurity (difficulty paying regular bills, difficulty paying medical bills, income loss) and two types of perceived food insecurity (economic obstacles, logistical obstacles) during the early months of the COVID-19 pandemic. We evaluated the extent to which associations are moderated by three personal characteristics (age, sex, race/ethnicity) and two pandemic-specific risk factors (job loss, COVID-19 diagnosis).

METHODS

Data are from a random 25 percent subsample of Health and Retirement Study (HRS) participants who completed a COVID-19 module introduced in June 2020. We estimated logistic regression models to predict each of five self-reported hardships during the pandemic.

RESULTS

Bivariate analyses showed that persons with three or more functional limitations were more likely to report both types of food insecurity, and difficulty paying regular and medical bills since the start of the pandemic, relative to those with no limitations. After controlling for health conditions, effects were no longer significant for paying medical bills, and attenuated yet remained statistically significant for other outcomes. Patterns did not differ significantly on the basis of the moderator variables. Job loss substantially increased the risk of economic insecurity but not food insecurity.

DISCUSSION

Older adults with more functional limitations were vulnerable to economic and food insecurity during the pandemic, potentially exacerbating the physical and emotional health threats imposed by COVID-19. Supports for older adults with disability should focus on logistical as well as financial support for ensuring their food security.

Occupational differences in advance care planning: Are medical professionals more likely to plan?

Advance care planning (ACP) helps ensure that treatment preferences are met at the end of life. Medical professionals typically are responsible for facilitating patients' ACP, and may be especially effective in doing so if they have first-hand insights from their own planning. However, no large-scale U.S. studies examine whether persons working on the front lines of health care are more likely than other workers to have done ACP. We contrast the use of three ACP components (living wills, durable power of attorney for health care, and informal discussions) among persons working in medical, legal, social/health support services, other professional, and other non-professional occupations. Data are from the Health and Retirement Study (n = 7668) and Wisconsin Longitudinal Study (n = 5464). Multivariable logistic regression analyses are adjusted for socioeconomic, demographic, health, and psychosocial factors that may confound associations between occupational group and ACP. Medical professionals in both samples are more likely than other professional workers to discuss their own treatment preferences, net of all controls. Medical professionals in the WLS are more likely to execute living wills and DPAHC designations, whereas legal professionals in the HRS are more likely to name a DPAHC. Non-professional workers are significantly less likely to do all three types of planning, although these differences are accounted for by socioeconomic factors. Social and health services professionals are no more likely than other professionals to do ACP. The on-the-job experiences and expertise of medical professionals may motivate them to discuss their own end-of-life preferences, which may render them more trustworthy sources of information for patients and clients. The Affordable Care Act provides reimbursement for medical professionals' end-of-life consultations with Medicare beneficiary patients, yet practitioners uncomfortable with such conversations may fail to initiate them. Programs to increase medical professionals' own ACP may have the secondary benefit of increasing ACP among their patients.

Posterior-Based Approaches to Open Reduction Internal Fixation of Bimalleolar and Trimalleolar Fractures: A Systematic Review and Meta-analysis

Although there is growing evidence supporting posterior-based surgical approaches to open reduction internal fixation (ORIF) of malleolar fractures, the lateral approach still remains the standard of care for this injury. The purpose of this review was to integrate the results of several studies investigating outcomes following posterior-based approaches to the ORIF of malleolar fractures. The literature search was undertaken using PubMed, the Cochrane Library, and Embase. Crude event rates for fracture healing and postoperative complications were calculated. When possible, meta-analyses were conducted to estimate the relative risk of these outcomes between patients treated by posterior-based approaches versus other approaches to ORIF of malleolar fractures. Twenty-two studies were eligible, and 4 studies were included in the meta-analyses. The healing rate was 100% in all patients, regardless of the surgical approach. Overall, 1.26% of patients developed an infection, 0.63% required reoperation, 1.13% experienced aseptic loosening, 5.53% experienced pain after treatment, and 2.52% experienced symptomatic hardware. No malunion or heterotopic ossification was reported in any study. Among patients treated with a posterior-based approach, the most frequently reported complication was infection (2.50%), with lower rates of reoperation and postoperative pain. Patients with trimalleolar fractures experienced slightly poorer outcomes. Patients treated by posterior-based approaches had a significantly increased risk of infection (p = .010) relative to those treated by the lateral approach; patients treated by the lateral approach had a significantly increased risk of pain after surgery (p = .004) and symptomatic hardware (p = .007). This study brought together evidence that posterior-based surgical approaches and non-posterior-based approaches to ORIF are effective in healing malleolar fractures, with significant differences in specific postoperative complications that need to be further explored.

End of Life: A New Life Course Stage for Older Adults and Their Families?

Over the past two centuries, death has transitioned from an unexpected and uncontrollable event to a protracted process that requires individuals and families to make difficult decisions regarding where and under what conditions one will die. This new life course stage, spanning the period from diagnosis to death, provides older adults and their families an opportunity to prepare for difficult medical decisions, yet also may be a time marked by suffering and conflict. In this paper, I provide an overview of the technological, demographic, and legal context of end-of-life in the 21st century, and its implications for the quality of life for dying patients and their families. I underscore that historical shifts have created a context in which the quality of one’s end-of-life experiences and autonomy are stratified by race and socioeconomic status, creating challenges for older adults and their loved ones. I highlight implications for research, policy, and practice.

Responding to Reviewers

An invitation to “revise and resubmit” one’s manuscript, especially for a highly competitive journal, is an important achievement. However, it is not a guarantee that a revised manuscript will ultimately be accepted for publication. I will provide insights into what differentiates a “major” versus “minor” R&R invitation, will provide background on how editors and reviewers arrive at these decisions, and will provide detailed tips for crafting a revision memo and revised manuscript that has an excellent chance of being accepted for publication (while staying within a journal’s word count limits). I will also offer suggestions for navigating revisions when reviewers offer discrepant feedback, or make suggestions that may not ultimately enhance the quality or impact of the manuscript.

Racial Differences in the Impact of Subjective Life Expectancy on Advance Care Planning

The need for advance care planning (ACP) is heightened during the COVID-19 pandemic, especially for older Blacks and Latinx persons who are at a disproportionate risk of death from both infectious and chronic disease. A potentially important yet underexplored explanation for well-documented racial disparities in ACP is subjective life expectancy (SLE), which may impel or impede ACP. Using Health and Retirement Study data (n=7484), we examined the extent to which perceived chances of living another 10 years (100, 51-99, 50, 1-49, or 0 percent) predict three aspects of ACP (living will (LW), durable power of attorney for health care designations (DPAHC), and discussions). We use logistic regression models to predict the odds of each ACP behavior, adjusted for sociodemographic, health, and depressive symptoms. We found modest evidence that SLE predicts ACP behaviors. Persons who are 100% certain they will be alive in ten years are less likely (OR = .68 and .71, respectively) whereas those with pessimistic survival prospects are more likely (OR = 1.23 and 1.15, respectively) to have a LW and a DPAHC, relative to those with modest perceived survival. However, upon closer inspection, these patterns hold only for those whose LW specify aggressive measures versus no LW. We found no race differences for formal aspects of planning (LW, DPAHC) although we did detect differences for informal discussions. Blacks with pessimistic survival expectations are more likely to have discussions, whereas Latinos are less likely relative to whites. We discuss implications for policies and practices to increase ACP rates.

Do Perceptions of Own and Spouse Survival Affect Advance Care Planning?

COVID-19 has intensified the need for advance care planning (ACP), or formal preparations for end-of-life care, prior to the time such decisions are required. We propose that older adults’ perceived chances of survival, and one’s perceptions of whether they will outlive their spouse may be powerful motivators of ACP. Using data from the Wisconsin Longitudinal Study (WLS, n=4908, M age = 65), we examine the extent to which: (a) one’s perceived 10- and 20-year survival and (b) projections of dying before, after, or at the same time as one’s spouse affect three aspects of ACP (living will, durable power of attorney for health care designations (DPAHC), and discussions). Multivariate analyses are adjusted for health, demographics, socioeconomic characteristics, and death anxiety. In the full sample, women who perceived a high likelihood of 20-year survival were less likely (OR=.604, p < .05) whereas their male counterparts were more likely (OR = 1.4, p <.01) to name a DPAHC (relative to those who perceived a medium likelihood of survival). Among married persons only (n=3860), people who perceive that they will pre-decease their spouse are 1.5 times as likely to name their spouse as DPAHC (vs. no DPAHC), but are no more likely to name a different person to the role (relative to those who perceive that they and spouse will die at the same time). Practitioner and family conversations about older patients’ projected survival and how it shapes decision making are especially important as COVID-19 may require rapid decisions about end-of-life treatments.

Time Use and Experienced Wellbeing of Older Caregivers: A Sequence Analysis

BACKGROUND AND OBJECTIVES

The diminished wellbeing of caregivers is well documented, but studies typically draw upon coarse measures of time use and thus provide limited understanding of the role of specific care activities in the daily lives of care providers. This study uses time diary data to explore whether there are signature care patterns throughout the day and whether these care patterns have implications for caregivers' experienced wellbeing.

RESEARCH DESIGN AND METHODS

Using a national sample of 511 time diaries from older caregivers in the Disability and Use of Time supplement to the Panel Study of Income Dynamics, we examine minutes of care provided on the prior day, overall and for four broad care categories (household, personal care, transportation, and visiting), and patterns of care over the day, the latter based on sequence and cluster analysis.

RESULTS

Older caregivers spend on average 2.3 hr providing care to another adult on care days. Caregiving follows a roller-coaster pattern over the day, peaking at mealtimes. Sequence analysis suggests five distinctive caregiving patterns, which vary by both demographic characteristics of the caregiver (gender, work status) and care arrangement type (relationship to recipient, whether sole caregiver to recipient). The 40% who provide only marginal assistance of about 1 hr report lower experienced wellbeing than the 28% who provide sporadic assistance with a mix of activities for about 2 hr.

DISCUSSION AND IMPLICATIONS

A substantial share of older caregivers provides only 1 hr of assistance on a given day but appears to be at risk for reduced wellbeing. Better understanding of the reason for their marginal involvement and reduced wellbeing is warranted.

Insufficient Advance Care Planning? Correlates of Planning Without Personal Conversations

Objectives

Advance care planning (ACP) typically comprises formal preparations (i.e., living will and/or durable power of attorney for health care) and informal discussions with family members and health care providers. However, some people complete formal documents without discussing them with others. If they become incapacitated, their appointed decision makers may lack guidance on how to interpret or enact their formal wishes. We document the prevalence and correlates of this partial approach to ACP.

Method

Using multinomial logistic regression models and data from a U.S. sample of 4,836 older adults in the 2018 wave of the National Health and Aging Trends Study (NHATS), this brief report evaluated associations between social integration indicators and the odds of completing (a) both discussions and formal plans (two-pronged ACP), (b) discussions only, (c) no ACP, and (d) formal ACP only (reference category). We adjust for demographic and health characteristics established as correlates of ACP.

Results

A minority (15%) of NHATS participants reported formal plans without having discussed them. Indicators of social isolation (e.g., smaller social networks and fewer social activities) increased the odds of engaging in formal planning only compared to two-pronged ACP. Socioeconomic disadvantage and probable dementia reduced the odds of having end-of-life conversations, whether as one’s only preparation or in tandem with formal preparations.

Discussion

Socially isolated persons are especially likely to do formal planning only, which is considered less effective than two-pronged ACP. Health care professionals should recognize that older adults with few kin may require additional support and guidance when doing ACP.

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.

Terrestrial Toxicity of Synthetic Gas-to-Liquid versus Crude Oil-Derived Drilling Fluids in Soil

Unlike most other conventional petroleum products that are derived from crude oil, gas-to-liquids (GTLs) are petroleum products that are synthesized from natural gas (methane). This process results in GTL products having no sulfur and low aromatic content, so they should have less impact on human health and the environment compared with crude oil-derived products. The GTLs have been registered for use as nonaqueous base fluids (NABFs) in drilling muds, which aid in the process of drilling wells for oil and gas extraction; it is through these uses and others that they enter terrestrial environments. The primary objective of the present study was to determine whether GTLs were less toxic to terrestrial soil biota than conventional NABFs used for land-based drilling, such as diesel and low-toxicity mineral oil (LTMO). A second objective was to understand the fate and impact of these fluids under more realistic soil and aging conditions of a common west Texas (USA) oil-producing region (i.e., sandy loam soil with low organic matter and a hot arid climate). Acute terrestrial toxicity studies were conducted on the soft-bodied terrestrial invertebrate earthworm (Eisenia fetida) along with 3 plant species-alfalfa (Medicago stavia), thickspike wheatgrass (Elymus lanceolatus), and fourwing saltbrush (Atriplex canescens). We also assessed changes in microbial community structure of the soils following additions of NABF. Overall, the GTL NABFs had lower toxicity compared with conventional NABFs like diesel and LTMO, as measured by invertebrate toxicity, plant seed germination, and impact on the microbial community. Environ Toxicol Chem 2020;39:721-730. © 2020 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals, Inc. on behalf of SETAC.

Families in Later Life: A Decade in Review

Later-life families encompass the legal, biological, romantic, and kin-like relationships of persons ages 65 and older. Research on older families has flourished over the past decade, as population aging has intensified concerns regarding the capacities of families to care for older adults and the adequacy of public pension systems to provide an acceptable standard of living. Shifting patterns of family formation over the past half-century have created a context in which contemporary older adults' family lives differ markedly from earlier generations. Decreasing numbers of adults are growing old with their first and only spouse, with rising numbers divorcing, remarrying, forming non-marital romantic partnerships, or living single by choice. Remarriage and the formation of stepfamilies pose challenges and opportunities as older adults negotiate complex decisions such as inheritance and caregiving. Family relationships are consequential for older adults' well-being, operating through both biological and psychosocial mechanisms. We synthesize research from the past decade, revealing how innovations in data and methods have refined our understanding of late-life families against a backdrop of demographic change. We show how contemporary research refines classic theoretical frameworks and tests emerging conceptual models. We organize the article around two main types of family relationships: (1) marriage and romantic partnerships and (2) intergenerational relationships. We discuss how family caregiving occurs within these relationships, and offer three promising avenues for future research: ethnic minority and immigrant families; older adults without close kin ("elder orphans"); and the potentials of rapidly evolving technologies for intergenerational relationships and caregiving.

Mental health of older widows and widowers: Which coping strategies are most protective?

I examine: whether specific emotion-focused coping and help-seeking strategies adopted by older widow(er)s 6 months postloss affect depressive, anger, and yearning symptoms 1 year later; whether these effects are accounted for by psychosocial factors which guide the selection of coping strategies; and the extent to which patterns differ by gender. I estimate nested multivariate OLS regression models using data from the Changing Lives of Older Couples, a prospective multiwave survey of spousal bereavement (N = 164). Widows are more likely to use positive reframing, active distraction, help-seeking, and turning to God for strength, whereas widowers tend to use avoidant strategies, and are more likely to seek connection with their late spouse. Avoidant strategies like trying to forget and dulling the pain with alcohol increase depressive and anger symptoms; substance use is particularly consequential for men's anger symptoms. Positive reframing increases depressive symptoms yet mitigates against anger. Seeking comfort from God also protects against anger. Seeking help from a doctor increases anger and depressive symptoms in baseline models, although effects are accounted for by selection. Maladaptive coping strategies are linked with anger, whereas depression and yearning are relatively immune to coping strategies, reflecting the relatively short-lived time course of these two symptoms. The results carry implications for bereavement theories and mental health interventions targeting older widow(er)s. Older widowers who cope by turning to unhealthy behaviors are especially prone to anger, which has documented physical health effects and may alienate potential sources of social support.

HOW TO SUCCESSFULLY NAVIGATE A REVISE-AND-RESUBMIT DECISION AND HANDLE REJECTIONS

Anyone who has ever submitted a manuscript to a peer-review journal has experienced rejection. Rejection can be demoralizing, for emerging and senior scholars alike, but is especially so for those on the job market and tenure-track. This presentation will explain the manuscript review process and suggest strategies for addressing decisions that include: (1) rejection without peer review (desk reject); (2) revise and resubmit invitations; and (3) rejection after peer review. Fixable problems (e.g., editorial, conceptual, minor methodological issues) will be distinguished from non-fixable problems (e.g., small sample size, flawed design). Advice will focus on how to successfully revise and resubmit a manuscript; how to write an effective revision memo; how to develop a “plan B” for a rejected article; and how to manage the emotional sting of rejection.

CUMULATIVE DISADVANTAGE OF EARLY-LIFE ADVERSITY AND HEALTH IN MIDLIFE AND LATER ADULTHOOD

Cumulative dis/advantage (CDA) framework is one of the most influential theoretical frameworks in understanding how early adversity creates health disparities across adulthood. The CDA model posits that adverse experiences early in life may lead to subsequent adversities over time and accumulates across the life course. Various studies have shown that middle-aged and later adulthood are periods when accumulated disadvantages proliferate, resulting in heightened risks for an individual’s health and well-being. This symposium includes four presentations that build on such existing knowledge, and its primary aim was to further examine the complexity of how various types of adverse childhood experiences may influence physical and psychological health in middle and later adulthood. This symposium addresses a wide range of early adversities, including low socioeconomic status, parental maltreatment, and household dysfunctions. The four presentations also focus on examining various aspects of physical and psychological health outcomes in later adulthood, including measures of body mass index, physical functional ability, somatic symptoms, and clinical risk for rapid declines in kidney function. Furthermore, these presentations will demonstrate the utilization of innovative and robust methodological approaches, including latent class analysis, multilevel structural equation modeling, and latent growth modeling on examining the association between early life adversity on the long-term trajectory of change in health status using large-scale longitudinal data. Lastly, this symposium consists of an outstanding group of multidisciplinary presenters with diverse backgrounds who aim to enhance the understanding of the processes and mechanisms of CDA and how they affect individuals’ life courses.

ARE FAMILY RELATIONSHIPS A PROTECTIVE RESOURCE AMONG ADULTS WITH FUNCTIONAL IMPAIRMENT?

Health-related declines that affect physical functioning are a common stressor among older adults. Functional impairment can take a toll on older adults’ psychological well-being as it limits one’s capacities to independently carry out meaningful daily activities. The extent to which impairment affects mental health may vary based on the levels of support and strain in one’s personal relationships. Stress buffering perspectives suggest that support mitigates the detrimental psychological consequences of impairment, whereas stress amplification perspectives predict that strain will amplify these consequences. We use data from 2012 and 2016 waves of the Health and Retirement Study (N=3800) to explore: (a) the direct effects of functional limitation on depressive symptoms (CES-D); (b) the extent to which these associations are moderated by spouse, child, other relative, and friend support/strain; and (c) gender and marital status differences therein. Using lagged endogenous regression models, we find that impairment significantly increases depressive symptoms among men and women, and these effects are intensified by marital strain for both married men and women. However, buffering effects are found for women only, such that marital support mitigates against depressive symptoms in the face of current impairment. These results may reflect the gendered nature of marriage, where men with impairment uniformly benefit from marriage although women may experience protective effects of only in highly supportive unions. Results for other strain and support moderators also reveal gender differences, reflecting the distinctive ways that men and women interact with kin and friends over the life course.

IMPACT OF SOCIAL SUPPORT AND STRAIN ON DEPRESSIVE SYMPTOMS: MARITAL STATUS AND GENDER DIFFERENCES

Social relationships are a well-established correlate of late-life well-being. Extensive research finds social support is associated with fewer depressive symptoms, yet few studies distinguish fine-grained types of support from spouse, children, other family and friends, nor whether these linkages differ by gender and marital status. Studies exploring coarse associations between support and well-being may conceal gender and marital status differences. We use data from two waves of the Health and Retirement Study (HRS; 2006 and 2010) to study fine-grained linkages between diverse types of relationship strain and support and depressive symptoms (CESD) among adults aged 51+. The results show that the association between support/strain and depressive symptoms varies based on the source of support. For instance, among married/partnered older adults, spousal support is negatively associated with depressive symptoms whereas friend strain is positively associated with depressive symptoms. Among widowed respondents, friend support is negatively associated with depressive symptoms. These marital status patterns differed by gender however, such that the impact of friend strain on depressive symptoms was especially large for divorced men. Our results suggest that no single form of social support (or strain) is uniformly protective (or distressing), so services and interventions to enhance late-life mental health should more fully consider older adults’ social location, including gender and marital status. For current cohorts of older adults, who have lower rates of marriage and childbearing than their predecessors, it is critically important to understand both the levels and impacts of alternative sources of support from other kin and friends.

INCOMPLETE ADVANCE CARE PLANNING? CORRELATES OF PLANNING WITHOUT PERSONAL CONVERSATIONS

In the course of advance care planning (ACP), people may elect any of the following: a living will, a durable power of attorney for health care, and discussions with family members and health care providers. A small proportion of planners complete legal documents without discussing them with others (formal planning only, FPO). If people who have done FPO become incapacitated, their family and health care professionals may lack guidance on how to direct their care. To better understand this group, we drew on four large surveys of community-dwelling adults. Social isolation, measured by living alone and lack of a confidante, increased the odds of FPO across all studies. We also found some evidence that economic disadvantage and depressive symptoms were linked with FPO. We discuss implications for policy and practice, underscoring that ACP is yet another important domain affected by the crisis of social isolation in old age.

UNDERSTANDING THE ROLE OF STRESS PROCESSES IN CUMULATIVE DIS/ADVANTAGE PROCESSES

In my book Golden Years (2019), I argue that the psychosocial consequences of normal biological processes of aging are intensified for those who have had lives of disadvantage, just as the harmful consequences of life-course disadvantages are particularly acute for those experiencing age-related physical health declines. In this paper, I discuss the role of stress processes, including stress proliferation and amplification, as possible mechanisms contributing to cumulative dis/advantage. I evaluate these ideas empirically by focusing on the linkages between functional limitations (an indicator of normal biological aging) and psychological well-being in later life, and explore the extent to which these linkages are amplified diverse indicators of life course disadvantage including low education; poor-quality employment; avoidant coping strategies; and family-related strains including intensive caregiving. Analyses are based on data from the Midlife in the United States (MIDUS) study. I discuss the implications of incorporating stress process models in cumulative dis/advantage research.

THE JOURNAL OF GERONTOLOGY: SOCIAL SCIENCES: GLOBAL SCHOLARSHIP CHALLENGES AND OPPORTUNITIES

Journal of Gerontology: Social Sciences aims to publish the highest quality social scientific research on aging and the life course in the U.S. and worldwide. The disciplinary scope is broad, encompassing scholarship from demography, economics, psychology, public health, and sociology. A key substantive focus is identifying the social, economic, and cultural contexts that shape aging experiences worldwide. In the coming decade, social gerontology research is poised to present many opportunities for cross-national and cross-cultural scholarship – driven in part by the proliferation of large parallel data sets from many nations in Europe, Latin America, and Asia. I will discuss the role that peer-reviewed cross-national scholarship can play in disseminating knowledge that informs gerontological research, policy, and practice internationally. I will also identify under-researched areas that will be of great interest to scholars in the coming decade, including LGBT older adults, aging in the Global South, reconfigured families, and centenarians.

LONGITUDINAL MENTAL HEALTH CONSEQUENCES OF PHYSICAL DISABILITIES: THE MEDIATING ROLE OF PERCEIVED DISCRIMINATION

Individuals with disabilities have been historically mistreated by discrimination. The detrimental mental health effects of self-reported interpersonal discrimination are well established. However, little empirical attention has been given to the role of perceived discrimination in the adverse mental health outcomes of adults with physical disabilities. This study aims to examine whether daily interpersonal discrimination (i.e., microaggression) mediates the prospective association between having a functional impairment and subsequent changes in the individuals’ mental health outcomes over their midlife and old age. To address this question, this study used data from two waves of a population-based national study, the National Survey of Midlife Development in the United States, covering a 7- to 9-year period (n= 2,503; Mage at baseline = 57, SDage = 11). Physical disability or functional impairment was assessed with items adapted from the SF-36, capturing difficulty with nine activities of daily living. Having functional impairment at the baseline assessment was associated with increases in depressive symptoms and negative affect over the study period. Daily interpersonal discrimination partially mediated this longitudinal association, explaining 7.4% (for depressive symptoms) to 8.1% (for negative affect) of the total effects. Exposure to discrimination and its mental health consequences were also more pronounced at younger ages. Disability-related perceived discrimination is an under-recognized mechanism that is likely to contribute to mental health inequities in later life. Professionals in health and disability policy, research, and practice need to concentrate efforts on developing policy and programs that reduce discrimination experienced by US adults with disabilities.

BEREAVEMENT IN A FAMILY CONTEXT

Bereavement is an impactful, often difficult experience for individuals throughout the life course. Moreover, bereavement experiences inherently involve wider family networks: The death of a spouse is often also the death of a parent, grandparent, or sibling, as well. The present symposium investigates a variety of different family loss experiences that individuals are exposed to in adulthood and older age, and situates such bereavement in a larger family context. Stahl explores how daily routines and sleep patterns can be altered by spousal bereavement, and assesses an intervention designed to improve widowed older adults’ behaviors and, in turn, reduce their depressive symptomology. Kim and colleagues analyze the death of a parent in adulthood, examining the extent to which pre-loss relationship quality and relationship importance may predict post-loss symptoms of grief. Stokes and colleagues extend this intergenerational perspective, examining the death of a grandparent in adulthood, and whether adult grandchildren’s relationships with their middle-generation parents – bereaved adult children themselves – impact their experiences of grief after loss. Focus is also paid to the influence of gender across all three generations. Lastly, Donnelly explores the cumulative consequences of experiencing multiple family deaths throughout the life course for adults’ health trajectories. Together, these papers expand the scope of bereavement research to incorporate spousal, multigenerational, and cumulative loss experiences and their repercussions for midlife and older adults. As discussant, Carr will assess the contributions of these papers to theory and the literature, and highlight potential directions for future research concerning aging, families, and bereavement.

Perceived interpersonal and institutional discrimination among persons with disability in the U.S.: Do patterns differ by age?

RATIONALE

One-third of U.S. adults have an activity-limiting health condition and this proportion increases with age. However, it is unclear whether functional limitation renders one vulnerable to institutional and interpersonal discrimination, and whether this vulnerability differs over the life course. Stigma theories suggest disability would be more discrediting to younger persons relative to older adults, as it violates cultural norms and expectations regarding able-bodied working-age adults.

OBJECTIVE

We evaluate whether U.S. adults with functional impairment report higher levels of perceived interpersonal mistreatment and institutional discrimination relative to persons without impairment, and whether these patterns differ across age groups.

METHOD

We use data from the second wave of the National Survey of Midlife Development in the United States (MIDUS II), collected between 2004 and 2006 (n = 3931). We estimate OLS and logistic regression models to predict interpersonal and institutional discrimination, respectively.

RESULTS

Persons with impairment report more frequent encounters of disrespectful treatment, insults, and being treated as if they have a character flaw, and elevated odds of workplace- and service-related discrimination, net of sociodemographic, and physical and mental health characteristics. Effects are significantly larger among early (age 40-49) and late (age 50-64) midlife versus older (age 65+) adults.

CONCLUSIONS

We discuss implications for policy and practice, and underscore that stigmatization processes may further amplify health and socioeconomic disparities between those with versus without functional limitations.

Method for Recording Broadband High Resolution Emission Spectra of Laboratory Lightning Arcs

Lightning is one of the most common and destructive forces in nature and has long been studied using spectroscopic techniques, first with traditional camera film methods and then digital camera technology, from which several important characteristics have been derived. However, such work has always been limited due to the inherently random and non-repeatable nature of natural lightning events in the field. Recent developments in lightning test facilities now allow the reproducible generation of lightning arcs within controlled laboratory environments, providing a test bed for the development of new sensors and diagnostic techniques to understand lightning mechanisms better. One such technique is a spectroscopic system using digital camera technology capable of identifying the chemical elements with which the lightning arc interacts, with these data then being used to derive further characteristics. In this paper, the spectroscopic system is used to obtain the emission spectrum from a 100 kA peak, 100 µs duration lightning arc generated across a pair of hemispherical tungsten electrodes separated by a small air gap. To maintain a spectral resolution of less than 1 nm, several individual spectra were recorded across discrete wavelength ranges, averaged, stitched, and corrected to produce a final composite spectrum in the 450 nm (blue light) to 890 nm (near infrared light) range. Characteristic peaks within the data were then compared to an established publicly available database to identify the chemical element interactions. This method is readily applicable to a variety of other light emitting events, such as fast electrical discharges, partial discharges, and sparking in electrical equipment, apparatus, and systems.

Well-Being at the End of Life

This review proposes that the end of life is a uniquely contemporary life course stage. Epidemiologic, technological, and cultural shifts over the past two centuries have created a context in which dying has shifted from a sudden and unexpected event to a protracted, anticipated transition following an incurable chronic illness. The emergence of an end-of-life stage lasting for months or even years has heightened public interest in enhancing patient well-being, autonomy, and the receipt of medical care that accords with patient and family members' wishes. We describe key components of end-of-life well-being and highlight socioeconomic and race disparities therein, drawing on fundamental cause theory. We describe two practices that are critical to end-of-life well-being (advance care planning and hospice) and identify limitations that may undermine their effectiveness. We conclude with recommendations for future sociological research that could inform practices to enhance patient and family well-being at the end of life.

Do Family Relationships Buffer the Impact of Disability on Older Adults' Daily Mood? An Exploration of Gender and Marital Status Differences

OBJECTIVE

We evaluate whether non-spousal family support and strain moderate the effect of disability on two daily emotions (happiness and frustration) among older adults, and whether these patterns differ by gender among married persons, and by marital status among women.

BACKGROUND

Stress buffering perspectives predict that harmful effects of stress on well-being are buffered by family support, whereas stress proliferation models suggest these effects are intensified by family strain. The extent to which family relationships moderate associations between stress and well-being may vary on the basis of gender and marital status, as non-spousal family ties are considered especially salient for women and those without a romantic partner.

METHOD

Daily diary data are from the 2013 Disability and Use of Time supplement to the Panel Study of Income Dynamics (n=1,474), a national sample of adults ages 60+. Multivariate regression models are estimated for married/partnered men and women, and formerly married women.

RESULTS

Neither family support nor strain moderated the effect of severe impairment on married men's daily emotions. Family support buffered the effect of severe impairment on frustration among divorced and widowed women, but not their married counterparts. Counterintuitively, family arguments mitigated against frustration and increased happiness among married women with severe impairment.

CONCLUSION

Consistent with stress buffering perspectives, family support was most protective for the vulnerable population of formerly married older women with severe impairment.

IMPLICATIONS

This study underscores the importance of family support for the large and growing population of formerly married women managing health-related challenges in later life.