Moves to age-restricted housing and functional health trajectories among independent living older adults

Abstract Where independent living older adults live has been found to have strong links with disability. For example, older adults living in age-restricted housing contexts (e.g., retirement communities) have been found to have worse functional health compared to those living in non-age-restricted settings. Theories and empirical research demonstrate positive and negative aspects of living in age-restricted housing. Recent availability of population-level longitudinal data with sufficiently large samples has made examination of this heterogeneity possible. In this study we examine whether a move to age-restricted housing is associated with functional health trajectories and whether age at time of move moderates this link. We examine these questions using nine waves of longitudinal data from a representative sample of 8,687 U.S. adults age 65 and older from the National Health and Aging Trends Study. Spline-like growth curve models were estimated to determine the intercept, slope prior to move to age-restricted housing, and slope after the move. We also tested whether these processes are conditional on age at time of move. Results indicate that regardless of age all respondents experienced a decline in functional health following a move to age-restricted housing. However, there is variation in the steepness of this decline by age at time of the move. People who move to age-restricted housing earlier experience a less steep decline in functional health post-move compared to those who move later. Findings suggest moving to age-restricted housing earlier may enable older adults to utilize resources often available in these settings to prevent steep health declines.

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Tracking personalized functional health in older adults using geriatric assessments

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-01283-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Anup K. Mishra ◽

Marjorie Skubic ◽

Mihail Popescu ◽

Kari Lane ◽

Marilyn Rantz ◽

...

Keyword(s):

Older Adults ◽

Activities Of Daily Living ◽

Case Studies ◽

Daily Living ◽

Short Form ◽

Depression Scale ◽

Functional Health ◽

Adverse Health ◽

Health Trajectories ◽

Model Predictions

Abstract Background Higher levels of functional health in older adults leads to higher quality of life and improves the ability to age-in-place. Tracking functional health objectively could help clinicians to make decisions for interventions in case of health deterioration. Even though several geriatric assessments capture several aspects of functional health, there is limited research in longitudinally tracking personalized functional health of older adults using a combination of these assessments. Methods We used geriatric assessment data collected from 150 older adults to develop and validate a functional health prediction model based on risks associated with falls, hospitalizations, emergency visits, and death. We used mixed effects logistic regression to construct the model. The geriatric assessments included were Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Short Form 12 (SF12). Construct validators such as fall risks associated with model predictions, and case studies with functional health trajectories were used to validate the model. Results The model is shown to separate samples with and without adverse health event outcomes with an area under the receiver operating characteristic curve (AUC) of > 0.85. The model could predict emergency visit or hospitalization with an AUC of 0.72 (95% CI 0.65–0.79), fall with an AUC of 0.86 (95% CI 0.83–0.89), fall with hospitalization with an AUC of 0.89 (95% CI 0.85–0.92), and mortality with an AUC of 0.93 (95% CI 0.88–0.97). Multiple comparisons of means using Turkey HSD test show that model prediction means for samples with no adverse health events versus samples with fall, hospitalization, and death were statistically significant (p < 0.001). Case studies for individual residents using predicted functional health trajectories show that changes in model predictions over time correspond to critical health changes in older adults. Conclusions The personalized functional health tracking may provide clinicians with a longitudinal view of overall functional health in older adults to help address the early detection of deterioration trends and decide appropriate interventions. It can also help older adults and family members take proactive steps to improve functional health.

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Productive Activity Patterns and Functional Health: A Comparison of Urban and Rural Chinese Older Adults

The International Journal of Aging and Human Development ◽

10.1177/0091415019900168 ◽

2020 ◽

Vol 91 (4) ◽

pp. 538-562

Author(s):

Jiao Yu ◽

Yulin Yang ◽

Eva Kahana

Keyword(s):

Older Adults ◽

Latent Class ◽

Activity Patterns ◽

Productive Aging ◽

Functional Health ◽

Productive Activity ◽

Multilevel Regression ◽

Chinese Older Adults ◽

Health Trajectories ◽

Urban Rural

This study examines the association between productive activity patterns and functional health trajectories of Chinese older adults and whether this association varies by urban/rural residence. Using three waves of the China Health and Retirement Longitudinal Study from a sample of 7,503 older adults, we first performed latent class analysis (LCA) to identify productive activity patterns based on four activities (work, caregiving, informal help, and formal volunteering). Next, multilevel regression analyses were conducted to assess the association between the identified productive activity patterns and functional health trajectories among older adults. Four productive activity patterns are identified from LCA: nonengagers, working-caregivers, workers, and helpers. We find that participation in productive activities is associated with slower functional health decline. The moderation effects of urban/rural differences are prominent across identified groups. Our findings highlight the importance of the urban/rural context in understanding productive aging and its health consequences among Chinese older adults.

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HOUSING CONTEXT AND FUNCTIONAL HEALTH AMONG LOWER INCOME OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.3509 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S968-S968

Author(s):

Noah J Webster

Keyword(s):

Older Adults ◽

Assisted Living ◽

Independent Living ◽

Functional Health ◽

Assisted Living Facilities ◽

Lower Income ◽

Free Standing ◽

Senior Housing ◽

Multiunit Housing ◽

Nationally Representative

Abstract The characteristics of where older adults live have strong links with disability. Although lower income older adults experience disability at higher rates, less is known about the link between housing characteristics and functional health in this group. A within group comparison among this population is needed to understand how aspects of this vulnerable subgroup’s housing context are associated with health outcomes. The present study examines the association between housing and functional health among a U.S. nationally representative sample of independent living (i.e., not living in nursing homes or assisted living facilities) lower income adults age 65+. Using data from round one of the National Health and Aging Trends Study, a sub-sample of N=2,865 lower income (<$15,000 in the past year) older adults was selected for analysis. Regression analyses indicate that lower income older adults living in multiunit buildings reported better functional health compared to those in other housing contexts (e.g., free-standing homes). This link also significantly varied by age and gender. Living in multiunit housing was associated with better functional health among those age 90+, not associated among those age 80-90, and was negatively associated among those age 65-79. In terms of gender, the link between multiunit housing and better functional health was only significant among women. Findings highlight variation in health across lower income older adults’ housing contexts. Potential explanatory mechanisms (e.g., social isolation) will be discussed. Such information can inform senior housing policy regarding best approaches to providing housing for older adults that optimizes and promotes independent living.

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Rumination and Sleep Quality Among Older Adults:Examining the Role of Social Support

The Journals of Gerontology Series B ◽

10.1093/geronb/gbaa230 ◽

2020 ◽

Author(s):

Christina M Marini ◽

Stephanie J Wilson ◽

Suyoung Nah ◽

Lynn M Martire ◽

Martin J Sliwinski

Keyword(s):

Social Support ◽

Older Adults ◽

Sleep Quality ◽

Independent Living ◽

Protective Factor ◽

Multilevel Models ◽

Spousal Support ◽

Retirement Communities ◽

Negative Effects

Abstract Objectives Although the adverse link between rumination and sleep quality is well established, much of the literature neglects the role of social factors. This study examined the role of older adults’ perceived social support from spouses and from family/friends in modifying the association between trait rumination and sleep quality. Existing hypotheses suggest that social support may play three unique roles, each tested within the current study: (H1) support may act as a protective factor that buffers negative effects of rumination on sleep quality, (H2) support may curtail rumination and, in turn, promote sleep quality, and (H3) rumination may erode support and, in turn, undermine sleep quality. Method Data came from 86 partnered older adults in independent-living or retirement communities (Mage = 75.70 years). We utilized three waves of interview data collected annually between 2017 and 2019. The first hypothesis was tested using moderation in multilevel models; the second two hypotheses were evaluated with prospective associations using multilevel mediation. Results Negative effects of high-trait rumination on time-varying sleep quality were attenuated among those who reported high, stable levels of support from their spouses. Perceived family/friend support did not yield the same protective effect. There was no evidence that support preempted, or was eroded by, rumination. Discussion Perceived spousal support may act as a psychosocial resource that mitigates negative effects of trait rumination on older adults’ sleep quality. Interventions aimed at mitigating maladaptive outcomes of rumination on sleep quality for older adults should consider spousal support as a key target.

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Effectiveness of a community-wide intervention for population-level frailty and functional health in older adults: A 2-year cluster nonrandomized controlled trial

Preventive Medicine ◽

10.1016/j.ypmed.2021.106620 ◽

2021 ◽

pp. 106620

Author(s):

Satoshi Seino ◽

Yui Tomine ◽

Mariko Nishi ◽

Toshiki Hata ◽

Yoshinori Fujiwara ◽

...

Keyword(s):

Older Adults ◽

Controlled Trial ◽

Population Level ◽

Functional Health

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Intraindividual Variability in Late-Life Functional Limitations Among White, Black, and Hispanic Older Adults

Research on Aging ◽

10.1177/0164027516655583 ◽

2017 ◽

Vol 39 (4) ◽

pp. 549-572 ◽

Cited By ~ 5

Author(s):

Jielu Lin ◽

Jessica Kelley-Moore

Keyword(s):

Older Adults ◽

Physical Function ◽

Functional Limitations ◽

Ethnic Disparities ◽

Functional Health ◽

Intraindividual Variability ◽

Health Trajectories ◽

Racial Ethnic ◽

Retirement Study ◽

Average Health

Consistent with the weathering hypothesis, many studies have captured racial/ethnic disparities in average functional health trajectories. The same mechanisms of social inequality that contribute to worse average health among minority adults may also contribute to greater fluctuations in their physical function at upper ages. Using panel data from the Health and Retirement Study, we examine patterns of intraindividual variability over time in trajectories of functional limitations for White, Black, and Hispanic older adults. Intraindividual variability increases with age for both Whites and Blacks and such increase is greater for Blacks. Hispanics have the greatest intraindividual variability but there is no age-based pattern. Socioeconomic status and comorbidity are associated with intraindividual variability for all race/ethnicity yet do not explain the age-based increase in intraindividual variability for Whites or Blacks. The findings suggest further nuances to the weathering hypothesis—social disadvantage can generate instability in physical function as minority adults age.

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Discontinued Information and Communication Technology Usage among Older Adults in Continuing Care Retirement Communities in the United States

Gerontology ◽

10.1159/000482017 ◽

2017 ◽

Vol 64 (2) ◽

pp. 188-200 ◽

Cited By ~ 5

Author(s):

R.V. Rikard ◽

Ronald W. Berkowsky ◽

Shelia R. Cotten

Keyword(s):

Older Adults ◽

Health Information ◽

Independent Living ◽

General Information ◽

Retirement Communities ◽

Continuing Care ◽

Ict Use ◽

Continuing Care Retirement Communities ◽

Information And Communication ◽

Ict Training

Background: Older adults are increasingly using information and communication technologies (ICTs). Recent studies show beneficial effects of using ICTs for older adults, particularly in terms of reducing loneliness and depression. However, little is known about the factors that may prevent discontinued ICT use in populations that may be at greater risk, such as those in continuing care retirement communities (CCRCs). Objectives: The purpose of this study is to examine a range of factors that may influence discontinued (1) ICT use, (2) searching for health information, and (3) searching for general information over time among CCRC residents. Methods: We use longitudinal data from a randomized controlled trial conducted with residents of 19 CCRCs. We use flexible parametric models to estimate the hazard ratio or hazard rate over 5 waves of data to determine what factors significantly predict discontinued (1) ICT use, (2) health information searching, and (3) general information searching. Results: The analysis reveals that independent living residents who took part in an 8-week ICT training intervention were less likely to stop using ICTs. Age and the number of instrumental activities of daily living (IADL) impairments significantly predicted an increased likelihood of stopping ICT use. When examining specific ICT-related activities, the analysis reveals that independent living residents who took part in the ICT training intervention were less likely to stop searching for health information and general information online. In addition, age and the number of IADL impairments were associated with increased likelihood of discontinued health information searches and discontinued general information searches. Conclusion: ICT training interventions may motivate residents of CCRCs to stay connected by increasing the ICT skill level and promoting confidence, thus decreasing the probability that they will discontinue using ICTs and searching for general information. However, the effects of ICT training on motivating continued ICT usage may be more pronounced among independent living residents. Limitations in the number of IADL impairments is a key factor leading to discontinued use of ICTs among CCRC residents, suggesting that designers of ICTs should be cognizant of the cognitive and physical limitations among this group.

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Pandora's Box

BJPsych International ◽

10.1192/bji.2021.28 ◽

2021 ◽

Vol 18 (3) ◽

pp. 75-76

Keyword(s):

Longitudinal Data ◽

Perceived Stress ◽

Functional Health ◽

Chronological Age ◽

Buffer Effect ◽

Sociodemographic Variables ◽

Health Decline ◽

Steep Decline ◽

German Ageing Survey ◽

Stress Buffer

If you have started feeling your age or even older, stop right there! Feeling younger makes us feel better and healthier both physically and mentally; at least so say researchers from Germany. They examined longitudinal data collected over a period of three years (2014–2017) by the German Ageing Survey, with a mean age of 64 years (40–95). Controlling for baseline functional health and sociodemographic variables, they found that greater perceived stress was associated with a steeper decline in functional health, which increased with advancing chronological age. However, they also found that those who felt younger than their age showed a less steep decline in functional health and greater perceived stress was less strongly associated with functional health decline. Furthermore, they were less likely to feel stressed and this stress buffer effect was greater with increasing age.

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