Health Of Older Americans Research Articles

Food Security and Health Outcomes following Gray Divorce.

The study evaluates the immediate and long-term consequences of gray divorce (i.e., marital dissolution after age 50) for the food security, depression, and disability of older Americans. Staggered Difference-in-Difference models were fitted to a nationally representative longitudinal sample of adults aged ≥ 50 years from the Health and Retirement Study, 1998-2018. Food insecurity and disability increase in the year of gray divorce and remain significantly elevated for up to six years or more following the event, consistent with the chronic strain model of gray divorce. Gray divorce has particularly adverse consequences for the food security of older women, while no gender differences were observed for disability. Increasing trends in gray divorce have important negative implications for food security and health of older Americans, particularly women, who appear to be less prepared to financially withstand a marital collapse in older age. Targeted policies to provide nutrition assistance and support in reemployment might be necessary to reduce the burden of food insecurity in the wake of gray divorce among women.

Is the Health of Older Americans With a GED Equivalent to Their Peers With a High School Diploma?

The aim of this study was to identify differences in the prevalence and odds of cognitive impairment, hearing impairment, vision impairment, limitations in activities of daily living (ADLs), and ambulation limitations among three groups of older American adults: high school dropouts, General Educational Development (GED) recipients, and high school graduates. This study used secondary analysis of the nationally representative 2017 American Community Survey. The sample included 20,489 GED recipients, 154,892 high school graduates, and 49,912 high school dropouts. Our findings indicate that there is a gradient in health outcomes among older Americans, with the highest prevalence and odds of cognitive impairment, hearing impairment, vision impairment, ADL limitations, and ambulation limitations among high school dropouts, followed by GED recipients, and the lowest among high school graduates. Although GED recipients have better health outcomes than high school dropouts, there is still a significant disparity in health status between GED recipients and high school graduates.

Diet Quality and Health in Older Americans.

Adequate nutrition is an essential component of healthy ageing. This study documents the quality of diets among older Americans and implications of healthy eating for their physical and mental health. Using a nationally representative longitudinal sample of adults aged ≥50 years, from the Health and Retirement Study (HRS) 2010–2016 and food intake data from the 2013 Health Care and Nutrition Study (HCNS), the study evaluates the onset of health problems along the spectrum of diet quality measured by the Healthy Eating Index (HEI)-2015. Older adults adhering to healthier diets, in the high HEI group, have a significantly lower risk of developing limitations in activities of daily living (15.2% vs. 19.6%, p < 0.01) and depression (11.8% vs. 14.9%, p < 0.01), as compared to participants with low HEI scores. Consuming healthier diets also predicts more favorable health outcomes, as measured by blood-based biomarkers, including C-reactive protein (3.3 vs. 3.8, p < 0.05), cystatin C (1.1 vs. 1.2, p < 0.1), total cholesterol (192.1 vs. 196.4, p < 0.1), and high-density lipoprotein (57.2 vs. 53.8, p < 0.01). Most older Americans can benefit from improving diet to reduce their risk of disability, chronic disease, and depression.

Screening and Priority-Setting to Determine Home- and Community-Based Aging Services for Older Floridians.

The National Aging Network serves millions of older Americans seeking home- and community-based services, but places others on waitlists due to limited resources. Little is known about how states determine service delivery and waitlists. We therefore conducted a process evaluation and analyzed data from one five-county Area Agency on Aging in Florida, where an algorithm calculates clients' priority scores for service delivery. From 23,225 screenings over 5.5 years, clients with higher priority scores were older, married, living with caregivers, and had more health problems and needs for assistance. Approximately 51% received services (e.g., meals/nutrition, case management, caregiver support), 11% were eligible/being enrolled, and 38% remained on waitlists. Service status was complex due to multiple service enrollments and terminations, funding priorities, and transfers to third-party providers. More research is needed regarding how other states determine eligibility and deliver services, potentially informing national standards that promote optimal health in older Americans.

Sleep Disturbance Mediates the Association Between Loneliness and Health in Older Americans

As the research documenting loneliness as a risk factor for morbidity and mortality continues to grow, it becomes increasingly critical to understand the mechanics of this relationship. This study assessed whether sleep disturbance mediates the relationship between loneliness and health. Data came from the 2006, 2010, and 2014 waves of the Health and Retirement Study, a longitudinal study of older Americans; participants ≥ 65 who completed the Psychosocial and Lifestyle Questionnaire in 2006 were included (n = 5067). Measures include the Hughes loneliness scales, a modified version of the Jenkins sleep scale, and self-reported health. Cross-lagged mediation models (i.e., path analysis) were used to model the relationships between loneliness, sleep disturbance, and self-reported health over the 8-year span. Loneliness predicted subsequent sleep disturbance, which in turn predicted subsequent self-reported health. Moreover, there was evidence of both direct and indirect effects (via sleep disturbance) of loneliness on self-reported health. These effects remained after controlling for demographics, isolation, and depression. Sleep disturbance partially mediates the relationship between loneliness and self-reported health over 8years. These findings are not attributable to isolation or depression. Further research is necessary to develop and assess a more comprehensive model of how loneliness shapes health. This study indicates that targeting sleep disturbance may mitigate the health risks of loneliness in older Americans.

Learning to Lead: Reflections from the Tideswell-AGS-ADGAP Emerging Leaders in Aging Program Scholars.

The Tideswell Emerging Leaders in Aging (ELIA) Program is a 1-year leadership training program focused on developing a sustainable pipeline of leaders in aging who are poised to lead initiatives that will optimize the health of older people. The Tideswell ELIA Program is jointly administered by the American Geriatrics Society, the Association of Directors of Geriatric Academic Programs, and Tideswell at University of California, San Francisco (UCSF), a program within the Division of Geriatrics at UCSF. The ELIA Program prepares early to midcareer healthcare professionals in aging (scholars) for their transition into key leadership roles that involve one or more areas of patient care, education, and research. The program emphasizes the understanding of one's own and others' inherent work strategies and communication styles as integral to leading programs. Approximately 15 ELIA scholars are selected annually to participate in this interactive leadership development program. We conducted a qualitative analysis of program evaluations from 2015 to 2018 scholars (n = 47) to determine effectiveness and impact. All scholars (100%) completed the end-of-training survey. Scholars' satisfaction with the program is high. Scholars reported heightened leadership development and improvements in leadership skills, including communication, team building, and self-awareness. Scholars also reported enhancement of personal leadership attributes that contributed to career advancement. The Tideswell ELIA Program accelerates scholars' personal career development, positively impacts their institutions, and ultimately benefits older people. Sustaining leadership programs such as the Tideswell ELIA Program is vital to ensure a continuous pipeline of leaders skilled in both advocating for and advancing the health of older Americans. J Am Geriatr Soc 67:434-436, 2019.

The Health of Older Americans: A Primer on Medicare and a Local Perspective.

Our work with older adults, particularly those with limited incomes, has provided significant insight into the complexities of Medicare and the U.S. healthcare system. This article provides a brief history and overview of Medicare; describes the array of insurance choices Medicare beneficiaries face; and considers the effect of income, race, and health literacy on an individual's ability to navigate Medicare. We discuss how health is more than healthcare service delivery and that it takes community efforts to ensure that older adults not only understand their insurance, but also have access to other important resources that influence their health such as safe, affordable housing; food security; and transportation.

Physical and Social Activities of Older Adults With Functional Limitations

This study examined the associations of physical and social activities with health status and functional disabilities (FDs) in a sample of Medicare beneficiaries who completed the 2004 National Long-Term Care Study (NLTCS) (N = 3,225). Factors associated with the health of older Americans with functional limitations included older age, higher education, employment, absence of chronic illness, performance of physical activities, and friends’ visits. Older age, higher education, diabetes, heart disease, and the absence of all types of physical activities and friends’ visits were associated with FDs. It is recommended that physical and social activities be encouraged for seniors with disabilities.

Sense of Control and Self-Reported Health in a Population-Based Sample of Older Americans: Assessment of Potential Confounding by Affect, Personality, and Social Support

Sense of control has been linked to improved health outcomes, but it is unclear if this association is independent of other psychosocial factors. The aim of this study is to test the strength of association between sense of control and self-reported health after adjustment for positive and negative affect, "Big 5" personality factors, and social support. Data on sense of control (measured by personal mastery, perceived constraints, and a health-specific rating of control), affect, personality, social support, and two measures of self-reported health (global rating of fair or poor health and presence of functional limitations) were obtained on 6,891 participants in the Health and Retirement Study, a population-based survey of older Americans. The cross-sectional association between sense of control measures and each measure of self-reported health was tested in hierarchical logistic regression models, before and after adjustment for affect, personality, and social support. Participants with higher personal mastery were less likely to report fair/poor health (odds ratio 0.76 per 1-point increase) while those with higher perceived constraints were more likely to report fair/poor health (odds ratio 1.37 per 1-point increase). Associations remained after adjustment for affect, but adjustment for affect attenuated the association of personal mastery by 37% and of perceived constraints by 67%. Further adjustment for personality and social support did not alter the strength of association. Findings were similar for the health-specific rating of control, and for associations with functional limitations. Sense of control is associated with self-reported health in older Americans, but this association is partly confounded by affect.

Trends in the Health Status of Older Koreans

Several recent studies have suggested that mortality, disability, and self-rated health in older Americans have improved in last decade, but data from rapidly aging Asians remain sparse, and it is unclear that improvement extends to various health outcomes among older Korean populations. Trends in mortality, morbidity, disability, health behavior, and self-rated health in older Koreans were assessed. Data were obtained from the National Death Statistics (1983-2006) and three representative and repeated cross-sectional nationwide surveys: the National Elderly Activity Status and Welfare Needs Survey, the National Long-term Care Needs Survey, and the Korean National Health and Nutrition Examination Survey. All-cause mortality and disability decreased rapidly among older Koreans over the survey years, although some dimensions of health, including mortality from cancer, ischemic heart disease, and diabetes mellitus, have continued to deteriorate during this same period. Data on self-rated health have also confirmed this trend toward diminished health status. These results are not consistent with the theory of compression of morbidity. Given the complexity and controversies characterizing health changes in the older population, continuing examination of the latest information about various aspects of mortality, disability, morbidity, and health behavior is necessary for the development of future improvements in healthy life expectancies in older Koreans.

Trends In The Health Of Older Americans, 1970–2005

The health of Americans age sixty-five and older has improved on nearly all major indicators: longevity, self-reported health, and functioning. Both health care services use and health spending have risen. The increased use of restorative procedures and prescription medicines suggests that medical advances have had an important role in the better health of older Americans. Factors that might limit prospects for future improvements include rising rates of obesity and diabetes, particularly among the middle-aged.

The Effect of Obesity on Disability vs Mortality in Older Americans

The association between obesity and mortality is reduced or eliminated in older subjects. In addition to mortality, disability is an important health outcome. The objectives of this study were to examine the association between body mass index (BMI), calculated as weight in kilograms divided by height in meters squared, and subsequent disability and mortality among older Americans, as well as to estimate the effect of BMI on life expectancy and disability-free life expectancy among older Americans. We studied 8359 non-Hispanic white Americans, 1931 African Americans, and 2435 Mexican Americans 65 years or older who were not disabled at baseline from 5 sites of the Established Populations for Epidemiologic Studies of the Elderly. Measures included BMI, medical conditions, activities of daily living, and demographic information. Cox proportional hazards regression analysis was used to estimate the hazard ratios (HRs) for subsequent disability and mortality during 7 years of follow-up. Total life expectancy and disability-free life expectancy were estimated using the interpolation of Markov chain approach. The lowest HR (1.02; 95% confidence interval [CI], 0.94-1.10) for disability was at a BMI of 25 to less than 30. Subjects with BMIs of lower than 18.5 or 30 or higher at baseline were significantly more likely to experience disability during the follow-up period. In contrast, the lowest HRs for mortality were seen among subjects with BMIs of 25 to less than 30 (HR, 0.78; 95% CI, 0.72-0.85) and 30 to less than 35 (HR, 0.80; 95% CI, 0.72-0.90), with subjects with BMIs of lower than 25 or 35 or higher experiencing higher hazards for mortality. Disability-free life expectancy is greatest among subjects with a BMI of 25 to less than 30. Assessments of the effect of obesity on the health of older Americans should account for mortality and incidence of disability.

Issues Affecting the Health of Older Citizens: Meeting the Challenge

The health of older Americans will become a critical national policy issue during this century. As the population of older adults increases dramatically, there are few signs that adequate resources are available to meet the challenge of providing health care and good quality of life for older adults and their families. A fundamental change in the values emphasized in the American culture, and in other cultures, will be required to change the present health care system from one which focuses on diagnosis and treatment of disease to a system that attends to the major issues that affect quality of life of older adults and their families. This article discusses four critical areas influencing the quality of life of older Americans: providing resources to individuals to help manage chronic medical conditions, assuring a sufficient number of primary health care providers educated in geriatrics and gerontology, removing financial barriers to accessing health care and medications, and changing the American cultural value system that emphasizes disease treatment over providing emotional, educational, and support resources. To make these profound changes in the formal health care system, health care providers, health care organizations, and policy makers must commit to embracing the importance of quality of life as an integral component of health care for older citizens.

Racial and Ethnic Differences in the Health of Older Americans. National Research Council Committees

<i>Racial and Ethnic Differences in the Health of Older Americans</i>. National Research Council Committees

Racial and Ethnic Differences in the Health of Older Americans, Edited by Linda Martin and Beth Soldo

Racial and Ethnic Differences in the Health of Older Americans, Edited by Linda Martin and Beth Soldo