Aging Trends Study Research Articles

Dementia Prevalence, Incidence, and Mortality Trends Among U.S. Adults Ages 72 and Older, 2011-2021.

U.S.-focused studies have reported decreasing dementia prevalence in recent decades, but have not yet focused on the implications of the coronavirus disease 2019 (COVID-19) pandemic for trends. We use the 2011-2021 National Health and Aging Trends Study (N = 48 065) to examine dementia prevalence, incidence, and mortality trends among adults ages 72 and older, and the contribution to prevalence trends of changes in the distribution of characteristics of the older population ("compositional shifts") during the full and prepandemic periods. To minimize classification error, individuals must meet dementia criteria for 2 consecutive rounds. The prevalence of probable dementia declined from 11.9% in 2011 to 9.2% in 2019 and 8.2% in 2021 (3.1% average annual decline). Pre-pandemic declines continued for women and non-Hispanic White individuals and emerged over the 2011-2021 period for men and those ages 80-89. Declines in dementia incidence were stronger for the 2011-2021 period than for the prepandemic period, while mortality among those with dementia rose sharply with the onset of the COVID-19 pandemic. Shifts in the composition of the older population accounted for a smaller fraction of the decline over the full period (27%) than over the prepandemic period (45%). Declines in dementia prevalence continued into years marked by onset of the COVID-19 pandemic, along with declines in incidence and sharp increases in mortality among those with dementia. However, declines are no longer largely attributable to compositional changes in the older population. Continued tracking of dementia prevalence, incidence, and mortality among those with and without dementia is needed to understand long-run consequences of the pandemic.

Risks and Outcomes of New Onset of Unmet Need for Mobility and Self-care Daily Activities.

Among community-living older adults who have limitations in completing Activities of Daily Living (ADLs), unmet need occurs when they cannot complete an ADL task because no one was available to help. Prior research described correlates of existing unmet needs but did not consider which older adults are at risk for new onset of unmet needs. This study assessed health characteristics that increased risk for new onset of unmet needs within a year and subsequent health outcomes. Data are from the 2011-2019 annual interviews of the National Health and Aging Trends Study. For each pair of two consecutive annual interviews, we determined whether new onset of unmet needs occurred between the first and second consecutive interviews. Mixed effects logistic regression models were computed to assess risks for new onset of unmet need across 14,890 paired observations from persons who needed help with mobility tasks and 12,514 paired observations from persons who needed help with self-care tasks. Although demographic characteristics and chronic conditions had modest associations with new onset of unmet need, hospitalization between the two consecutive interviews was associated with a two-fold increase in risk for new onset of unmet need. New onset of unmet need was associated with hospitalization, nursing home placement, and death in the year following the two consecutive annual interviews. The findings inform the need for frequent assessments of ADL care needs with the goal of preventing new onset of unmet needs, especially after hospitalization.

Longitudinal Changes in Peak Expiratory Flow Predict Risk for Incident Dementia.

Impaired respiratory function, measured via peak expiratory flow (PEF), has been associated with increased dementia risk. However, much of the current literature uses cross-sectional measures of PEF, whereas longitudinal relationships between changes in respiratory function and dementia risk are underexplored. Using 10 years of data (2011-2021) from 2,439 adults ages 65 and older in the National Health and Aging Trends Study (NHATS), we examined whether 5-year changes in PEF (2011-2016) were associated with risk for incident dementia over the subsequent 5-year period (2017-2021). PEF slopes for each participant were estimated using linear mixed-effects models and then grouped into quartiles: rapid, moderate, mild, and no declines. Discrete-time Cox proportional hazards models were used to estimate the risk for incident dementia by PEF slope category, while controlling for several health and sociodemographic characteristics. After excluding dementia cases during the exposure window (2011-2016), we identified 338 cases of incident dementia (13.9%) between 2017-2021. Rapid PEF declines between 2011-2016 were associated with 85% higher risk for incident dementia between 2017-2021 compared to those with no declines in PEF (HR=1.85; 95% CI [1.24, 2.76]). Results were robust to several sensitivity analyses. These findings demonstrate that declines in PEF may precede declines in cognition, suggesting that respiratory function may be an important dementia risk factor in older adults. Additionally, these findings highlight the utility of measuring PEF via a peak flow meter, which is a simple and inexpensive measure of respiratory function.

Residential Relocation of Community-Dwelling Older Adults: The Role of Physical Function and the Housing Environment.

Most older adults in the United States (U.S.) prefer to remain in their current housing as they age, but difficulty with mobility (e.g., walking) may make this more challenging. We estimated the association between difficulty with mobility (mobility) and residential relocation in the following year. We included adults aged ≥65 participating in ≥2 rounds (years 2011-2019) of the National Health and Aging Trends Study. Mobility was self-reported and change in permanent address was captured by study staff. We used a prospective cohort design and logistic regression with a clustering correction to estimate adjusted associations. We did not find evidence that mobility was associated with relocation versus no relocation in our sample of 26,444 observations from 5699 older adults. However, mobility was positively associated with moves to housing with fewer environmental barriers. Mobility is associated with relocation to housing that is more accessible and may be an indicator of greater need for supports to age in place.

Prevalence of Hearing Loss and Hearing Aid Use Among Persons Living With Dementia in the US

Dementia and hearing loss are prevalent and represent public health priorities, but little is known about the prevalence of hearing loss among persons living with dementia at a population level. To estimate the prevalence of hearing loss and hearing aid use among a nationally representative sample of persons living with dementia. In this cross-sectional study, we analyzed data from Medicare beneficiaries who participated in round 11 of the National Health and Aging Trends Study (NHATS). The analytic sample included participants who had complete audiometric data and a dementia classification, and survey weights were applied to yield nationally representative estimates. Data were collected from June to November 2021, and analyzed from October 12, 2023, to February 27, 2024. Audiometric measures of hearing loss and self-reported hearing aid use. National prevalence estimates of possible and probable dementia and hearing loss were estimated by applying NHATS survey weights of sex and age to the population aged 71 years or older based on the US Census Bureau's 2020 American Community Survey data. The analytic sample comprised 2613 NHATS participants (74.6% aged 71-79 years and 25.4% aged ≥80 years; 52.9% female). Overall prevalence of hearing loss among participants with dementia was estimated at 79.4% (95% CI, 72.1%-85.3%). The prevalence of hearing loss increased with age, from 61.1% (95% CI, 37.7%-80.2%) among participants aged 71 to 74 years to 94.2% (95% CI, 88.8%-97.0%) among those aged 85 years or older. Among participants with hearing loss, 21.7% (95% CI, 16.2%-28.3%) reported hearing aid use. In this cross-sectional study, the findings suggest that hearing loss is highly prevalent among individuals with dementia, with a low prevalence of hearing aid use. These findings reveal a potential opportunity for intervention.

Digital Divide Among Homebound and Semi-Homebound Older Adults.

Using the 2022 National Health and Aging Trend Study data, we examined the digital divide among homebound and semi-homebound older adults. About 11% of older Medicare beneficiaries in 2022 were homebound or semi-homebound. Compared to non-homebound older adults, homebound older adults were significantly less likely to own a cellphone. Among those with any information and communication technology (ICT) device, homebound older adults were also less likely to have used email/texting and gone online. Older age, low income, dementia diagnosis, and moderate/severe depressive/anxiety symptoms contributed to the digital divide. Among homebound older adults, Hispanic older adults or those with limited English proficiency were less likely to have used ICT. To reduce the digital inequity among homebound older adults who are low-income, racial/ethnic minority, limited English proficient, and/or residents in non-metropolitan areas, social/structural inequities in accessibility and affordability, along with individual-level barriers, need to be addressed.

Using Deep Learning Neural Networks to Improve Dementia Detection: Automating Coding of the Clock-Drawing Test.

Alzheimer's disease and related dementias (ADRD) is a growing public health concern. The clock-drawing test (CDT), where subjects draw a clock, typically with hands showing 11:10, has been widely used for ADRD-screening. A limitation of including CDT in large-scale studies is that the CDT requires manual coding, which could result in biases if coders interpret and implement coding rules differently. This study created and evaluated an intelligent CDT Clock Scoring system built with Deep Learning Neural Networks (DLNN) to automatically code CDT images. We used a large, publicly available repository of CDT images from the 2011-2019 National Health and Aging Trends Study (NHATS) and compared three advanced DLNN methods - ResNet101, EfficientNet and Vision Transformers (ViT) in coding CDT into binary and ordinal (0 to 5) scores. We extended beyond the traditional nominal classification approach (which does not recognize order) by introducing structured ordering into the coding system and compared DLNN-coded CDT images with manual coding. Results suggest that ViT outperforms ResNet101 and EfficientNet, as well as manual coding. The ordinal coding system has the ability to allow researchers to minimize either under- or over-estimation errors. Starting in 2022, our developed ViT-coding system has been used in NHATS' annual CDT-coding.

Defining and Validating Criteria to Identify Populations Who May Benefit From Home-Based Primary Care.

Home-based primary care (HBPC) is an important care delivery model for high-need older adults. Currently, target patient populations vary across HBPC programs, hindering expansion and large-scale evaluation. Develop and validate criteria that identify appropriate HBPC target populations. A modified Delphi process was used to achieve expert consensus on criteria for identifying HBPC target populations. All criteria were defined and validated using linked data from Medicare claims and the National Health and Aging Trends Study (NHATS) (cohort n=21,727). Construct validation involved assessing demographics and health outcomes/expenditures for selected criteria. Delphi panelists (n=29) represented diverse professional perspectives. Criteria were validated on community-dwelling Medicare beneficiaries (age above 70) enrolled in NHATS. Criteria were selected via Delphi questionnaires. For construct validation, sociodemographic characteristics of Medicare beneficiaries were self-reported in NHATS, and annual health care expenditures and mortality were obtained via linked Medicare claims. Panelists proposed an algorithm of criteria for HBPC target populations that included indicators for serious illness, functional impairment, and social isolation. The algorithm's Delphi-selected criteria applied to 16.8% of Medicare beneficiaries. These HBPC target populations had higher annual health care costs [Med (IQR): $10,851 (3316, 31,556) vs. $2830 (913, 9574)] and higher 12-month mortality [15% (95% CI: 14, 17) vs. 5% (95% CI: 4, 5)] compared with the total validation cohort. We developed and validated an algorithm to define target populations for HBPC, which suggests a need for increased HBPC availability. By enabling objective identification of unmet demands for HBPC access or resources, this algorithm can foster robust evaluation and equitable expansion of HBPC.

Caregiving Trajectories and Unmet Care Needs in Later Life.

The evolution of care networks accompanying older adults' changing care needs-and implications for unmet care needs-are not well described. Using group-based trajectory models, we identify 4 incident care need patterns ("care need trajectory groups") for 1,038 older adults in the 2012-2018 National Health and Aging Trends Study and 5 caregiving patterns ("caregiving trajectory groups") and a transient group among their 4,106 caregivers. We model associations between care need/caregiving trajectory groups and the rate of (approximating the proportion of rounds with) unmet care needs. We illustrate how predicted rates vary by care need trajectory groups and by network composition for networks with 2 caregivers. The percentage of rounds with unmet care needs varies from 13% among older adults with few, stable needs to 62% among those with many, stable needs (p<.01). In models, care need trajectory group is strongly associated with the rate of unmet care needs; among those with steep increasing care needs, network composition is also predictive. For older adults with steep increasing care needs, when one caregiver provides high, variable and another medium, stable care hours, the predicted rate of unmet care needs is low (0.16) and similar to those with few, stable care needs (0.12). Findings highlight the complexity and heterogeneity of older adults' care needs and caregiving patterns over time. For those with rapidly increasing needs, identifying and assessing the evolving care network may be a fruitful direction for forestalling unmet care needs.

Peak expiratory flow predicts motoric cognitive risk syndrome: A cohort study.

Poor respiratory function, including low peak expiratory flow (PEF), is a risk factor for dementia. Motoric cognitive risk syndrome (MCR) is a predementia syndrome characterized by slow gait and subjective cognitive complaints. However, the association between PEF and MCR remains unclear. This study examined the cross-sectional and longitudinal association between PEF and MCR. The National Health and Aging Trends Study (NHATS), which is a nationally representative cohort of adults ≥65 years of age in the United States, was analyzed from 2011 to 2017. Logistic regression and discrete-time proportional hazards models tested the association of PEF standardized residuals (SR) at baseline with prevalent and incident MCR, respectively. The models adjusted for multiple sociodemographic and health-related covariates. Among 5328 participants (57% women) included at baseline, lower PEF SR was associated with higher prevalence of MCR. Compared with the ≥80 PEF SR percentile group, the <30 and 30-50 percentile groups had significantly higher odds of prevalent MCR (OR 3.04 [95% CI 1.85, 5.01]; OR 2.06 [95% CI 1.19, 3.54], respectively). Over six years of follow-up, lower PEF SR was also associated with higher incidence of MCR. Compared with the ≥80 PEF SR percentile group, the <30 and 30-50 percentile groups had significantly higher risk of incident MCR (HR 1.81 [95% CI 1.24, 2.66]; HR 1.55 [95% CI 1.02, 2.34], respectively). Lower PEF was associated with higher prevalence and incidence of MCR. Poor respiratory function should be further investigated as a potentially modifiable risk factor for MCR and cognitive decline.

Impact of Polypharmacy on Symptoms and Health Outcomes in Older Adults With and Without Alzheimer's Disease and Related Dementias.

There is a critical gap in understanding the symptom experience and health outcomes of older adults with and without Alzheimer's Disease and related dementias (ADRD) and polypharmacy (PPY). The primary aim of the study was to compare the number of symptoms experienced over time in older adults with and without ADRD by polypharmacy status. The secondary aim was to examine the trajectory of physical function and health outcomes over time in each group. This study utilized longitudinal data from the National Health and Aging Trends Study, a nationally representative sample of Medicare beneficiaries from 2016-2019. The sample was separated into four groups (N = 2,052): neither ADRD or PPY (n = 1,048), PPY only (n = 761), ADRD only (n = 116), and both ADRD and PPY(n = 127). The overall sample was predominately female (57.9%), White (70.9%), aged 84 or younger (75%), married (46%), and had some college or a college degree (50%). Participants with both ADRD and PPY experienced more symptoms on average, had higher odds of falls, hospitalizations, and mortality than all other groups. Older adults with both ADRD and PPY had lower physical function, needed more assistance with activities of daily living and higher assistive device utilization compared to the other three groups. Findings indicate that older adults with both ADRD and PPY experience more symptoms, negative health outcomes and physical function decline that can negatively impact their quality of life. Further research is needed to identify strategies for reducing PPY in people with ADRD.

The Association Between Social Isolation and Incident Dementia Among Older Adults: Evidence From National Health and Aging Trend Study.

Older adults are vulnerable to social isolation, making it crucial to understand its impact on dementia risk. Yet, existing evidence lacks consistency, with studies using varied measures of social isolation and overlooking potential confounders. We aim to investigate the associations between social isolation and dementia risk among older adults, hypothesizing that this association may diminish after adjusting for confounding factors. We used 2 977 community-dwelling older adults who had no dementia in 2015 from National Health and Aging Trends. Group-based trajectory modeling was used to analyze the trajectories of social isolation, depression, and anxiety from 2011 to 2015. Cox proportional hazards regression models were then employed to estimate the association between social isolation trajectories and incident dementia from 2015 to 2022, adjusting for demographic variables, depression, anxiety, self-rated health, smoking status, and cardiovascular disease-related variables. Three social isolation trajectories were identified: minimal, moderate, and high levels of social isolation. During a mean follow-up of 3.6 years, 19.0% of participants were diagnosed with dementia. When only demographics were adjusted, individuals in the moderate social isolation group were 22% less likely to develop dementia compared to those with high social isolation. This association between social isolation and incident dementia became nonsignificant after further adjustment for depression, anxiety, and health indicators. The association between social isolation and dementia risk may be mediated by factors such as depression and other health indicators.

Hospital stays and probable dementia as predictors of relocation to long-term care facilities.

This study aims to investigate the relocation of older adults in the US from community living to long-term care facilities (LTCFs). Specifically, it examines the predictive roles of possible and probable dementia and hospital stays in this complex health care transition. Utilizing data from the National Health and Aging Trends Study, a longitudinal cohort study (2011-2019), we employed a panel data approach, which consists of multiple observations over time for the same participants, allowing us to account for both cross-sectional variations (differences between participants) and time-series variations (changes in the same participant over time). The analysis involved longitudinal logistic regression models. Using the AD8 dementia screening interview, clock drawing test, immediate and delayed word recall test, orientation, and history of dementia diagnosis, we placed participants into categories of having no dementia, possible dementia, and probable dementia. A survey asked about hospital stays in the past year. Relocation to LTCFs was examined based on the changes to the living location. The proportion of individuals transitioning to LTCFs tripled between 2011 and 2019, emphasizing the need to understand and manage this health care transition. Hospital stays significantly increased the probability of moving to LTCFs, especially nursing homes. Probable dementia demonstrated a 3-fold increase, aligning with the rising prevalence of Alzheimer disease. Difficulty walking and climbing stairs significantly increased relocation probabilities. The study findings emphasize complexity in late-life relocations influenced by dementia and hospital stays. Screening for cognitive function among community-dwelling older adults, particularly those with a history of hospital stays and mobility difficulties, can inform interventions and policies. Implications extend to health care policy, geriatric care, and the imperative for targeted interventions considering demographic variations. Future research should explore additional variables and address limitations to refine our understanding of the relocation process.

Confidants and Caregivers: Network Multiplexity and Subjective Well-Being of Older Adults.

Older adults rely on personal networks for different types of support. Given shifts in family composition in later adulthood, more work is needed to map network members who can provide multiple aspects of support and the implications for older adults. We explore the phenomenon of having the same network members as both a confidant and a caregiver (multiplexity) and its implications for the well-being of older adults. Using the 2011 National Health and Aging Trends Study (NHATS), we describe the prevalence of having someone as both a confidant and a caregiver (henceforth "multiplex helper") for older adults and examine its association with subjective well-being. We also investigate the differences by having whom as multiplex helpers. About three-quarters (76%) of older adults with at least one confidant and one caregiver have at least one multiplex helper. Partnered older adults are more likely to have any multiplex helpers than unpartnered counterparts and usually nominate their partner as a multiplex helper, whereas the unpartnered are more likely to rely on their children to serve multiple roles, especially for widowed older adults. Having a multiplex helper is associated with better subjective well-being. Network multiplexity is prevalent and positively associated with the subjective well-being of older adults who have at least one confidant and one caregiver, above and beyond having any confidants or caregivers separately. The baseline patterns established in this study lay the groundwork for future research to further explore support dynamics in older adults' networks.

Examining Care Network Characteristics in Older Adults' Relocation to Residential Care Settings.

When older adults face increasing care needs or limited support, remaining safely and comfortably at home becomes challenging. Extant research has primarily concentrated on characteristics of the older adult or their primary caregiver on nursing home admission. This study examines the risk of older adults transitioning to residential care (e.g., assisted living, nursing home), focusing on the influence of their care network or involvement of multiple helpers. Using the National Health and Aging Trends Study, we conducted competing risk regression models that account for mortality, following 7,085 initially community-dwelling older adults across Rounds 1-9 (2011-2019). We assessed network composition, size, shared tasks, and the number of in-network specialists or generalists while controlling for individual sociodemographic and health factors. Individuals with care networks that shared medical tasks had the highest risk of moving to a residential care setting, followed by those sharing household tasks. Conversely, shared mobility or self-care and transportation responsibilities were associated with lower risks. Having more generalists, but not specialists, increased the risk. Larger networks were associated with heightened risk, although having close family members like a spouse was protective. The findings underscore that care network characteristics are critical to older adults' ability to age in place. Specifically, older adults with larger networks, lacking a spouse or child, and providing complex care are at greater risk for relocating. Understanding care networks can guide interventions related to care network coordination and resource allocation to help avoid or postpone a residential care move.

Neighborhood social cohesion and physical disorder in relation to social isolation in older adults: racial and ethnic differences

BackgroundNeighborhood factors of social isolation have been understudied, hindering efforts to reduce social isolation at the neighborhood level. This study aims to investigate the longitudinal effects of neighborhood social cohesion and physical disorder on social isolation in community-dwelling older adults, as well as to examine whether race/ethnicity moderates the neighborhood-isolation relationship.MethodsWe used 11-year data from the National Health and Aging Trend Study, a longitudinal national study of Medicare beneficiaries aged 65 and older. Social isolation was measured through a summary score across four domains: marital/partner status, family and friend contact, religious attendance, and club participation. A series of weighted mixed-effects logistic regression models were performed to test the study aims. Sample sizes ranged from 7,303 to 7,291 across individual domains of social isolation.ResultsApproximately 20% of participants reported social isolation. Findings indicated a negative association between neighborhood social cohesion and social isolation. Higher levels of neighborhood social cohesion were longitudinally associated with lower odds of social isolation (odds ratio [OR] = 0.52, 95% CI: 0.47–0.58). Yet, the presence of neighborhood physical disorder was associated with an increased risk of overall social isolation ([OR] = 1.2, 95% CI: 1.00, 1.44). Race/ethnicity significantly moderated the effects of neighborhood social cohesion and physical disorder on social isolation. The odds of no in-person visits associated with neighborhood social cohesion are smaller among Black adults compared to White adults. Black adults had constantly lower odds of isolation from religious attendance compared to White adults regardless of the level of neighborhood social cohesion. Hispanic adults had decreased odds of having no friends associated with signs of physical disorder, while no associations were found among older White adults. White adults had higher odds of isolation from in-person visits when living in neighborhoods with signs of physical disorder, whereas no association was observed among older Black and Hispanic adults.ConclusionsThis study elucidates the role of neighborhood characteristics in shaping social isolation dynamics among older adults. Furthermore, the observed moderation effects of race/ethnicity suggest the need for culturally sensitive interventions tailored to address social isolation within specific neighborhood and racial contexts.

Population reference equations for handheld peak expiratory flow in older U.S. adults

BackgroundPeak expiratory flow (PEF) is a simple, inexpensive measure of respiratory effort and is a valuable predictor of health outcomes in older adults. Yet, there is a lack of epidemiological data validating PEF prediction equations among older adult populations, especially those ≥80 years. The National Health and Aging Trends Study (NHATS) is a large, nationally representative sample of U.S. adults ages ≥65 years that offers a unique opportunity to develop PEF population reference equations. MethodsUsing a healthy subsample from the NHATS 2011 cohort (N = 1740; 68.9 % female; mean [SD] age = 77.0 [7.9] years), sex-specific reference equations were generated for PEF, measured via a handheld flow meter, using height and age as predictors. Reference equations for both sexes were validated against the NHATS 2015 cohort by testing measured vs. predicted PEF values. Additionally, new reference equations were compared to spirometry PEF reference equations from the National Health and Nutrition Examination Survey (NHANES). ResultsAfter applying NHATS 2011 reference equations to the NHATS 2015 cohort, measured vs. predicted PEF values were not significantly different (Ps > 0.05). The NHANES equations tended to slightly overestimate handheld PEF measurements in the NHATS 2015 cohort by an average of 29.3 L/min and 10.1 L/min in males and females, respectively. ConclusionsResults demonstrate the comparability of PEF reference equations from a handheld meter to spirometry reference equations in older adults. New reference equations can be applied to a traditionally undersampled population with an easily obtained and low-cost measure.

Social Isolation and Hospitalization in Community-Dwelling Older Adults by Dementia Status.

Social isolation is a well-known risk factor for poor health outcomes, including incident dementia, yet its associations with outcomes among persons living with dementia are understudied. We examined the association between social isolation and hospitalization among a nationally representative sample of older adults with and without dementia. This observational cohort study included 5 533 community-dwelling Medicare beneficiaries from the 2015 and 2016 National Health and Aging Trends Study (NHATS). Using multivariable logistic regression analyses, we examined associations between social isolation and hospitalization in the following year, examining differences by dementia status. Social isolation was measured using a 4-item typology. Dementia was identified using a prespecified classification in NHATS. 20.7% of older adults were socially isolated. Social isolation was more prevalent among persons with dementia (35.4%) than among those without dementia (19.0%) (p < .001). Among persons with dementia, social isolation was associated with 1.68 greater odds of hospitalization (confidence interval [CI]: 1.23-2.28), translating into a 9% average increase in the predicted probability of hospitalization for persons with dementia who were socially isolated compared to those who were not (p = .001). In the combined sample that included persons with and without dementia, there was a significant moderation effect of dementia on the association between social isolation and hospitalization (odds ratio: 1.70; CI: 1.19-2.43). For persons with dementia, social isolation is prevalent and associated with greater odds of subsequent hospitalization. Efforts to reduce acute healthcare utilization should explore ways to bolster social connection to improve health outcomes among persons with dementia.

Effects of Information and Communication Technology Use on the Executive Function of Older Adults Without Dementia: A Longitudinal Fixed-effect Analysis.

Impaired executive function is common in older adults. This study examined the causal relationship between the use of information and communication technology (ICT) and executive function in older adults over time. This study performed a secondary analysis of data from four waves (2016-2019) of the National Health and Aging Trends Study (NHATS). A fixed-effect analysis was conducted to examine the effects of ICT on the executive function of older adults without dementia aged ≥65 years. This study analyzed data from 3,334 respondents. We observed significant positive effects of ICT use on executive function over time (standardized β = 0.043-0.045, 95% confidence interval [CI] = 0.001-0.043, p < 0.05). The current findings support the use of ICT as a protective approach to prevent decline in executive function in community-dwelling older adults.

Population-based estimates of major forms of housing insecurity among community-living older Americans.

The number of older adults struggling to maintain adequate housing is growing. Prior studies have used various criteria to measure housing insecurity; however, no standardized definition exists to date. Using a multidimensional approach, our study sought to calculate population-based estimates of various forms of housing insecurity among community-living older Americans and determine how these estimates differ across key characteristics. This study utilized data from the 2011 round of the National Health and Aging Trends Study (NHATS), a prospective longitudinal study of Medicare beneficiaries aged 65 years or older. Three key forms of housing insecurity were operationalized: poor housing affordability (PHA), poor housing quality (PHQ), and poor neighborhood quality (PNQ). Population-based estimates of these forms of housing insecurity were calculated using analytic sampling weights and stratified by age, gender, race and ethnicity, frailty status, and dementia status. Totally 6466 participants were included in the analysis, representing 29,848,119 community-living older Americans. The mean (standard deviation) age was 77.3 (7.7) years; by weighted percentages, 56.0% identified as female, 81.3% as White, 8.2% Black, and 7.1% Hispanic. At least one form of housing insecurity was identified in 38.5% of older Americans. Individually, the prevalence of PHA was 14.8%, PHQ 24%, and PNQ 12.5%. The prevalence of at least one form of housing insecurity was higher among persons of color (62.9% Black and 66% Hispanic vs White; p < 0.001), those with frailty (40.9% pre-frail and 49.4% frail vs robust; p < 0.001), and those with cognitive impairment (48.1% possible and 51% probable dementia vs no dementia; p < 0.001). Nearly one in three community-living older Americans experience at least one form of housing insecurity. This was most common among vulnerable subgroups. Our multidimensional approach to defining various forms of housing insecurity can be used for future studies focused on improving social determinants of health among high-risk older adults.