Journal of Aging and Health recent issues

Visual Function and Cognitive Speed of Processing Mediate Age-Related Decline in Memory Span and Fluid Intelligence

2009-05-12

Objectives: To evaluate the relationship between sensory and cognitive decline, particularly with respect to speed of processing, memory span, and fluid intelligence. In addition, the common cause, sensory degradation and speed of processing hypotheses were compared. Method: Structural equation modeling was used to investigate the complex relationships among age-related decrements in these areas. Results: Cross-sectional data analyses included 842 older adult participants (M = 73 years). After accounting for age-related declines in vision and processing speed, the direct associations between age and memory span and between age and fluid intelligence were nonsignificant. Older age was associated with visual decline, which was associated with slower speed of processing, which in turn was associated with greater cognitive deficits. Discussion: The findings support both the sensory degradation and speed of processing accounts of age-related, cognitive decline. Furthermore, the findings highlight positive aspects of normal cognitive aging in that older age may not be associated with a loss of fluid intelligence if visual sensory functioning and processing speed can be maintained.

Medication Adherence in Healthy Elders: Small Cognitive Changes Make a Big Difference

Hayes, T. L., Larimer, N., Adami, A., Kaye, J. A. — 2009-05-12

Objective: This was a cross-sectional study of the ability of independently living healthy elders to follow a medication regimen. Participants were divided into a group with High Cognitive Function (HCF) or Low Cognitive Function (LCF) based on their scores on the ADAS-Cog. Method: Thirty-eight participants aged 65 or older and living independently in the community followed a twice-daily vitamin C regimen for 5 weeks. Adherence was measured using an electronic 7-day pillbox. Results: The LCF group had significantly poorer total adherence than the HCF group (LCF: 63.9 ± 11.2%, HCF: 86.8 ± 4.3%, t₃₆ = 2.57, p = .007), and there was a 4.1 relative risk of non-adherence in the LCF group as compared to the HCF group. Discussion: This study has important implications for the conduct of clinical drug trials, as it provides strong evidence that even very mild cognitive impairment in healthy elderly has a detrimental impact on medication adherence.

Sense of Mastery, Social Support, and Health in Elderly Canadians

Gadalla, T. M. — 2009-05-12

Objective: This study aims to examine the structural relationships among sense of mastery (SOM), income level, social support, physical health, and stress in older Canadians, while controlling for demographic characteristics. Method: This research uses data collected in the National Population Health Survey on Canadians aged 65 years and older (N = 1,399). Results: Higher income predicts better health and more social support, which, in turn, predicts higher SOM. The relationship between physical health and stress is fully mediated through SOM for both genders. The SOM fully mediates the relationship between social support and stress for men and partially mediates this relationship for women. Discussion: Findings confirm the importance of a network of social services targeting older persons with low income, diminished physical health, and/or those living alone.

Is Greater Self-Neglect Severity Associated With Lower Levels of Physical Function?

XinQi Dong, , Mendes de Leon, C. F., Evans, D. A. — 2009-05-12

Objective: This study examined the association between severity of self-neglect and physical function in a population of community-dwelling older adults. Method: Participants were older adults (N = 1,094) reported to the Chicago Department on Aging for suspected self-neglect from 1993 to 2005, who also participated in the Chicago Health Aging Project. The primary outcome of physical function was assessed using physical performance tests. Secondary outcomes were assessed using the Katz, Nagi, and Rosow-Breslau scales. Multiple regression models were used to assess these associations. Results: After adjusting for confounders, higher self-neglect severity scores were associated with lower physical performance testing (coefficient = —.062, p = .001). Greater self-neglect severity was also correlated with the reported number of impairments on the Katz, Nagi, and Rosow-Breslau scales (coefficients = .024, .024, and .016, respectively, p = .001). Discussion: Higher self-neglect severity is associated with lower levels of physical function among older adults.

The Use of Mobility Devices Among Institutionalized Older Adults

Clarke, P., Chan, P., Santaguida, P. L., Colantonio, A. — 2009-05-12

Objectives: The purpose of this article is to examine the demographic, health, and social characteristics of mobility device users in long-term care settings. Methods: Data were used from a recently institutionalized sample of older adults from the Canadian Study of Health and Aging. Multinomial logistic regression was used to examine the factors associated with the use of different mobility devices (cane, walker, or wheelchair). Results: Over 70% used mobility aids (over 50% used a wheelchair). Mobility limitations were strongly associated with the use of mobility devices. However, among those with mobility limitations, educational resources reduced the odds of wheelchair use. Conclusions: Consistent with findings from the community setting, need factors are strongly associated with the use of mobility aids in institutions. However, socioeconomic resources may provide older adults with alternate ways to manage mobility limitations in institutional settings.

Surrogate Decision Makers' Understanding of Dementia Patients' Prior Wishes for End-of-Life Care

2009-05-12

Objectives: This study examines how surrogate decision makers for dementia patients developed an understanding of patient preferences about end-of-life (EOL) care and patient wishes. Methods: Semistructured interviews were conducted with 34 surrogate decision makers for hospice-eligible nursing home patients with dementia. The data were content analyzed. Results: Most surrogates reported that patients had previously completed an advance directive (59%), discussed preferences for EOL care (56%), or done both (38%). Catalysts for and barriers to completing an advance directive or having EOL care discussions included factors that were both intrinsic and extrinsic to the patient. The most commonly reported wish for EOL care was to not be kept alive by "machines" or "extraordinary measures." Discussion: Health care providers may be able to assist patients and families by normalizing discussions of dying, encouraging advance care planning, helping them identify goals for EOL care, and providing information to support treatment decisions consistent with patients' wishes.

The Relationship of Neighborhood Climate to Perceived Social Support and Mental Health in Older Hispanic Immigrants in Miami, Florida

2009-03-24

Objective: This study examines the relationship of neighborhood climate (i.e., neighborhood social environment) to perceived social support and mental health outcomes in older Hispanic immigrants. Method: A population-based sample of 273 community-dwelling older Hispanic immigrants (aged 70 to 100) in Miami, Florida, completed self-report measures of neighborhood climate, social support, and psychological distress and performance-based measures of cognitive functioning. Structural equation modeling was used to model the relationship of neighborhood climate to elders' perceived social support and mental health outcomes (i.e., cognitive functioning, psychological distress). Results: Neighborhood climate had a significant direct relationship to cognitive functioning, after controlling for demographics. By contrast, neighborhood climate had a significant indirect relationship to psychological distress, through its relationship to perceived social support. Moreover, social support mediated the relationship between neighborhood climate and psychological distress. Discussion: Findings suggest that a more positive neighborhood social environment may be associated with better mental health outcomes in urban, older Hispanic immigrants.

Activity Restriction Related to Fear of Falling Among Older People in the Colombian Andes Mountains: Are Functional or Psychosocial Risk Factors More Important?

Curcio, C.-L., Gomez, F., Reyes-Ortiz, C. A. — 2009-03-24

Objective: This study examines the associations between activity restriction related to fear of falling and sociodemographic and health factors among people aged 60 and older living in the Colombian Andes mountains. Method: The sample includes 1,668 community-living participants. Outcomes included no fear of falling, fear of falling alone, or activity restriction related to fear of falling. Results: Fear of falling was reported by 83.3%, and of these 52.2% reported activity restriction. Independent factors for activity restriction (vs. fear of falling alone) were low income, functional difficulty, falling or decreasing physical activity, polypharmacy, poor self-perceived health, and depression. Discussion: The prevalence of overall fear of falling and related activity restriction was surprisingly high because this is a physically active population. Participants with activity restriction related to fear of falling have decreased physical activity or functional status, poor self-perceived health, and worse depressive symptoms than those who have fear of falling alone.

Impact of a Community-Based Falls Prevention Program on Maintenance of Physical Activity Among Older Adults

2009-03-24

Objective: This study examines the 9-month impact of a 12-week falls prevention program (called Stand Up!) which included balance exercises and educational components on maintenance of physical activity among community-dwelling seniors. Method: Data were collected among 98 experimental and 102 control participants at baseline, immediately after the program and 9 months later. Involvement in physical activity was measured with three indicators. Program effects were examined using linear and logistic regression procedures. Results: Both groups showed similar increases in weekly frequency of exercise at the 9-month posttest. However, the program's participants showed higher increases in their variety of exercises at the 9-month posttest (especially among those with greater baseline scores). Among seniors reporting lower levels of energy expenditure at baseline, the program's participants showed significantly greater increases in energy expenditure than control participants. Discussion: These preliminary findings suggest that programs such as Stand Up! have the potential to stimulate continued involvement in physical activity.

Perceived Problems With Access to Medical Care and Depression Among Older Puerto Ricans, Dominicans, Other Hispanics, and a Comparison Group of Non-Hispanic Whites

Rodriguez-Galan, M. B., Falcon, L. M. — 2009-03-24

The relationship between problems accessing medical care and depression is examined in a sample of older Hispanics (Puerto Rican, Dominican, and Other Hispanic) in Massachusetts and a comparison group of same-neighborhood non-Hispanic Whites. The research questions are: Do older Hispanics experience more problems with access to medical care than do older non-Hispanic Whites? What types of access problems do Hispanics encounter, and how do these relate to depression symptoms? The data come from the Massachusetts Hispanic Elders Study; descriptive and multivariate regression analysis procedures are used. Older Hispanics report more problems obtaining medical care than do older non-Hispanic Whites. Puerto Ricans report significantly more transportation problems to access medical care. For Dominicans and Puerto Ricans, being female, living alone, and lower education attainment are associated with depression. For Puerto Ricans, health problems, disability, and access problems are also significant.

Strength Training Preserves the Bone Mineral Density of Postmenopausal Women Without Hormone Replacement Therapy

Bocalini, D. S., Serra, A. J., dos Santos, L., Murad, N., Levy, R. F. — 2009-03-24

Objective: The study was designed to evaluate the effects of strength training (ST) on the bone mineral density (BMD) of postmenopausal women without hormone replacement therapy. Method: Subjects were randomized into untrained (UN) or trained (TR) groups. The TR group exercised three ST sessions per week for 24 weeks, and body composition, muscular strength, and BMD of the lumbar spine and femur neck were evaluated. Results: Body weight, mass index, and fat percentage were lower after 24 weeks only in the TR group (p < .05). SR also improved the one repetition maximum test in 46% and 39% of upper and lower limbs, respectively. The percentage of demineralization was higher in the UN group than in the TR group at the lumbar spine and femoral neck (p < .05). Discussion: Results indicated that 24 weeks of ST improved body composition parameters, increased muscular strength, and preserved BMD in postmenopausal women.

Caregiving Tasks and Training Interest of Family Caregivers of Medically Ill Homebound Older Adults

Wilkins, V. M., Bruce, M. L., Sirey, J. A. — 2009-03-24

Objectives: This study assessed the caregiving activities and training interests of family caregivers of medically ill older adults without dementia who receive home health care. Methods: Participants were 101 family caregivers of patients from the Training in the Assessment of Depression (TRIAD) study. Caregivers were assessed using a sociodemographic questionnaire and measures of caregiver tasks and training interest. Results: Family caregivers provided a variety of caregiving tasks and their interest in training was independent of current provision of tasks. Black caregivers expressed greater overall interest in receiving training than did White caregivers, as did younger caregivers compared to same-generation caregivers. Discussion: Family caregivers in this study evidenced both a range of care provision and clear interest in improving caregiving skills through training. Research efforts should focus on meeting the specific training needs of family caregivers and determining the impact training can have on patient health outcomes.

Acknowledgments

2009-03-24

Three-Year Measured Weight Change in the African American Health Study

2009-02-09

Objective: This study examines 3-year weight change in African Americans. Method: Nine hundred and ninety-eight participants 49 to 65 years old were assessed at baseline and 3 years later. Weight was measured, and weight change was defined as clinically meaningful increases or decreases (± 5 kg). Potential risk factors were investigated using multinomial logistic regression. Results: In-home measured weights were available for 752 participants (75%): 504 (67%) had stable weights, 131 (17%) gained more than 5 kg, and 117 (16%) lost more than 5 kg. Among all participants, the risks for weight gains were cancer, chronic obstructive pulmonary disease, lower income, and Medicaid status; the risks for weight losses were angina, cancer, high measured systolic blood pressure, asthma, and physical inactivity. Sex-stratified analyses reveal differences involving age, socioeconomic status, cancer, blood pressure, and lower body function. Discussion: Three-year weight changes in middle-aged African Americans were frequent and significantly associated with several risk factors.

Contribution of Residential Relocation and Lifestyle to the Structure of Health Trajectories

Hong, S.-I., Chen, L.-M. — 2009-02-09

Objectives: Underlining ecological theories of aging, we assessed the impact of relocation, residential type, and individual lifestyle factors on the structure of health status overtime. Methods: From the data of Longitudinal Study on Aging II, we included older adults aged 70 and older (N = 5,294). To analyze individual longitudinal trajectories of health outcomes, Latent Growth Curve Modeling (LGCM) was employed. Results: LGCMs supported that older adults' residential relocation and health-related lifestyles were important in preserving better health outcomes. Multiple structural equations corroborated the causal chains in the multidimensionality of health structure. Discussion: These findings suggest a necessity to design policies for older adults to create a synergy between housing and health care and to translate meaningful health-related lifestyles into diverse long-term care settings.

Trends in Disability-Free Life Expectancy Among Chinese Older Adults

Jufen Liu, , Gong Chen, , Xinming Song, , Chi, I., Xiaoying Zheng, — 2009-02-09

Objectives: This study evaluates trends in disability-free life expectancy (DFLE) of Chinese adults aged 60 and older. Methods: Based on two national disability surveys in 1987 and 2006 as well as mortality data from World Population Prospects, the Sullivan method was used to calculate DFLE. Results: DFLE increased from 13.0 to 13.9 years at age 60 and from 1.2 to 1.5 years at age 90 in1987 and 2006, respectively. The proportion of DFLE increased after age 75. The proportion of DLE_x with severe disability decreased while that of least disability increased. Onset of disability was delayed from 0.3 years to 4.7 years across disability types. Conclusions: Trends in DFLE by age and severity of disability as well as the delayed onset of disability provide evidence for the compression of morbidity among the oldest old in China. But a similar trend was not found among the young-old.

Sharing the Good, Sharing the Bad: The Benefits of Emotional Self-Disclosure Among Middle-Aged and Older Adults

Magai, C., Consedine, N. S., Fiori, K. L., King, A. R. — 2009-02-09

Objective: The present study was designed to assess the impact of experimentally manipulating positive and negative self-disclosure on three domains of well-being among healthy middle-aged and older adults: emotional, psychological, and physical. Method: Using a modified self-disclosure paradigm for sad, mixed (sad and happy), and neutral content, the authors examine changes in depressive symptomatology, stress, sad and happy mood, and self-reported health across 4 weeks in a sample (N = 200) of African American and European American men and women (age M = 54 years). Results: Consistent with research on younger groups, health symptomatology declined over time (irrespective of condition). However, although African Americans reported reductions in stress and depressive symptomatology in the sad condition, European Americans experienced similar reductions only in the neutral condition. Discussion: Results are discussed in terms of applications of the self-disclosure paradigm to developmentally and ethnically diverse groups.

The Effects of Socioeconomic Status on Participation in Care Among Middle-Aged and Older Adults

Wiltshire, J. C., Roberts, V., Brown, R., Sarto, G. E. — 2009-02-09

Objective: This study assesses the effects of socioeconomic status (education and poverty) on seeking health information and subsequent use of this information during the medical encounter. Method: Data on 19,944 adults (aged 45 and older) were drawn from the 2000-2001 Household Component of the Community Tracking Study, a nationally representative survey of non-institutionalized individuals. Results: Higher levels of education were associated with a greater likelihood of seeking health information and mentioning information to physicians. The poor and near poor were less likely to seek health information, but only the near poor were significantly less likely to mention information to the physician. Discussion: These findings underscore the importance of education in the acquisition and use of health information among middle-aged and older adults.

Health-Related Quality of Life in Community-Dwelling Older Whites and African Americans

Yuri Jang, , Chiriboga, D. A., Borenstein, A. R., Small, B. J., Mortimer, J. A. — 2009-02-09

Objective: This study assesses structural and functional characteristics of Short Form-36 Health Survey (SF-36) domains using community-based samples of older Whites and African Americans. Although the eight domains of the SF-36 have by convention been collapsed into two summary categories— physical health and mental health—the authors examine a three-factor model including physical health, mental health, and general well-being. They hypothesized that the general well-being factor would be a mediator between physical and mental health in both groups. Method: Analyses using structural equation modeling provide support for the approach. Results: In both White and African American samples, the three-factor model demonstrated a better fit than the two-factor model. Also, in both groups, general well-being mediated the relationship between physical health and mental health. Discussion: Findings suggest that general well-being serves as an intervening step between physical and mental health in both White and African American older adults.

Protecting Personhood and Achieving Quality of Life for Older Adults With Dementia in the U.S. Health Care System

Murray, L. M., Boyd, S. — 2009-02-09

Objective: As the numbers of persons diagnosed with Alzheimer's disease and related dementias increase, many questions arise pertaining to the quality of life of those diagnosed and the health care system as it relates to the provision of quality care for this population. This article examines the health disparities among older adults with dementia, emphasizing the protection of personhood and quality of life, along with a review of the barriers to health care access and utilization of persons living with dementia. Method: This literature review utilized electronic databases and other documents. Results: The findings suggest that while progress has been realized toward protecting personhood and achieving an improved quality of life among older adults with dementia in the U.S. health care system challenges still exist. Discussion: The implications of current and future public policy, avenues for further research, and strategies by which the health care community may better serve persons with dementia are outlined.

Making Meaningful Connections: A Profile of Social Isolation and Health Among Older Adults in Small Town and Small City, British Columbia

Kobayashi, K. M., Cloutier-Fisher, D., Roth, M. — 2009-02-09

Objective: The objectives of the study are: (a) to develop a profile of socially isolated older adults (SIOA) in British Columbia (BC) based on sociodemographic and health characteristics and (b) to examine whether SIOA under-or overutilize health care services. Method: This study uses telephone interview data collected from a random sample of 1,064 older adults (65+) in BC. The sample was identified using established criteria from the six-item Lubben Social Network Scale. Results: The results indicate that 17% of the sample is socially isolated. To summarize, the strongest predictors of social isolation are income, gender, marital status, self-rated health, length of residence, and home ownership. Further analysis indicates that SIOA were not more inclined to overuse health services. Discussion: The findings underscore the importance of understanding differential profiles of need and service use for SIOA within broader social contexts, and are discussed in terms of their implications for health care policy and program planning for this vulnerable population.

Increased Mortality Risk in Older Adults With Persistently Low or Declining Feelings of Usefulness to Others

2009-02-09

Objective: This study seeks to determine if persistently low or declining feelings of usefulness to others in later life predict increased mortality hazard in older adults. Method: Data on change in perceptions of usefulness, health, behavioral and psychosocial covariates, and mortality originate from the MacArthur Study of Successful Aging, a prospective study of 1,189 older adults (aged 70 to 79). Results: Older adults with persistently low feelings of usefulness or who experienced a decline to low feelings of usefulness during the first 3 years of the study experienced a greater hazard of mortality (sociodemographic adjusted hazard ratio = 1.75; 95% confidence interval = 1.22, 2.51) during a subsequent 9-year follow-up as compared to older adults with persistently high feelings of usefulness. Discussion: Older adults with persistently low perceived usefulness or feelings of usefulness that decline to a low level may be a vulnerable group with increased risk for poor health outcomes in later life.

Race and Health Disparities Among Seniors in Urban Areas in Brazil

Trujillo, A. J., Vernon, J. A., Rodriguez Wong, L., Angeles, G. — 2009-01-14

Objectives: This article examines racial health disparities among the elderly in Sao Paulo, Brazil. It also explores whether these disparities differ among income groups. Methods: The study follows the conceptual framework developed by LaVeist (1994). A multistage analysis and Oaxaca-Blinder decomposition are used to explore the sources of racial disparities in health. Results: White seniors report better health than Black seniors. This is the case even after controlling for baseline health conditions and several demographic, socioeconomic, and family support characteristics. Discussion: This article suggests that the two most important factors driving racial disparities in health among seniors are historical differences in rural living conditions and current income. Present economic conditions are more relevant to racial disparities among poor than among rich seniors. Racial differences in health not attributable to observable characteristics are more important when comparing individuals in the upper half of the income distribution.

Chinese Health Beliefs of Older Chinese in Canada

Lai, D. W. L., Surood, S. — 2009-01-14

Objectives: This study examines the cultural health beliefs held by older Chinese in Canada. Methods: Chinese surnames are randomly selected from the local Chinese telephone directories. Telephone screening is then conducted to identify eligible Chinese people 55 years of age or older to take part in a face-to-face interview to complete a structured survey questionnaire. Results: The results of exploratory factor analysis indicate that the health beliefs of the older Chinese are loaded onto three factors related to beliefs about traditional health practices, beliefs about traditional Chinese medicine, and beliefs about preventive diet. Education, religion, country of origin, length of residency in Canada, and city of residency are the major correlates of the various Chinese health beliefs scales. Discussion: The findings support the previous prescriptive knowledge about Chinese health beliefs and illustrate the intragroup sociocultural diversity that health practitioners should acknowledge in their practice.

Church-Based Volunteering, Providing Informal Support at Church, and Self-Rated Health in Late Life

Krause, N. — 2009-01-14

Objective: To assess the relationships among volunteer work at church, providing informal support to fellow church members, religious commitment, and change in self-rated health over time. Method: Data are obtained from a nationwide longitudinal sample of 681 older adults. The study participants are aged 66 years or older at the baseline interview. The between-round interval was 6 years. Results: The findings suggest that providing informal tangible support to fellow church members is associated with better health but only for study participants who were more deeply committed to their faith. In contrast, a comparable interaction effect between volunteer work at church and religious commitment do not emerge from the data. Discussion: Although older people may assist others in different ways within the church, the informal assistance they provide to coreligionists appears to be more strongly associated with health when they are more deeply committed to their faith.

Factors Affecting Frontline Workers' Satisfaction With Supervision

Noelker, L. S., Ejaz, F. K., Menne, H. L., Bagaka's, J. G. — 2009-01-14

Objective: This research was guided by a stress and support model to examine the effects of frontline workers' background characteristics, personal stressors, job-related stressors, and workplace support on satisfaction with supervision. Method: Survey data were collected from 644 workers in 49 long-term—care settings that employed them. Regression analysis were used to determine the effects of worker level and then Hierarchical Linear Modeling (HLM) and organizational factors on the outcome. Results: Although all four variable categories made significant contributions to explaining satisfaction with supervision, the most powerful were personal stressors and job-related stressors. Results from HLM analysis showed frontline workers in nursing homes and those employed in for-profit organizations had lower levels of satisfaction with supervision. Discussion: Findings suggest organizational interventions to address workers' financial and health issues and management practices such as better training programs and peer mentoring could enhance workers' satisfaction with supervision.

Self-Silencing and Age as Risk Factors for Sexually Acquired HIV in Midlife and Older Women

Jacobs, R. J., Thomlison, B. — 2009-01-14

Objectives: This study explores the contribution of psychosocial factors on sex behaviors of midlife and older women. Methods: A community-based sample of ethnically diverse women (N = 572) between the ages of 50 and 93 completed standardized measures of self-silencing, self-esteem, sensation-seeking behavior, HIV-related stigma behavior, sexual assertiveness, and safer sex behaviors. Results : Results from the regression analysis indicated the model significantly predicted safer sex behaviors (p < .001), with self-silencing (β = —.115, p < .05) and age (β = .173, p < .001) as significant predictors. Bivariate correlation analysis indicated an inverse correlation between HIV stigma (p < .05) and safer sex behaviors. Discussion: Implications for further study and practice are discussed to include considerations for development of age- and gender-appropriate prevention interventions assisting women with interpersonal processes combined with skills for active involvement in addressing high-risk sex behaviors.

Network Bridging Potential in Later Life: Life-Course Experiences and Social Network Position

Cornwell, B. — 2009-01-14

Objectives: Much work in social gerontology has examined older adults' social connectedness, but we know little about the extent to which older adults occupy positions of power and independence in their networks. The author uses health and life-course frameworks to understand older adults' prospects of occupying bridging positions between otherwise unconnected individuals. Methods: Egocentric social network data were collected from a nationally representative sample of 3,005 older adults between the ages of 57 and 85 in 2005-2006. A series of multivariate regression analyses was used to examine how health and life-course factors relate to bridging. Results: Age is not significantly associated with bridging. However, retirees and people with poor health are less likely to have bridging potential. At the same time, widows are more likely to serve as bridges. Discussion: The discusses the need for more dialogue between social network researchers and social gerontologists to help explain older adults' bridging prospects.

Neighborhood Social Cohesion and Disorder in Relation to Walking in Community-Dwelling Older Adults: A Multilevel Analysis

2009-01-14

Objectives: To examine the role of neighborhood social conditions and walking in community-dwelling older adults. Methods: A multi-level analysis of data from 4,317 older adults (mean age = 74.5; 73% black) from a geographically-defined urban community. Participants completed structured interviews including 14 questions on neighborhood conditions and self-reported walking. The neighborhood questions were summarized into individual-level measures of perceived neighborhood social cohesion and disorder. These measures were aggregated by neighborhood to construct neighborhood-level measures of social cohesion and disorder. Results: Neighborhood-level disorder, but not social cohesion, was significantly associated with walking, independent individual-level neighborhood perceptions and other correlates of walking. Further adjustment for race weakened this association to a marginally significant level. Discussion: Neighborhood conditions may shape walking behavior in older adults, especially conditions that reflect physical neglect or social threat. Promotion of walking behavior in older adults may require improvement of the safety and upkeep of the neighborhood environment.

Assisted Living Pilot Program: Background, Methods, and Facility Characteristics

2009-01-14

Objectives: The Department of Veterans Affairs (VA) funded assisted living (AL), adult family home (AFH), and residential care for the first time in the Assisted Living Pilot Program (ALPP). This article describes the background and methods of the ALPP evaluation and the characteristics and experiences of the facilities. Method: Facility data were collected from the contracting/inspection process and a survey of ALPP facilities and those contacted but not participating in ALPP. Results: Data on 131 participating facilities are presented: 41 AFHs, 47 assisted living facilities (ALFs), and 43 residential care facilities (RCFs). The average facility had 33 beds (about one quarter Medicaid beds), for-profit ownership, and private rooms for ALPP residents, and about half had private baths. About two thirds of ALPP AFH providers spoke a primary language other than English. Discussion: Findings indicate that a wide range of community facilities were willing to provide care to residents with heterogeneous needs on VA funding.

Assisted Living Pilot Program: Health Outcomes

2009-01-14

Objectives: Assisted living programs demonstrate variation in structure and services. The Department of Veterans Affairs funded this care for the first time in the Assisted Living Pilot Program (ALPP). This article presents resident health outcomes and the relationship between facility characteristics and outcomes. Method: This article presents results on 393 ALPP residents followed for 12 months after admission to 95 facilities. Results: A total of 19.8% residents died, and the average activities of daily living impairment did not change significantly. Half of the residents remained in an ALPP facility, with the average resident spending 315 days in the community during the 12-month follow-up period. This article found a limited number of characteristics of structure and staffing to be significantly associated with outcomes. Discussion: If differences among facility characteristics are not clearly related to differences in outcomes, then choices among type of setting can be based on the match of needs to available services, location, or preferences.

Assisted Living Pilot Program: Utilization and Cost Findings

2009-01-14

Objective: The Department of Veterans Affairs funded assisted living, adult family home, and adult residential care for the first time in the Assisted Living Pilot Program (ALPP). This article compares the use and cost for individuals that entered ALPP and a comparison group. Method: This was a nonrandomized study. The comparison group consisted of VA patients who were eligible but did not enter an ALPP facility. The ALPP (n = 393) and comparison (n = 259) groups were followed for 12 months to assess ALPP facility, case management, and health care costs. Results: ALPP facility and ALPP case management costs were respectively $5,560 and $2,830 per individual. Total health care costs, including ALPP costs, were $11,533 higher for the ALPP group compared to the comparison group after adjusting for baseline differences. Discussion: Although ALPP successfully helped individuals transition to longer term care in these facilities, it was more costly than the comparison group.