Journal of Aging and Health recent issues

Family Caregivers' Strains: Comparative Analysis of Cancer Caregiving With Dementia, Diabetes, and Frail Elderly Caregiving

Kim, Y., Schulz, R. — 2008-07-14

Objectives: This study aimed to investigate the impact of cancer from family caregivers' perspective, based on a comparative analysis of caregiving burden and distress, among four types of caregivers. Methods: The sample included caregivers of persons with cancer, dementia, diabetes, or frail elderly from a nationally representative sample of 606 caregivers. Results: Although the four different types of caregivers were comparable in most sociodemographic characteristics, caregiving involvement and caregiving outcomes differed among the caregiving groups. Both cancer and dementia caregivers reported greater levels of physical burden and psychological distress than other caregivers, after controlling for sociodemographic and caregiving involvement (i.e., level of burden and caregiving duration) factors. Discussion: The comparative analysis provided a systematic review of cancer caregiving in the context of three other types of caregiving. Given the high levels of burden and distress, greater emphasis should be placed on developing social service policy and practice for cancer caregivers.

The Association Between Low Vision and Function

Berger, S., Porell, F. — 2008-07-14

Objective: This study considers the relationship between low vision and function, specifically exploring whether vision loss is differentially associated with activities of daily living (ADL) versus instrumental activities of daily living (IADL) disability. Methods: Guided by the World Health Organization's International Classification of Functioning, Disability, and Health framework, multinomial logistic regression analyses were performed for IADL and ADL on a sample of 9,115 adults aged 65 years and above from the 1998 Health and Retirement study. Results: The data supports the fact that ADL and IADL disabilities are associated with vision loss, and there is a differential relationship among functions, with IADLs being more challenging and requiring better visual abilities. Discussion: The findings provide evidence that ADL and IADLs require different skills and are associated differently depending on numerous variables. As the incidence of people living with vision loss is increasing to epidemic proportions due to an aging population, understanding the relationship between vision and participation in meaningful activities has important implications.

Personality and Defense Mechanisms in Late Adulthood

Yong Yu, , Chamorro-Premuzic, T., Honjo, S. — 2008-07-14

Objective: Current understanding of the use of psychological defense mechanisms (DMs) in older adults is limited. This study set out to examine individual differences in DMs and Cloninger's biosocial model of personality in two age groups (50—64, 65—93), as well as their influence on health. Methods: A Japanese community sample (N = 330) completed the Temperament and Character Inventory (TCI-125), the Defense Style Questionnaire (DSQ-40), and the General Health Questionnaire (GHQ-28). Results: Across age groups, psychological well-being was related to lower levels of harm avoidance and higher levels of self-directedness. In addition, older age was related to decreases in reward dependence, cooperativeness, and increases in self-transcendence, DMs of isolation, denial, and splitting. Discussion: An Age x Gender interaction revealed that men and women varied in their pattern of age differences for some specific DMs. Results further suggest that image-distortion defense may function to compensate resource loss.

Religion, Risk, and Medical Decision Making at the End of Life

Van Ness, P. H., Towle, V. R., O'Leary, J. R., Fried, T. R. — 2008-07-14

Objectives: The purpose of this study is to present empirical evidence about whether religious patients are more or less willing to undergo the risks associated with potentially life-sustaining treatment. Methods: At least every 4 months 226 older community-dwelling persons with advanced cancer, congestive heart failure, or chronic obstructive pulmonary disease were asked questions about several dimensions of religiousness and about their willingness to accept potentially life-sustaining treatment. Results: Results were mixed but persons who said that during their illness they grew closer to God (odds ratio [OR] = 1.79; 95% confidence intervals [CI] = 1.15, 2.78) or those grew spiritually (OR = 1.61; 95% CI = 1.03, 2.52) were more willing to accept risk associated with potentially life-sustaining treatment than were persons who did not report such growth. Discussion: Not all dimensions of religiousness have the same association with willingness to undergo potentially life-sustaining treatment. Seriously ill older, religious patients are not especially predisposed to avoid risk and resist treatment.

Parent Caregiving Choices of Middle-Generation Blacks and Whites in the United States

White-Means, S. I., Rubin, R. M. — 2008-07-14

Objective: This study compares how middle-generation caregivers and non-caregivers differ by race and explores racial differences in activities of daily living (ADL), instrumental activities of daily living (IADL), and financial assistance that middle-generation caregivers provide for their parents. Method: Using 2000 Health and Retirement Study data, racially stratified descriptive analyses and logistic regression models for ADL, IADL, and financial assistance are presented. Results: Parental need and race influence support, with similar patterns of Black and White ADL support, but racial differences in IADL and financial support. Having more children motivates Whites to increase IADL support and reduce financial support; more children decreases Blacks' IADL support. Sibling caregiver networks influence IADL and financial support in ways that vary by race. The number employed is a key determinant for Blacks for all support, but only influences White ADL support. Discussion: The findings of this article indicate the importance of sample stratification by race and that employment or other subsidies may aid the expansion of caregiving by middle-generation adults.

Content of Advance Directives for Individuals With Advanced Dementia

2008-07-14

Objectives: To examine how people with end-stage dementia have conveyed their wishes for end-of-life care in advance directives. Method: The documents of 123 residents of three Maryland nursing homes, all with end-stage dementia, were reviewed. Results: More years of education and White race were significantly associated with having an advance directive. With the exceptions of comfort care and pain treatment, advance directives were used primarily to restrict, not request, many forms of care at the end of life. Decisions about care for end-stage conditions such as Alzheimer's dementia are less often addressed in these documents than for terminal conditions and persistent vegetative state. Discussion: For advance directives to better reflect a person's wishes, discussions with individuals and families about advance directives should include a range of care issues in the settings of terminal illness, persistent vegetative state or end-stage illness. These documents should be reviewed periodically to make certain that they convey accurately the person's treatment preferences.

Impact of Functional Limitations and Medical Comorbidity on Subsequent Weight Changes and Increased Depressive Symptoms in Older Adults

2008-04-30

Objectives: The primary goal of this study was to determine the effect of the onset of major medical comorbidity and functional decline on subsequent weight change and increased depressive symptoms. Methods: The sample included a prospective cohort of 53 to 63 year olds (n = 10,150) enrolled in the Health and Retirement Study. Separate lagged covariate models for men and women were used to study the impact of functional decline and medical comorbidity on subsequent increases in depressive symptoms and weight change 2 years later. Results: Functional decline and medical comorbidity were individual predictors of subsequent weight changes but not increased depressive symptoms. Most specific incident medical comorbidities or subtypes of functional decline predicted weight changes in both directions. Discussion: The elevated risk of weight gain subsequent to functional decline or onset of medical comorbidities may require the receipt of preventive measures to reduce further weight-related complications.

Disability Trends in Hong Kong Community-Dwelling Chinese Older Adults: 1996, 2000, and 2004

Chou, K.-L., Leung, J. C. B. — 2008-04-30

Objective: This article examines the trends of disability in six activities of daily living (ADLs) among Hong Kong community-dwelling older adults during the period from 1996 to 2004 by using three independent cross-sectional surveys of representative samples. Method: Logistic regression was performed to assess the association between the year of survey and the presence of any ADL limitation with a wide range of covariates. Results: We found that older adults in 2004 were more likely to report ADL disability than their counterparts in 1996, and the results would remain valid after considering the prevalence of ADL disability in nursing home residents. In addition, we found that age, education, the use of proxy, and the presence of six medical conditions were significantly related to ADL limitation. Discussion: In general, public health efforts to prevent ADL limitation should be supported to reduce the demand for long-term care services in the coming decades.

Urinary Incontinence and Self-Reported Health Among the U.S. Medicare Managed Care Beneficiaries

Chang, C.-H., Gonzalez, C. M., Lau, D. T., Sier, H. C. — 2008-04-30

Objectives: To examine the prevalence and management of urinary incontinence (UI) and their impact on self-reported health in the U.S. Medicare managed care beneficiaries. Methods: Data were from the 2003 Medicare Health Outcomes Survey Cohort VI Baseline. Only beneficiaries aged 65 years or older and who self-completed the telephone interview were included. Results: About 37% of the study sample (N = 82,196) reported having accidental urine leakage (the UI group). A total of 75% of the UI group indicated UI's being a problem and 41% of them had spoken with a doctor about it. Of these, 50% had received treatment. The findings indicate the UI group generally had significantly worse SF-36 Survey Scale scores than the non-UI group with and without adjusting other covariates. Discussion: UI is prevalent but undertreated as it adversely affects many health domains in this population. This study highlights the need for early detection, proper education, and access to effective treatment options for UI in the elderly.

Evaluating the SF-36 Health Survey (Version 2) in Older Vietnamese Americans

Ngo-Metzger, Q., Sorkin, D. H., Mangione, C. M., Gandek, B., Hays, R. D. — 2008-04-30

Objectives: The SF-36^® Health Survey (Version 2; SF-36) was evaluated among older Vietnamese Americans to determine whether underlying dimensions of physical and mental health were similar to those of other groups in the United States. Method: Field testing of participants from senior centers. Results: The study provided support for the reliability and validity of the SF-36. Structural equation modeling provided confirmation of physical and mental health factors. However, the factor loadings for the SF-36 scales were more consistent with previous results from Asian countries than the typical pattern observed in the United States. Discussion: As the older populations in the United States become more diverse, it is important to have standardized health-related quality of life measures. However, the conceptualization of physical and mental health and associations among different scales may be different for Asian immigrants than for other groups. Thus, the interpretation of the SF-36 scores needs to account for cultural differences.

In the Company of Wolves: The Physical, Social, and Psychological Benefits of Dog Ownership

Knight, S., Edwards, V. — 2008-04-30

Objectives: The increase in aging populations has implications for the provision of health and social services. A preventative approach is taken to address this problem by examining a mechanism that can enhance physical health and reduce minor ailments. Methods: Participants in 10 focus groups discussed physical, psychological, and social benefits associated with human—dog interactions. Methods provided a rich database of individual perspectives on dogs as motivators to a healthy lifestyle. Results: Interaction between humans and dogs is a mechanism that can enhance the physical and psychological health of elderly citizens and promote a social support network between dog owners. In turn, dependence and impact on health and social services are alleviated. Discussion: The social and community consequences of promoting dog ownership in the elderly are addressed, and it is concluded that the benefits of dog ownership should be promoted among the elderly and acknowledged by relevant agencies.

Educational Differentials in Life Expectancy With Cognitive Impairment Among the Elderly in the United States

Lievre, A., Alley, D., Crimmins, E. M. — 2008-04-30

Objective: This article provides estimates of education differentials in life expectancy with and without cognitive impairment for the noninstitutionalized population aged 70 years and older in the United States. Method: Life expectancy with cognitive impairment was calculated using multistate models, allowing transitions between cognitively intact and cognitively impaired states and from each of these states to death and allowing transition rates to vary across age and education. Four waves of the Assets and Health Dynamics of the Oldest Old survey were used. Results: Those with low levels of education are more likely to become cognitively impaired and do so at an earlier age. After age 70, persons with low educational levels can expect to live 11.6 years, and persons with high education 14.1 years, without cognitive impairment. Length of life with cognitive impairment differs by education (1.6 years and 1.0 years at age 70, respectively) but differs little by age. Discussion: Although those with higher education have lower rates of both cognitive impairment and mortality, those who do become cognitively impaired appear to be in poorer health, leading to a reduced probability of improved cognition and increased probability of mortality relative to those with lower educational levels.

Going Outdoors Daily Predicts Long-Term Functional and Health Benefits Among Ambulatory Older People

2008-03-10

Objective: This article examines the association between frequency of going out of the house and health and functional status among older people. Method: A randomly chosen cohort of ambulatory participants born in 1920 or 1921 from the Jerusalem Longitudinal Study underwent assessments for health, functional, and psychosocial variables at ages 70 and 77. Twelve-year mortality data were collected. Results: Women went out daily less than did men. Participants going out daily at age 70 reported significantly fewer new complaints at age 77 of musculoskeletal pain, sleep problems, urinary incontinence, and decline in activities of daily living (ADLs). Logistic regression analysis indicated that not going out daily at age 70 was predictive of subsequent dependence in ADL, poor self-rated health, and urinary incontinence at age 77. Discussion: Going out daily is beneficial among independent older people, correlating with reduced functional decline and improved health measures.

Education and Psychological Distress Among Older Chinese

Ross, C. E., Wei Zhang, — 2008-03-10

Objectives: The goal of this research is to see if more highly educated older Chinese have lower levels of distress than do their poorly educated counterparts and whether engaging in cognitively stimulating activities such as reading and playing mahjong explains the association. Method and Results: Using the Chinese Healthy Longevity Survey, the authors find a significant negative association between education and psychological distress. Much of the association is mediated by activities, but not all in the ways expected. Reading, playing mahjong, and watching television all negatively correlate with distress. Discussion: Better-educated older Chinese have lower levels of distress than do their less-well-educated counterparts in part because they engage in cognitively stimulating activities, have better economic circumstances, and engage in more physical activity.

Religion: A Sociocultural Predictor of Health Behaviors in Mexico

Benjamins, M. R., Buck, A. C. — 2008-03-10

Objective: Tobacco, alcohol, and physical inactivity are now among the top 10 risk factors for mortality in the Americas region. Subsequently, a more complete understanding of the various cultural factors that influence health behaviors such as these is needed. Method: This study investigates how religion influences the use of alcohol and cigarettes within a large, nationally representative sample of older adults in Mexico (Mexican Health and Aging Study, N = 10,399). Results: Religious salience and participation in religious activities are both significantly associated with smoking status, but not alcohol use. Discussion: This is one of the first studies to examine these associations in a developing country. Despite cultural differences, the negative relationship between religion and smoking in Mexico corresponds to associations seen in the United States and other Western countries. This type of information may be useful to health researchers, providers, and policy makers attempting to reduce deaths due to preventable causes.

Effects of Own and Spousal Disability on Loneliness Among Older Adults

Korporaal, M., Broese van Groenou, M. I., van Tilburg, T. G. — 2008-03-10

Objectives: This study examines the effects of own and spousal disability on social and emotional loneliness among married adults aged 65 and older. Method: Data from 710 men and 379 women of a Dutch community sample were analyzed with linear regression analyses. Results: For men, only their wives' disability was related to higher levels of social loneliness, whereas for women mainly their own disability was related to higher levels of social loneliness. Own disability and spousal disability were related to higher levels of emotional loneliness among both men and women. Effects of disability remained unaffected after controlling for characteristics of the social network and the marital relationship. Discussion: Findings underscore the importance of considering effects of both spouses' health on measures of individual well-being. Also, the traditional division of social roles makes older married men relatively vulnerable to social loneliness when their wives suffer from disability.

Racial and Ethnic Variations in Caregiver Service Use

Scharlach, A. E., Giunta, N., Chow, J. C.-C., Lehning, A. — 2008-03-10

Objectives: This article examines whether race and ethnicity contribute to the differential use of caregiver support services, when controlling for caregiver and care recipient characteristics, as represented by predisposing, enabling, and need factors included in the Behavioral Model of Health Services Use. Methods: The study includes 1,508 individuals who provide care to an ill or disabled adult aged 50 or older, identified through a random digit dial telephone survey of California households. Logistic regression analysis is utilized to examine factors that predict use of caregiver support services. Results: Race and ethnicity do not contribute significantly to caregiver service utilization, when controlling for relevant covarying factors such as age, education, emotional support, family contribution, care recipient service use, and care recipient impairment. A significant interaction exists between ethnicity and family closeness, with reduced rates of service use among Asian and Pacific Island caregivers whose families are brought closer by the caregiving experience. Discussion: These findings suggest that racial and ethnic disparities in caregiver service use found at the bivariate level are attributable to covarying predisposing, enabling, and need factors. Further research and theoretical development are suggested to clarify the impact of sociocultural factors on caregiver service use.

Life Course Socioeconomic Disadvantage and Cognitive Function Among the Elderly Population of Seven Capitals in Latin America and the Caribbean

Cat Tuong Nguyen, , Couture, M.-C., Alvarado, B. E., Zunzunegui, M.-V. — 2008-03-10

Objectives: To examine the influence of life course socioeconomic disadvantages (SED) on cognitive function in later life. Method: Data originate from a survey of people 60 and older living in seven Latin American and Caribbean cities. Cognitive function was measured with a modified Mini-Mental State Examination and the Pfeffer Scale of Functional Capacity. Homogeneity tests were used to pool data. Associations between cognitive function and SED were evaluated, fitting logistic regressions. Results: Cognitive impairment (CI) prevalence ranged from 0.3% to 6.5% in men and 1.2% to 10.1% in women. Childhood rural living, poor childhood health, illiteracy, housewife or farmer occupation, and insufficient income were associated with CI in all seven cities. The odds of CI increase with cumulative exposure to disadvantages along life course. Conclusions: Life course SED is related to cognitive function later in life. Difficulty in properly distinguishing cognitive function from test performance remains an issue.

Self-Rated Health: Changes, Trajectories, and Their Antecedents Among African Americans

2008-02-20

Objective: Little is known about changes in self-rated health (SRH) among African Americans. Method: We examined SRH changes and trajectories among 998 African Americans 49 to 65 years old who we reinterviewed annually for 4 years, using multinomial logistic regression and mixed effect models. Results: Fifty-five percent had the same SRH at baseline and 4 years later, 25% improved, and 20% declined. Over time, men were more likely to report lower SRH levels, individuals with hypertension were less likely to report lower SRH levels, and those with congestive heart failure at baseline were more likely to report higher SRH levels. Lower SRH trajectory intercepts were observed for those with lower socioeconomic status, poorer health habits, disease history, and worse functional status. Those with better cognitive status had higher SRH trajectory intercepts. Discussion: The decline in SRH levels among 49- to 65-year-old African Americans is comparable to that of Whites.

The Evolution of Unintentional Injury Mortality Among Elderly in Europe

2008-02-20

Objectives: To compare cause-specific unintentional injury mortality trends among elderly (65+) in the European Union over a 10-year period. Method: Overall and cause-specific data for 23 out of the 29 EU and European Free Trade Association countries with population ≥ 1,000,000 were retrieved from the World Health Organization (WHO), and age-standardized mortality rates for the first and last 3 available years of the study period were calculated. Proportional mortality changes were estimated through linear regression. Results: Circa 1993, country-specific rates varied widely (>fourfold), but this gap is closing and a statistically significant downward trend in overall mortality is noted circa 2002, in about half of the countries. Rates from falls were reduced by 4.3%, from motor vehicle traffic by 3.1%, and from smoke, fire, and flames by 3.1%. Discussion: A large proportion of EU countries enjoys steady declining trends by major unintentional injury mortality category. Success factors and barriers underlying these benchmarking patterns should be further explored to accelerate the process of injury reduction.

Testing Measurement Reliability in Older Populations: Methods for Informed Discrimination in Instrument Selection and Application

Van Ness, P. H., Towle, V. R., Juthani-Mehta, M. — 2008-02-20

Objective: The authors recommend confidence intervals as measures of precision for reliability coefficients, regression modeling as supplements for such omnibus reliability statistics, and unreliability detection as a goal of reliability testing distinct from reliability inference. Methods: Illustrative reliability analyses are conducted on measures selected from a study of clinical features associated with urinary tract infection in older nursing home residents. Results: Standard methods for reliability testing (e.g., kappa coefficients) are often inappropriate for small samples, and exact methods or descriptive reliability statistics are viable alternatives. Discussion: Supplementation of omnibus statistics by loglinear regression modeling is especially appropriate for aging research because it facilitates tests of marginal homogeneity and comparisons of reliability results for relatively young and old subgroups. Latent class regression analysis is useful for older samples because multifactorial health conditions are often measured in multiple ways and assessment of their reliability can be integrated, granting certain assumptions, with validity assessment.

Self-Care and Professionally Guided Care in Osteoarthritis: Racial Differences in a Population-Based Sample

Albert, S. M., Musa, D., Kwoh, C. K., Hanlon, J. T., Silverman, M. — 2008-02-20

Objective: The aim of this study was to examine the prevalence of self-management practices among older White and African American persons with osteoarthritis. Self-management was defined broadly to include all behaviors adopted to reduce morbidity, whether recommended by physicians or not. Methods: A population-based sample of Medicare beneficiaries (N = 551) was recruited. An expanded set of self-management behaviors using structured and open-ended inquiry, along with use of arthritis-specific medications was elicited. Results: Few differences in self-care behaviors between race groups were found. However, older African American persons were significantly less likely to have prescriptions for nonsteroidal anti-inflammatory agents (NSAIDs) and more likely to use over-the-counter nonprescription analgesics. Discussion: Older White and African American persons made similar use of self-care strategies to reduce disease morbidity. African Americans without access to prescription pain relievers substituted nonprescription analgesics. A broader view of self-management is valuable for assessing the ways people may move between professionally guided care and self-care.

The Relationship of Older Adults' Activities and Body Mass Index

Kristi Rahrig Jenkins, , Fultz, N. H. — 2008-02-20

Objectives: To investigate the relationship between Body Mass Index (BMI) and older adults' hours of participation in 31 activities. Methods: Descriptive statistics are presented for the relationships between BMI and sociodemographics, health behaviors, and health characteristics. Linear regression was used to model the number of hours of participation in each activity. Results: The hypothesis that being overweight or obese is associated with older adults' activities was supported. For example, compared to those of normal weight, obese older adults spend fewer hours walking, exercising, praying and meditating, house cleaning, and engaging in personal grooming. And, compared to normal weight older adults, obese older adults spend a greater number of hours watching television. Discussion: These results substantiate prior findings of a negative relationship between physical activity and excess weight, and the lack of a relationship between social activity and BMI.

Cohabitation Status and Onset of Disability Among Older Danes: Is Social Participation a Possible Mediator?

Nilsson, C. J., Lund, R., Avlund, K. — 2008-02-20

Objectives: To investigate the effect of cohabitation status in older men and women on (a) onset of disability at 3- and 4.5-year follow-up and (b) changes in functional ability between 3- and 4.5-year follow-up, and to analyze whether this effect was mediated by social participation. Method: A total of 2,533 nondisabled older men and women enrolled in the Danish Intervention Study on Preventive Home Visits constituted the study population. Data were collected by mailed questionnaires in 1998-1999, 2000, 2001-2002, and 2003. Results: Living alone significantly increased the risk of onset of disability (T3 OR = 1.60[1.06-2.43], T4 OR = 1.74[1.22-2.47]) and the risk of sustained poor functional ability (OR = 2.35[1.44-3.84]) among men, but not among single-living women. Social participation mediated only a small part of the effect of cohabitation status on functional ability. Discussion: Our results underline the importance of cohabitation/marriage for maintaining a high functional ability among older men.