EMPLOYMENT OUTCOMES AMONG OLDER ADULTS WITH A HISTORY OF INCARCERATION

Racial Differences in Employment Outcome After Traumatic Brain Injury at 1, 2, and 5 Years Postinjury

We examined the association between history of incarceration (HOI) and food insecurity (FI) among older adults using pooled data from 12,702 respondents aged 51+ who participated in the 2012 and 2014 waves of the Health and Retirement Study. In our sample, 12.8% of participants reported FI. Those with a HOI had an increased odds of FI (OR 1.83; 95% CI 1.52-2.21). Race/ethnicity moderated the association between HOI and FI. The positive and statistically significant association was concentrated among Non-Hispanic Black and Non-Hispanic White participants. No statistically significant association was found among Hispanic participants or among those from other racial/ethnic groups. Income, depressive symptoms, and functional limitations mediated the association between HOI and FI, with the largest indirect effects observed for income. FI is an important issue among older adults with a HOI. Programs and policy initiatives to increase food access and/or improve earnings in this population may be needed.

The number of older adults with criminal justice system involvement has increased by more than 280% since 1999. Previous studies show that justice-involved older adults have rates of chronic disease similar to those of the never-incarcerated; however, no studies have evaluated differences in disease management between groups. We examined associations between history of incarceration (HOI) and diabetes management using data from the Health and Retirement Study, a population-based sample of community-dwelling older adults. HOI was assessed via self-report. We assessed diabetes management via self-report/objective health indicators, health service utilization, and health behaviors. We used logistic and linear regression to evaluate associations between HOI and diabetes management, controlling for demographic characteristics. HOI was associated with fewer dental visits (OR: 0.069; 95% CI: 0.531, 0.917) and greater odds of insulin use (OR: 1.52, 95% CI: 1.13, 2.05), tooth loss (OR: 1.94, 95% CI 1.43, 2.65), foot swelling (OR: 1.44, 95% CI: 1.08, 1.90) and hospitalization in the last 2 years, (OR: 1.47, 95% CI: 1.12, 1.92). There was no association between HOI and other measures of diabetes management. Associations between tooth loss, dental visits, and incarceration were observed among White but not Black participants. Findings suggest that HOI may be associated with poorer diabetes management practices in some domains. Future research should identify interventions that improve diabetes-relevant outcomes among justice-involved older adults.

Although incarcerated older adults experience higher rates of chronic disease and geriatric syndromes, it is unknown whether community-dwelling older adults with a history of incarceration are also at risk for worse health outcomes. To evaluate the association between a history of incarceration and health outcomes, including chronic health conditions and geriatric syndromes, in older age. This cross-sectional study using population-based data from the nationally representative Health and Retirement Study included US community-dwelling adults aged 50 years or older who completed the 2012 or 2014 survey waves assessing self-reported history of incarceration. Statistical analysis was completed from December 2021 to July 2022. Self-reported history of incarceration. Geriatric health outcomes included cognitive impairment, mobility impairment, vision impairment, hearing impairment, urinary incontinence, and impairment of activities of daily living (ADLs). Chronic health outcomes included high blood pressure, diabetes, chronic lung disease, heart disease, stroke, mental health conditions, heavy alcohol use, and self-reported health. Survey weights were applied to adjust for the survey design. Among 13 462 participants, 946 (7.6%) had experienced incarceration (mean [SD] age, 62.4 [7.8] years); compared with 12 516 people with no prior incarceration (mean [SD] age, 66.7 [10.0] years), previously incarcerated adults were more likely to be male (83.0% vs 42.8%; P < .001) and in the lowest quartile of wealth (44.1% vs 21.4%; overall P < .001). After adjusting for age, sex, race and ethnicity, wealth, educational attainment, and uninsured status, a history of incarceration was associated with a 20% to 80% increased risk of all geriatric syndromes evaluated, including impairment of ADLs (relative risk [RR], 1.62; 95% CI, 1.40-1.88) and hearing impairment (RR, 1.22; 95% CI, 1.04-1.44). Incarceration was also associated with increased risk of some chronic diseases, including chronic lung disease (RR, 1.56; 95% CI, 1.27-1.91), mental health conditions (RR, 1.80; 95% CI, 1.55-2.08), and heavy alcohol use (RR, 2.13; 95% CI, 1.59-2.84). Prior incarceration was not associated with diabetes or cardiovascular conditions. In this study, at least 1 in 15 older US adults reported a history of incarceration in their lifetime. Past incarceration was associated with many chronic diseases and geriatric syndromes even after accounting for socioeconomic status. These findings suggest that attention to incarceration history may be an important consideration in understanding and mitigating health risks in older age.

OBJECTIVE: We sought to examine the independent and interactive effects of common mental health disorders and chronic pain conditions on employment and work outcomes among individuals younger than 65 years of age. METHODS: We analyzed cross-sectional data from the second wave of Healthcare for Communities (HCC2), a household telephone survey of U.S. civilian adults conducted in 2000 to 2001 (N=5328). Common mental disorders were assessed using the short-form versions of the World Health Organization’s Composite International Diagnostic Interview (CIDI-SF). Chronic pain conditions and labor market outcomes were identified by self report. Logistic and linear regression analysis was used to provide estimates for work impairment based on the presence of a mental health disorder and/or a chronic pain condition. RESULTS: The interaction between presence of a mental health disorder and presence of a chronic pain condition was significantly associated with no work for pay in the past 12 months (OR 2.3 [1.2–4.2]) and number of days of work missed in the past month due to health (regression coefficient 1.5 [0.6]). In stratified analyses, this effect persisted in women but not men. The presence of a mental health disorder or chronic pain condition were each independently associated with limitations in work and any work missed in the past 30 days due to health, although the interaction was not significant. CONCLUSION: Mental health disorders and chronic pain are each associated with work disability. Mental health disorders are more highly associated with some work disability outcomes when accompanied by chronic pain, especially in women.

African-Americans are overrepresented in the criminal justice system. Longer prison stays and release programs for older prisoners may result in an increased number of community-dwelling older adults with a history of incarceration. In recent years, there has been a substantial increase in research on health-related outcomes for currently incarcerated older adults; however, there has been little inquiry into outcomes for formerly incarcerated African-American older adults following community re-entry. In this study, we used secondary data from the Health and Retirement Study to describe employment, economic, and health-related outcomes in this population. Twelve percent of the 2238 African-Americans in our sample had been previously incarcerated. Those who had been previously incarcerated had higher rates of lung disease, arthritis, back problems, mobility problems, and mental health issues than their counterparts. They also had higher rates of hospitalization and lower use of dental health services. Further, while they did not experience lower employment rates than those with no criminal history, those who had been incarcerated had more physically demanding jobs and reported greater economic strain. Given the disproportionate incarceration rates among African-Americans, the aging of the prison population, and the increase in community re-entry for older prisoners, research that explores factors that impact the health and well-being of formerly incarcerated individuals has broad impact. Future work should focus on addressing the needs of this vulnerable population of African-American older adults.

Incarceration is linked to poor health outcomes across the life course. However, little is known whether and to what extent incarceration histories shape pain in later life. This study examines the relationships between incarceration histories and pain outcomes among middle-aged and older adults in the United States. Data from a nationally representative sample of community-dwelling adults aged 51 and over in the 2012-2018 biennial waves of the U.S. Health and Retirement Study was analyzed to examine how incarceration histories influence older adults' risks of reporting moderate-to-severe pain and pain with physical limitations. We relied on a propensity score matching approach to account for the potential confounding bias. We fit weighted generalized estimating equation models to assess the relationships between incarceration history and pain outcomes. Models were further stratified by gender. After propensity score matching, our sample included 2,516 respondents aged 65 years on average (SD = 8.72), 21% female, and 838 with incarceration histories. Persons with incarceration histories have a greater risk of reporting moderate-to-severe pain (prevalence ratio [PR] = 1.30, 95% confidence Interval [CI]: 1.20, 1.52) and pain with physical limitations (PR = 1.48, 95% CI: 1.30, 1.68) even after adjusting for sociodemographic covariates and early life experiences. In the models stratified by gender, the associations between incarceration histories and incarceration were similar among women and men. In a nationally representative sample of older adults (with or without incarceration history), our study demonstrates an independent association between a history of incarceration and pain in later life. Our findings highlight the far-reaching impact of incarceration and the need for developing optimal management strategies to reduce the burden of disabling pain. Interventions should prioritize socioeconomically vulnerable groups who may have the least access to pain treatment in later life.

Objectives Previous research has found that many incarcerated individuals have mental health conditions and that incarcerated women may be at elevated risk. These individuals have been shown to experience mental health concerns shortly after their release, but little is known about their mental health later in life. This study compared depressive symptoms in older adults with and without a history of incarceration and examined the impact of gender on this relationship. Method Data from 160 pairs of adults aged 65 or older (82.5% male, mean age = 73.4 years) who participated in the 2012 wave of the Health and Retirement Study (HRS) was utilized. Older adults with a history of incarceration were matched to those without based on age, gender, race, and education level. Depressive symptoms (CES-D) of older adults with and without a history of incarceration were compared using a repeated-measures ANOVA. Results The main effect of incarceration history (p=.001, partial eta2 =.07) and the interaction between incarceration history and gender (p=.01, partial eta2 =.04) were significant. Follow-up analyses revealed that the difference between depressive symptoms for older women with and without a history of incarceration was significant (p=.02, d = 0.69), whereas the difference for older men was not significant (p=.19, d = 0.16). Conclusions Findings suggest older adults with a history of incarceration report more depressive symptoms than those without and that the effect is seen among older women. Negative effects of incarceration on mental health may therefore persist into later life, highlighting the importance of pre- and post-release mental health services.

Racial Differences in Employment Outcomes After Traumatic Brain Injury

History of Incarceration and Dental Care Use Among Older Adults in the United States

The purpose of this study was to use a mixed methods approach to describe the association between history of incarceration (HOI) and food insecurity (FI) among older adults. Quantitative data were obtained from the Health and Retirement Study, a population-based study of community-dwelling adults (n=12,702) aged &amp;gt;50. Qualitative data were obtained via key informant interviews with formerly incarcerated older adults and the human service providers serving them (n=15). Multiple logistic regression was used to estimate the association between HOI and FI, adjusting for demographic variables. HOI was associated with increased odds of FI (OR 1.83; 95% CI 1.52-2.21). Race/ethnicity moderated the association between history of incarceration and food insecurity, with effects observed among Non-Hispanic Blacks (OR 1.78; 95% CI 1.29-2.46) and Whites (OR 2.27; 95% CI 1.74-2.97), but not Hispanics (OR 1.11; 95% CI 0.69-1.77) or those of other racial/ethnic groups (OR 1.79; 95% CI 0.71-4.52). Explanations for the association between HOI and FI obtained from qualitative interviews included ineligibility for food assistance programs due to felony conviction, lack of safe places to store healthy food, and difficulty using technologies needed to enroll in food assistance programs. The most common barrier associated with inaccessibility to healthful foods for this population, according to interviewees, is ineligibility for food assistance programs. FI is an important issue among older adults with a HOI. Re-examination of policies and procedures for accessing food assistance programs may be needed to reduce FI in this population.

Anemia in Frailty

The number of older adults with history of incarceration (HOI) has increased significantly since the 1990s; however, the psychological effects of incarceration on older adults are understudied. Using pooled data from the 2012 and 2014 waves of the Health and Retirement Study, we examined associations between HOI and older subjective age and explored potential mediators. Participants were considered to have older subjective age if they reported feeling older than their chronological age. We used logistic regression to evaluate the association between HOI and older subjective age, adjusting for demographic characteristics. To examine mediation effects, we performed a Karlson-Holm-Breen (KHB) decomposition analysis using logistic regression. Potential mediators included depressive symptoms, number of chronic conditions, income, number of difficulties with activities of daily living (ADLs), and years of education. We observed a significant association between HOI and older subjective age. (OR: 1.72; 95% CI: 1.44-2.05). Fifty-seven percent of the observed effect of HOI on older subjective age was accounted for by these mediators. Depressive symptoms were the primary mediator, accounting for 72.26% of the mediation effect. Number of chronic conditions, years of education, and number of ADLs accounted for 11.40%, 11.02%, and 7.02% of the mediation effect, respectively. Income did not contribute significantly. Our findings underscore the need to address the mental health needs in this population to promote healthier aging. Further, the significant impact of multiple mediators highlights the interplay of social, physical, and psychological vulnerabilities in this population.

This study aims to examine associations between history of incarceration (HOI) and two oral health outcomes (tooth loss and dental care utilization) among older adults with diabetes, as well as identify factors that may mediate these associations. The authors used self-report data from the 2012 and 2014 waves of the Health and Retirement Study (a population-based study of adults aged >50 in the USA) to evaluate associations between HOI and the two oral health outcomes, controlling for demographics. HOI was associated with greater odds of permanent tooth loss (OR = 1.43, 95% CI = 1.08-1.90) and reduced odds of dental care utilization in the past two years (OR = 0.70, 95% CI = 0.53-0.92). After adjusting for social support and perceived provider mistrust, the association remained but was attenuated (direct effect = -0.310, p = 0.030). Further, 11% of the total effect was explained by the mediators, with social support accounting for 74% of the indirect effect, and perceived provider mistrust accounting for the remaining 26%. Findings are limited by the study design. This cross-sectional study had data that was collected at one point in time. Thus, long-term follow-up could not occur. Additionally, the HRS does not differentiate between prison and jail, and health disparities tend to differ between jail and prison. Evidence from this study was preliminary and correlational, and longitudinal work should be conducted. There are disparities in oral health indicators among those with diabetes based on HOI. Future research should identify barriers to oral health diabetes management in prison and test potential interventions to improve diabetes management following release from prison. To the best of the authors' knowledge, this study is the first to provide evidence of oral health disparities among older adults with diabetes with a history of incarceration. No study has yet investigated these important health markers in individuals with a history of incarceration. This is important for future intervention to improve healthcare in the justice system.

Although people with disabilities have poorer employment outcomes, on average, than do people without disabilities, some of them fare relatively well in the labor market. To learn more about the individual characteristics associated with positive employment outcomes among people with disabilities, we use data from the 2009–2011 American Community Survey to examine differences in employment outcomes by demographic and other individual characteristics in a multivariable framework. Controlling for all other individual characteristics, we find the employment gap between individuals with and without disabilities is smaller among those in their 20s and 60s relative to the middle aged, Asians relative to Whites, Hispanics relative to non-Hispanics, married individuals, individuals with higher levels of educational attainment, and women. Overall, results suggest that policies and practices designed to improve employment outcomes among people with disabilities should consider how individual characteristics interact with disability as challenges to or facilitators of employment success.