scholarly journals Reduced access to care among older American adults during CoVID-19 pandemic: results from a prospective cohort study

2020 ◽  
Author(s):  
Ashis Kumar Das ◽  
Devi Kalyan Mishra ◽  
Saji Saraswathy Gopalan
Keyword(s):  
Older Adults ◽  
Social Security ◽  
Access To Care ◽  
Daily Living ◽  
Routine Care ◽  
Current Evidence ◽  
Multivariable Logistic Regression Model ◽  
Social Security Benefits ◽  
Retirement Study ◽  
Preexisting Conditions

AbstractBackgroundDue to preexisting conditions, older adults are at higher risk of COVID-19 related severe complications. Current evidence is limited on access to care for older adults during the COVID-19 pandemic.ObjectivesTo examine the extent of reduced access to care among older American adults during the COVID-19 pandemic, identify predictors and reasons of reduced access.Materials and methodsUsing publicly available data from the COVID-19 module (interim release) of the Health and Retirement Study, we undertook descriptive analyses of older adults stratified by sex, age group, race, education, marital status, employment, receipt of social security benefits, health insurance, number of limitations in activities of daily living and pre-existing conditions. Associations between reduced access to care and predictors were estimated using a multivariable logistic regression model.ResultsAbout 30% of respondents delayed or avoided care during the pandemic. Reduced access was more likely to be reported by respondents that were female, younger, educated, not receiving social security benefits, with limitations in daily activities and three preexisting conditions. In terms of the reasons, the majority of the respondents (45.9%) reported that their visit was either cancelled or rescheduled by the provider; 13.9% thought they could wait, 10.9% could not get an appointment, 9.1% found it unaffordable, and 7.4% were afraid to visit the provider. Respondents reported of reduced access to doctor’s visits, surgery, prescription filling, and dental care.ConclusionsWe suggest urgent attention on improving access to care for older adults during the pandemic. For nonemergency conditions and routine care that can be delivered virtually, telehealth services can be strengthened. Additionally, health messaging can reemphasize that neglecting medical care might lead to increased morbidity and mortality among older adults from preexisting illnesses.

scholarly journals Reduced access to care among older American adults during CoVID-19 pandemic: Results from a prospective cohort study

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Ashis Kumar Das ◽  
◽  
Devi Kalyan Mishra ◽  
Saji Saraswathy Gopalan ◽  
◽  
...  
Keyword(s):  
Older Adults ◽  
Access To Care ◽  
Logistic Regression Model ◽  
Routine Care ◽  
Morbidity And Mortality ◽  
Daily Activities ◽  
Health And Retirement Study ◽  
Multivariable Logistic Regression Model ◽  
Social Security Benefits ◽  
Retirement Study

Background: Reduced access to routine care can lead to higher morbidity and mortality among older adults. We assessed the extent of reduced access to care among older American adults during the COVID-19 pandemic, identified predictors and reasons for reduced access. Materials and methods: Using publicly available data from the COVID-19 module (interim release) of the Health and Retirement Study, we undertook descriptive analyses of older adults stratified by socio-demographic characteristics. Associations between reduced access to care and predictors were estimated using a multivariable logistic regression model. Results: 30.2% of respondents delayed or avoided care during the pandemic. Reduced access was more likely to be reported by respondents that were female, younger, educated, not receiving social security benefits, with limitations in daily activities and three preexisting conditions. In terms of the reasons, the majority of the respondents (45.9%) reported that their visit was either cancelled or rescheduled by the provider; 13.9% thought they could wait, 10.9% could not get an appointment, 9.1% found it unaffordable, and 7.4% were afraid to visit the provider. Respondents reported of reduced access to doctor’s visits, surgery, prescription filling, and dental care. Conclusions: We suggest urgent attention on improving access to care for older adults during the pandemic. For nonemergency conditions and routine care that can be delivered virtually, telehealth services can be strengthened. Additionally, health messaging can reemphasize that neglecting medical care might lead to increased morbidity and mortality among older adults from preexisting illnesses. Keywords: Older adults; Access to care; COVID-19; Health and retirement study

In Debt and Approaching Retirement: Claim Social Security or Work Longer?

2018 ◽  
Vol 108 ◽  
pp. 401-406 ◽  
Author(s):  
Barbara A. Butrica ◽  
Nadia S. Karamcheva
Keyword(s):  
Older Adults ◽  
Social Security ◽  
Labor Force ◽  
Social Security Benefit ◽  
Older Americans ◽  
The Past ◽  
Using Data ◽  
Social Security Benefits ◽  
To Receive ◽  
Retirement Study

Over the past couple of decades, older Americans have become considerably more leveraged. This paper considers whether household debt affects the timing of retirement and Social Security benefit claiming. Using data from the Health and Retirement Study, we find that older adults with debt are more likely to work and less likely to receive Social Security benefits than those who are debt-free. Indebted adults are also more likely to delay fully retiring from the labor force and claiming their benefits. Among the sources of debt, mortgages have a stronger impact on older adults' behavior than do other sources of debt.

scholarly journals Older peoples' willingness to delay social security claiming

2020 ◽  
pp. 1-16
Author(s):  
Raimond Maurer ◽  
Olivia S. Mitchell
Keyword(s):  
Social Security ◽  
Older Persons ◽  
Current System ◽  
Work Requirement ◽  
Lump Sum ◽  
Average Household Income ◽  
Time Work ◽  
Part Time ◽  
Social Security Benefits ◽  
Retirement Study

Abstract We have designed and implemented an experimental module in the 2014 Health and Retirement Study to measure older persons' willingness to defer claiming of Social Security benefits. Under the current system’ status quo where delaying claiming boosts eventual benefits, we show that 46% of the respondents would delay claiming and work longer. If respondents were instead offered an actuarially fair lump sum payment instead of higher lifelong benefits, about 56% indicate they would delay claiming. Without a work requirement, the average amount needed to induce delayed claiming is only $60,400, while when part-time work is stipulated, the amount is slightly higher, $66,700. This small difference implies a low utility value of leisure foregone, of under 20% of average household income.

scholarly journals A Friend in Need? Exploring the Influence of Disease and Disability Onset on the Number of Close Friends Among Older Adults

2019 ◽  
Vol 74 (8) ◽  
pp. e119-e124 ◽  
Author(s):  
Kenzie Latham-Mintus
Keyword(s):  
Older Adults ◽  
Heart Disease ◽  
Panel Data ◽  
Daily Living ◽  
Change Score ◽  
Network Activation ◽  
Life Threatening ◽  
Lagged Dependent Variable ◽  
Using Data ◽  
Retirement Study

Abstract Objectives This research examines whether onset of life-threatening disease (i.e., cancer, lung disease, heart disease, or stroke) or activities of daily living disability influences the reported number of close friends. Method Using data from the Health and Retirement Study (HRS; 2006–2012), this research capitalizes on panel data to assess changes in number of close friends over a 4-year period. Lagged dependent variable (LDV) and change score (CS) approaches were used. Results Both the LDV and CS models provide evidence that onset of life-threatening disease was associated with reporting more friends 4 years later. In particular, onset of cancer was associated with reporting more close friends. Discussion This research provides evidence of the network activation hypothesis following onset of life-threatening disease among older adults.

scholarly journals Association of Frailty With Recovery From Disability Among Community-Dwelling Older Adults: Results From Two Large U.S. Cohorts

2018 ◽  
Vol 74 (4) ◽  
pp. 575-581 ◽  
Author(s):  
Chenkai Wu ◽  
Dae H Kim ◽  
Qian-Li Xue ◽  
David S H Lee ◽  
Ravi Varadhan ◽  
...  
Keyword(s):  
Older Adults ◽  
Daily Living ◽  
Cardiovascular Health ◽  
Community Dwelling ◽  
Health Study ◽  
Cardiovascular Health Study ◽  
Factors Affecting ◽  
Frailty Assessment ◽  
Community Dwelling Older Adults ◽  
Retirement Study

Abstract Background Disability in activities of daily living (ADLs) is a dynamic process and transitions among different disability states are common. However, little is known about factors affecting recovery from disability. We examined the association between frailty and recovery from disability among nondisabled community-dwelling elders. Methods We studied 1,023 adults from the Cardiovascular Health Study (CHS) and 685 adults from the Health and Retirement Study (HRS), who were ≥65 years and had incident disability, defined as having difficulty in ≥1 ADL (dressing, eating, toileting, bathing, transferring, walking across a room). Disability recovery was defined as having no difficulty in any ADLs. Frailty was assessed by slowness, weakness, exhaustion, inactivity, and shrinking. Persons were classified as “nonfrail” (0 criteria), “prefrail” (1–2 criteria), or “frail” (3–5 criteria). Results In total, 539 (52.7%) CHS participants recovered from disability within 1 year. Almost two-thirds of nonfrail persons recovered, while less than two-fifths of the frail recovered. In the HRS, 234 (34.2%) participants recovered from disability within 2 years. Approximately half of the nonfrail recovered, while less than one-fifth of the frail recovered. After adjustment, prefrail and frail CHS participants were 16% and 36% less likely to recover than the nonfrail, respectively. In the HRS, frail persons had a 41% lower likelihood of recovery than the nonfrail. Conclusions Frailty is an independent predictor of poor recovery from disability among nondisabled older adults. These findings validate frailty as a marker of decreased resilience and may offer opportunities for individualized interventions and geriatric care based on frailty assessment.

Integrating geriatric assessment into routine gastrointestinal (GI) consultation: The Cancer and Aging Resilience Evaluation (CARE).

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 667-667 ◽  
Author(s):  
Grant Richard Williams ◽  
Kelly Kenzik ◽  
Mariel Parman ◽  
Gabrielle Betty Rocque ◽  
Andrew Michael McDonald ◽  
...  
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Geriatric Assessment ◽  
Daily Living ◽  
Performance Status ◽  
Stage Iv ◽  
Routine Care ◽  
Aging Research ◽  
Patient Reported ◽  
Tumor Types

667 Background: Integrating Geriatric Assessment (GA) in the management of older adults with cancer is recommended, yet rarely practiced in routine oncologic care. In this report, we describe the feasibility of integrating the routine incorporation of GA in the management of older adults with GI malignancies and characterize GA impairments. Methods: CARE was adapted from the Cancer and Aging Research Group GA with modifications to create a completely patient-reported version. The CARE assesses self-reported functional status, physical function, nutrition, social support, anxiety/depression, cognitive function, comorbidities, and social activities. Patients ≥ 60yo referred for consultation to the GI Oncology clinic were asked to complete the CARE (paper/pencil) on their first visit. The completed CARE was collected during nurse triage and submitted to the clinical team prior to the physician encounter. Feasibility was defined as completion of the CARE by ≥ 80% of eligible patients during the initial consultation. Results: Between September 2017 and August 2018, 199 eligible new patients attended the GI Oncology Clinic, 192 (96.5%) were approached, and 181 (90.4%) completed the CARE. Most patients (79.6%) felt the length of time to complete was appropriate (median time of 10 minutes [IQR 10-15 minutes]). The mean age was 70y (range 60-96), 54.3% were male, and 75.1% were non-Hispanic white. Common tumor types included colon (27.8%), pancreatic (21.2%), and rectal (10.2%) cancer; predominately advanced stage diseases (stage III: 26.9%; stage IV: 40.0%). GA impairments were prevalent: 48.6% reported dependence in Instrumental Activities of Daily Living, 18.0% reported dependence in Activities of Daily Living, 22.5% reported ≥ 1 fall, 29.4% reported a performance status ≥ 2, 51.3% were limited in walking one block, 75.7% reported polypharmacy (≥ 4 medications), and 84.3% had ≥ 1 comorbidity. Conclusions: Performing a GA in the routine care of older adults with GI malignancies is feasible, and GA impairments are common among older adults with GI malignancies. A fully patient-reported GA such as the CARE may facilitate broader incorporation of GA in the routine clinic work flow.

Late Career Job Loss and Retirement Behavior of Couples

2016 ◽  
Vol 39 (1) ◽  
pp. 7-28 ◽  
Author(s):  
Ajin Lee
Keyword(s):  
Social Security ◽  
Job Loss ◽  
Health And Retirement Study ◽  
Budget Constraints ◽  
Unexpected Earnings ◽  
Retirement Behavior ◽  
Using Data ◽  
Social Security Benefits ◽  
The Impact ◽  
Retirement Study

This article argues that wealth uncertainty influences when couples choose to retire. Using data from the Health and Retirement Study, I show that wives delay retirement when their husbands retire following a job loss. This effect is stronger when husbands are the primary earners, and couples are relatively poorer. This provides evidence of intra-household insurance that mitigates the impact of an unexpected earnings shock. I find that wives tend to delay retirement only until they become eligible for social security. This suggests that social security benefits can relax households’ budget constraints and allow wives to join their husbands in retirement.

Aging With Disability for Midlife and Older Adults

2017 ◽  
Vol 39 (6) ◽  
pp. 741-777 ◽  
Author(s):  
Lois M. Verbrugge ◽  
Kenzie Latham ◽  
Philippa J. Clarke
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Study Data ◽  
The Other ◽  
Personal Care ◽  
Household Management ◽  
Physical Limitations ◽  
Persistent Disability ◽  
Retirement Study

This analysis brings “aging with disability” into middle and older ages. We study U.S. adults ages 51+ and ages 65+ with persistent disability (physical, household management, personal care; physical limitations, instrumental activities of daily living [IADLs], activities of daily living [ADLs]), using Health and Retirement Study data. Two complementary approaches are used to identify persons with persistent disability, one based directly on observed data and the other on latent classes. Both approaches show that persistent disability is more common for persons ages 65+ than ages 51+ and more common for physical limitations than IADLs and ADLs. People with persistent disability have social and health disadvantages compared to people with other longitudinal experiences. The analysis integrates two research avenues, aging with disability and disability trajectories. It gives empirical heft to government efforts to make aging with disability an age-free (all ages) rather than age-targeted (children and youths) perspective.

scholarly journals From Snapshots to Movies: The Association Between Retirement Sequences and Aging Trajectories in Limitations to Perform Activities of Daily Living

2018 ◽  
Vol 31 (2) ◽  
pp. 293-321 ◽  
Author(s):  
Ariel Azar ◽  
Ursula M. Staudinger ◽  
Andrea Slachevsky ◽  
Ignacio Madero-Cabib ◽  
Esteban Calvo
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Labor Force ◽  
Daily Living ◽  
Full Time ◽  
Conventional Model ◽  
Older Americans ◽  
Part Time ◽  
Matching Models ◽  
Retirement Study

Objective: This study analyzes the dynamic association between retirement sequences and activities of daily living (ADLs) trajectories between ages 60 and 70. Method: Retirement sequences previously established for 7,880 older Americans from the Health and Retirement Study were used in hierarchical linear and propensity score full matching models, analyzing their association with ADL trajectories. Results: Sequences of partial retirement from full- or part-time jobs showed higher baseline and slower decline in ADL than sequences characterized by early labor force disengagement. Discussion: The conventional model in which people completely retire from a full-time job at normative ages and the widely promoted new conventional model of late retirement are both associated with better functioning than early labor force disengagement. But unconventional models, where older adults keep partially engaged with the labor force are also significantly associated with better functioning. These findings call attention to more research on potential avenues to simultaneously promote productive engagement and health later in life.

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