National Health And Aging Trends Study Research Articles

Claims-Based Frailty Index and Its Relationship with Commonly Used Clinical Frailty Measures.

The relationship of claims-based frailty index (CFI), a validated measure to identify frail individuals using Medicare data, and frailty measures used in clinical practice has not yet been fully explored. We identified community-dwelling participants of the 2015 National Health and Aging Trends Study (NHATS) whose CFI scores could be calculated using linked Medicare claims. We calculated 9 commonly used clinical frailty measures from NHATS in-person examination: Study of Osteoporotic Fracture Index (SOF), FRAIL Scale, Frailty Phenotype, Clinical Frailty Scale (CFS), Vulnerable Elder Survey-13 (VES-13), Tilburg Frailty Indicator (TFI), Groningen Frailty Indicator (GFI), Edmonton Frail Scale (EFS), and 40-item Frailty Index (FI). Using equipercentile method, CFI scores were linked to clinical frailty measures. Then, C-statistics and test characteristics of CFI to identify frailty defined by each clinical frailty measure were calculated. Of the 3,963 older adults, 44.5% were ≥75 years, 59.4% were female, and 82.3% were non-Hispanic White. A CFI of 0.25 was equipercentile to the following clinical frailty measures scores: SOF 1.4, FRAIL 1.8, Phenotype 1.8, CFS 5.4, VES-13 5.7, TFI 4.6, GFI 5.0, EFS 6.0, and FI 0.26. The C-statistics of using CFI to identify frailty defined by each clinical measure were above ≥0.70 except for CFS and VES-13. The optimal CFI cutpoints to identify frailty per clinical frailty measure ranged from 0.212 to 0.242, with sensitivity and specificity of 0.37-0.83 and 0.66-0.84, respectively. Understanding the relationship of CFI and commonly used clinical frailty measures can enhance the interpretability and potential utility of CFI.

Association between vision impairment and increased prevalence of falls in older US adults.

Vision impairment (VI) is associated with falls in older adults. However, past studies have relied on geographically constrained samples with limited generalizability or self-reports of visual difficulty. To date, there have not been nationally representative studies on the association of objective measures of visual function and falls outcomes. We used cross-sectional data from Round 11 of National Health and Aging Trends Study (NHATS), a nationally representative panel study of age-eligible Medicare beneficiaries (N = 2951). We performed Poisson regression to calculate the prevalence and prevalence ratio (PR) of >1 fall in the past year, any fall in the past month, fear of falling (FoF), and activity limitation due to FoF as a function of distance visual acuity, near visual acuity, and contrast sensitivity. Models were adjusted for demographic and health covariates and were weighted to make nationally representative parameter estimates. The weighted proportion of participants with VI was 27.6% (95% CI, 25.4%-29.9%). Individuals with any VI had a higher prevalence of falls compared with those without VI (18.5% vs. 14.1%, PR = 1.25, 95% CI 1.02-1.53). Specifically, contrast sensitivity impairment was associated with a higher prevalence of recurrent falls (20.8% vs. 14.7%; PR = 1.30, 95% CI 1.01-1.67) and recent falls (17.1% vs. 9.9%; PR = 1.40, 95% CI 1.01-1.94). This relationship existed even independent of near and distance visual acuity. Distance and near visual acuity were not significantly associated with falls. Having any VI was also associated with a higher prevalence of FoF (38.4% vs. 30.5%, PR = 1.17, 95% CI 1.02-1.34). The prevalence of falls is associated with poor contrast sensitivity but not with near or distance visual acuity. Findings suggest greater collaboration between geriatricians and eye care providers may be warranted to assess and address fall risk in older adults with VI.

Risk of dementia due to Co-exposure to air pollution and neighborhood disadvantage

BackgroundCo-exposure to air pollution and neighborhood disadvantage may influence cognition decline. We tested these associations in the context of dementia risk. MethodsWe leveraged a cohort of adults ≥65 years (n = 5397) enrolled from 2011 to 2018 in the National Health and Aging Trends Study (NHATS). Particulate matter (PM) ≤ 10 μm in diameter, PM ≤ 2.5 μm in diameter, carbon monoxide, nitric oxide, and nitrogen dioxide - and neighborhood disadvantage were tested for joint associations with dementia risk. Pollutant concentrations at the 2010 census tract level were assigned using the US Environmental Protection Agency's Community Multiscale Air Quality Modeling System. Neighborhood disadvantage was defined using the tract Social Deprivation Index (SDI). Dementia was determined through self- or proxy-report or scores indicative of “probable dementia” according to NHATS screening tools. Joint effects of air pollutants and SDI were tested using quantile g-computation Cox proportional hazards models. We also stratified joint air pollution effects across SDI tertiles. Analyses adjusted for age at enrollment, sex, education, partner status, urbanicity, income, race and ethnicity, years at residence, census segregation, and census region. ResultsSDI score (aHR = 1.08; 95% CI 0.96, 1.22), joint air pollution (aHR = 1.03, 95% CI 0.92, 1.16) and joint SDI with air pollution (aHR = 1.04, 95% CI 0.89, 1.22) were not associated with dementia risk. After accounting for competing risk of death, joint SDI with air pollution was not associated with dementia risk (aHR = 1.06; 95% CI 0.87, 1.29). In stratified models, joint air pollution was associated with greater risk of dementia at high (aHR = 1.19; 95% CI 0.87, 1.63), but not at medium or low SDI. ConclusionAir pollution was associated with greater dementia risk in disadvantaged areas after accounting for competing risks. Air pollution associations with dementia incidence may be attenuated when other risk factors are more prominent in disadvantaged neighborhoods.

Hearing and vision impairment and social isolation over 8 years in community-dwelling older adults

BackgroundLittle is known about the long-term impact of hearing and vision impairment on social isolation. This study quantifies the association between hearing, vision, and concurrent hearing and vision impairment (dual sensory impairment) and social isolation over 8 years among older adults.MethodsData were from the National Health and Aging Trends Study (NHATS), a cohort study (2011 – 2019) of U.S. Medicare beneficiaries aged 65 years and older. Social isolation was measured by a binary indicator incorporating four domains: living arrangement, core discussion network size, religious attendance, and social participation. Hearing, vision, and dual sensory impairments were measured by self-report and modeled categorically (no impairment [ref.], hearing impairment only, vision impairment only, dual sensory impairment). Associations between sensory impairments and odds of social isolation over 8 years were assessed using multivariate generalized logistic mixed models and adjusted for demographic and health characteristics.ResultsAmong 5,552 participants, 18.9% self-reported hearing impairment, 4.8% self-reported vision impairment, and 2.3% self-reported dual sensory impairment. Over 8 years, hearing impairment only was associated with 28% greater odds of social isolation. Participants with hearing impairment only were more likely to live alone and have limited social participation.ConclusionGreater clinical awareness of hearing impairment as a risk factor for social isolation can increase opportunities to identify and aid older adults who may benefit from resources and interventions to increase social connection and mitigate social isolation.

Analysis of agreement between measures of subjective cognitive impairment and probable dementia in the National Health and Aging Trends Study.

Subjective cognitive impairment (SCI) measures in population-based surveys offer potential for dementia surveillance, yet their validation against established dementia measures is lacking. We assessed agreement between SCI and a validated probable dementia algorithm in a random one-third sample (n=1936) of participants in the 2012 National Health and Aging Trends Study (NHATS). SCI was more prevalent than probable dementia (12.2%vs 8.4%). Agreement between measures was 90.0% and of substantial strength. Misclassification rates were higher among older and less-educated subgroups due to higher prevalence of false-positive misclassification but did not vary by sex or race and ethnicity. SCI sensitivity (63.4%) and specificity (92.5%) against dementia were comparable with similar metrics for the NHATS probable dementia measure against the "gold-standard" Aging, Demographics, and Memory Study-based dementia criteria, implying that population-based surveys may afford cost-effective opportunities for dementia surveillance to assess risk and inform policy. The prevalence of subjective cognitive impairment (SCI) is generally higher than that of a validated measure of probable dementia, particularly within the youngest age group, females, Whites, and persons with a college or higher degree. Percent agreement between SCI and a validated measure of probable dementia was 90.0% and of substantial strength (prevalence- and bias-adjusted kappa, 0.80). Agreement rates were higher in older and less-educated subgroups, driven by the higher prevalence of false-positive disagreement, but did not vary significantly by sex or race and ethnicity. SCI's overall sensitivity and specificity were 63.4% and 92.5%, respectively, against a validated measure of probable dementia, suggesting utility as a low-cost option for dementia surveillance. Heterogeneity in agreement quality across subpopulations warrants caution in its use for subgroup analyses.

Food sufficiency status and sleep outcomes in older adults: the National Health and Aging Trends Study (NHATS)

BackgroundStudies investigating the relationship between food insecurity and sleep among older populations are limited. This study aimed to cross-sectionally examine the associations between food sufficiency status and sleep outcomes in a nationally representative sample of older adults.MethodsOur study included 1,665 older adults (≥ 65 years), using data from the 2013 and 2014 National Health and Aging Trends Study (NHATS). Food insufficiency was determined via participants’ experience and utilization of food assistance programs (FAP). Sleep outcomes, including nighttime and total sleep hours, sleep latency, and sleep quality, were derived from self-reported data. Multivariable linear regression and logistic regression models were used to estimate the associations between food sufficiency status and sleep outcomes.ResultsIn 2013–2014, 86.1% of older adults were classified as food sufficient without FAP, 9.85% as food sufficient with FAP, and 4.08% as food insufficient. Adjusting for sociodemographic characteristics, food sufficient older adults with FAP reported more total sleep hours (\U0001d6fd = 0.31, 95% CI: -0.02, 0.64) than those participants who are food sufficient without FAP. Further adjusting for health factors, food sufficient participants with FAP had more nighttime sleep hours and greater total sleep hours compared to those participants food sufficient without FAP. Compared to those deemed as food sufficient without FAP, food sufficient participants with FAP had lower odds of having longer sleep latency (OR = 0.50, 95% CI: 0.28, 0.89), after further adjusting for physical function performance.ConclusionsAmong older adults, food sufficiency with FAP is associated with greater total sleep hours, greater nighttime sleep hours, and lower odds of longer sleep latency. Our findings may help inform nutrition food assistance programs targeting older populations.

Clinician Perception of Likelihood of Death in the Next Year Is Associated With 1-Year Mortality and Hospice Use Among Older Adults Receiving Home Health Care.

Background: Given the complex care needs of older adults receiving home health care (HHC), it is important for HHC clinicians to identify those with limited prognosis who may benefit from a transition to hospice care. Objectives: To assess the association between HHC clinician-identified likelihood of death and (1) 1-year mortality, and (2) hospice use. Methods: Prospective cohort study from the National Health and Aging Trends Study (NHATS) waves 2011-2018, linked to the Outcomes and Assessment Information Set (OASIS) HHC assessment and Medicare data among 915 community-dwelling NHATS respondents. HHC clinician-identified likelihood of death/decline was determined using OASIS item M1034. Multivariable logistic regression was used to assess the association between clinician-identified likelihood of death/decline and 1-year mortality and hospice use. Results: HHC clinicians identified 42% of the sample as at increased risk of decline or death. One year mortality was 22.3% (n = 548), and 15.88% (n = 303) used hospice within 12 months of HHC. HHC clinician-perceived likelihood of death/decline was associated with greater odds of 1-year mortality (odds ratio [OR], 6.57; confidence interval (95% CI), 2.56-16.90) and was associated with greater likelihood of hospice use (OR, 1.61; 95% CI, 1.00-2.62). Conclusion: HHC clinician perception of patients' risk of death or decline is associated with 1-year mortality. A better understanding of HHC patients at high risk for mortality can facilitate improved care planning and identification of homebound older adults who may benefit from hospice.

EXPANDING INSIGHTS INTO LATE-LIFE DISABILITY USING OBJECTIVE ASSESSMENTS IN NHATS

Abstract The National Health and Aging Trends Study (NHATS) is a NIA-funded national panel study that conducts annual in-home interviews with a representative sample of US Medicare beneficiaries ages 65 years and older. Designed as a platform for the scientific study of late life disability trends and trajectories, NHATS fosters research to guide efforts to maximize health, promote independent functioning, and enhance quality of life at older ages. NHATS has collected performance-based measures of physical function since its inception (2011). In 2021 NHATS responded to expanded interest in objective measures of sensory loss and physical activity, by adding measures of vision (visual acuity, contrast sensitivity), hearing (pure tone audiometry), and physical activity (accelerometry). This symposium will introduce these measures and demonstrate their scientific application to answer key research questions related to physical and cognitive health. Dr. Schrack will present an overview of the accelerometry data collection procedures, as well as results by key demographic and health-related features. Dr. Twardzik will examine the association between features of participants’ social and physical environments and patterns of accelerometry-based physical activity. Dr. Martinez-Amezcua will examine the association between hearing and phenotypic frailty. Dr. Davoudi will present evidence on the links among sensory and motor function and risk of dementia. Finally, Dr. Wanigatunga will describe the association between measures of hand and leg strength and dementia incidence. Collectively, these presentations will highlight population-level associations of objective measures of health and function with physical and cognitive outcomes to advance the science of disability in older adults.

ASSOCIATIONS OF HOME ENVIRONMENT AND UNMET CARE NEEDS AMONG LOW- AND MODERATE-INCOME OLDER ADULTS

Abstract The home environment is an increasingly important setting for long-term services and support. However, more information is needed about the relationship between the home environment and adverse consequences due to unmet needs (i.e., going without assistance with everyday activities such as eating or bathing) among older adults. We draw on information from N=4,898 low and moderate-income (annual income <$60,000) community-living respondents to the National Health and Aging Trends Study (NHATS). Two aspects of the home environment were directly observed by NHATS interviewers: home disorder (six items, including flooring problems, tripping hazards, pests) and home disrepair (five items, including missing siding and broken steps). NHATS asked participants who reported a disability whether they experienced one of seven adverse consequences (e.g., going without eating) due to no one being there to provide help or the activity is too difficult for them to complete on their own. About half of our sample (48.5%) reported a disability. We found home disorder and disrepair more prevalent among older adults with disabilities than those without (36.2% v. 28.1% and 18.2% v. 15.0%, respectively). Among older adults with disabilities, the presence of any home disorder and any home disrepair were associated with higher odds of experiencing an adverse consequence of an unmet care need in unadjusted analyses (home disorder: OR 1.33; 95% CI 1.11, 1.60; home disrepair: OR 1.16; 95% CI 0.90, 1.50). Findings show an association between home environment and unmet care needs and can signal the need to target housing-related risk factors in future interventions.

POPULATION ATTRIBUTABLE FRACTIONS FOR THE CONTRIBUTION OF HEARING LOSS ON DEMENTIA RISK ACROSS COHORT STUDIES

Abstract Estimates range from 2-8% of dementia cases in the US are attributable to hearing loss. Here, we investigate measurement considerations in quantifying the population attributable fraction (PAF) of dementia from hearing loss to highlight how differences in methodology can underestimate the PAF. We use two cohort studies of older adults in the US: the National Health and Aging Trends Study (NHATS), a nationally-representative sample of older Medicare beneficiaries; and the Atherosclerosis Risk in Communities (ARIC) Study, a large, community-based cohort study with longitudinal follow-up. Each study collects reference-standard hearing measures on participants. We have two specific aims. First, we compare two valid, formula-based approaches to quantifying the PAF. The advantages of quantifying a PAF using a well-characterized, biracial, community-based sample with a longitudinal design are weighed against those of using a nationally-representative sample with a cross-sectional design (moderate or greater hearing loss: PAF in NHATS, 16.9% [95% CI: 4.1-28.7%]; PAF in ARIC, 13.2% [95% CI: 2.2-20.9%]), highlighting the need for longitudinal designs in studies of the PAF from hearing loss. Second, we describe the impact of subjective versus objective measures of hearing loss on the PAF. In ARIC, subjective hearing loss was not associated with incident dementia (hazard ratio <1.0). PAFs of dementia from objective hearing loss were 6- to 8-fold greater than PAFs previously quantified using self-reported hearing measures in population-based studies. Our findings have broad implications for the inclusion of hearing loss as a potentially modifiable risk factor in clinical and public health initiative for dementia prevention.

EXPLORING THE LINK BETWEEN SLEEP AND DEMENTIA: MULTIFACETED APPROACHES

Abstract Sleep and sleep quality have been linked to cognitive function over time. The quality of caregiver sleep can also affect their ability to function and provide support to persons living with dementia. This symposium leverages longitudinal survey data from two large US population-based surveys: the National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC). This symposium aims to explore the relationship between sleep, cognitive function, and care activities for older adults living with and without dementia and their caregivers. First, Dr. Petrovsky will report findings that examined the relationship between caregiver sleep quality and persons living with dementia status using NHATS and NSOC data. Next, Dr. Esiaka will present cross-sectional findings from examining the relationship between older adult sleep quality, neighborhood disorder, and cognitive function using the NHATS data. Drs. Klingman and Sullivan will present the results of an analysis comparing the relationship between sleep and frequent hospitalization in persons living with dementia and those without dementia. Collectively, these papers will report on findings examining how a potentially modifiable factor, sleep, relates to cognitive function and caregiving.

NEW MEASURES AND POPULATION PREVALENCE OF VISION IMPAIRMENT IN NHATS

Abstract The National Health and Aging Trends Study (NHATS) is a nationally representative panel study of older U.S. adults that in 2021 (Round 11) added to its annual protocol a suite of objective visual function measures consisting of distance visual acuity, near visual acuity, and contrast sensitivity tests. These measures were developed to approximate clinical gold-standard tests, while allowing for administration on a tablet in participants’ homes. The tests were found to have good agreement with clinical gold-standards based on their limits of agreement, correlations, and lack of systematic bias between tests. In the initial 2021 fielding of the NHATS visual function measures, 27.8% (25.5%-30.1%) of U.S. adults over age 70 had one or more visual impairment (VI) (distance VI: 10.3% [8.9%-11.7%]; near VI: 22.3% [20.3%-24.3%]; contrast sensitivity impairment: 10.0% [8.5%-11.4%]), and the prevalence was highest among those who were older, had less education, lower income, and were of Hispanic ethnicity and non-White race. Additionally, the adjusted prevalence ratio for dementia was significantly higher among those with each type of VI compared to those with normal vision (moderate/severe distance VI=1.72 [1.26-2.35]; any near VI=1.40 [1.16-1.69]-; contrast sensitivity impairment =1.31 [1.04-1.66]). Since few other national studies of older adults include objective visual function measures, NHATS now serves as a vital resource for the study of vision epidemiology and the impact of VI and blindness on later-life health outcomes and trajectories.

INCIDENCE AND DYNAMICS OF MOBILITY DEVICE USE AMONG COMMUNITY-DWELLING OLDER ADULTS IN THE UNITED STATES

Abstract Mobility devices significantly enhance the activities and participation for individuals with mobility disability, particularly in the rapidly expanding population of older adults globally. This research reports patterns of mobility device use among community-dwelling older adults in the United States. Using the National Health and Aging Trends Study (NHATS) waves 1-9, data on basic demographics and mobility device use were collected in a nationally representative group of community-dwelling older adults (65+ years old). Mobility device use included canes, walkers, wheelchairs, and scooters. In a total of 47,722 person-years observed in community settings, 2,943 incident mobility device uses over an average of 3.8±3.0 years were identified among 2,591 participants, with an incidence rate of 61.7/1,000 person-year. Participants had an average age of 80.3±7.2 years, with 57.7% female, 70.2% White, 20.1% Black, and 5.7% Hispanic, and 34.6% living alone. The majority (51.3%) of incident mobility device use lasted no longer than one year, and only 18.6% continued for four or more years. The most popular combinations of mobility device types were cane only (44.3%), cane+walker (15.7%), walker only (15.1%), and walker+wheelchair (8.3%). 30.5% of community-dwelling older adults changed their patterns of mobility device use at least once, with the most common changes including cane only to cane+walker (16.4%), cane+walker to cane only (7.97%), walker only to walker+wheelchair (5.2%), and cane+walker to walker only (5.1%). Mobility device use among community-dwelling older adults is dynamic: use of mobility devices involves mostly short bouts and changes frequently, with a preference for a combination of mobility devices.

COVID-19 SYMPTOMS AND RISK OF COGNITIVE FUNCTION IMPAIRMENT/DEMENTIA AMONG COMMUNITY-DWELLING OLDER ADULTS

Abstract Most studies investigating the correlation between cognitive function (CF) and COVID-19 are cross-sectional, with less than one-year intervals post-contracting COVID-19. Using three waves of the National Health and Aging Trends Study (NHATS), this study aims to investigate the correlation between COVID-19 and CF impairment/dementia among community-dwelling older adults. After excluding known cases of dementia, we used before (2019 N=3,292), during (2020 N = 2,756) and one year after COVID-19 pandemic (2021 N=2,379) data. The severity of the disease and COVID-19 preventing contact with family and friends (CFF) were self-reported (in 2020), executive function (EF) was measured by Clock Drawing Test (CDT), memory using delay 10-words recall test (DWRT), and NHATS dementia classification (in 2021). Multivariable ordered logistic regression results showed no significant correlation between dementia (i.e., normal, probable, and possible) and self-reported COVID-19 symptoms or preventing CFF. COVID-19 symptoms did not predict the risk of EF impairment. However, controlling for race/ethnicity interaction with CFF showed Blacks with limited CFF were 74% and 136% more likely to have dementia and EF impairment than their White counterparts, respectively. Experiencing COVID symptoms in 2020 increased the risk of delayed memory impairment in 2021 by 63%, while limited CFF increased this risk by 39%, which was 120% higher for Blacks than Whites. In conclusion, experiencing COVID-19 symptoms can affect delayed memory when this effect cannot be specified as dementia. The impact of social isolation caused by the COVID-19 pandemic on CF and increasing the risk of dementia is more harmful among Blacks than Whites.

POPULATION REFERENCE VALUES FOR PEAK EXPIRATORY FLOW IN OLDER US ADULTS

Abstract Respiratory function predicts physical and cognitive health outcomes in older adults. Peak expiratory flow (PEF) is simple, inexpensive, and has been validated against traditional respiratory function measures (FEV1, FVC). PEF has additional utility because it measures maximal respiratory effort without relying on spirometry equipment. However, there is a lack of epidemiological data to support PEF reference values for aging populations, especially those ≥80 years. The National Health and Aging Trends Study (NHATS) is a large, nationally representative sample of US adults ages ≥65 that offers a unique opportunity to develop PEF population reference values. Using a healthy subsample from NHATS Round 1 (N=2,082), excluding those with history of smoking, respiratory, or cardiovascular diseases, we applied NHATS sampling weights to estimate age- and sex-specific PEF percentiles. The sample was stratified by sex (68.9% female) and categorized into six, 5-year age groups: 65-69, 70-74, … ≥90 (36.6% age ≥80 years). In a secondary analysis, we estimated age- and sex-specific PEF/height3 percentiles, per current recommendations. We calculated 5th, 95th, and 10th, 20th, … 90th percentiles, by age and sex, for both absolute and height-adjusted PEF. PEF population estimates were higher in healthy males vs. females (456.8±130.1 vs. 293.9±89.9 liters/minute [mean±SD]). After adjusting for height, estimates remained higher for males (83.1±22.4 vs. 70.9±21.5 liters/m3/minute) and higher for younger (65-79 years) vs. older (≥80 years) participants (78.9±19.7 vs. 62.9±26.6 liters/m3/minute). These results may serve as PEF population reference values for healthy older adults in the US.

ASSOCIATIONS BETWEEN HEARING LOSS AND HEALTH CARE UTILIZATION: EVIDENCE FROM NHATS

Abstract We investigated the association between self-reported hearing loss and healthcare utilization among community dwelling older Medicare beneficiaries (age ≥65) who were enrolled in the 2011 cycle of the National Health and Aging Trends Study (NHATS). Participants’ survey data were linked to fee-for-service Medicare claims data during the 2011-2016 period. Hearing loss was ascertained using based on participants’ hearing aid use, and difficulty hearing in various noisy situations. Those who reported any difficulty hearing or reported hearing aid use were categorized as having hearing loss. Healthcare utilization included: (1) number of inpatient hospitalizations, (2) number of Emergency Department visits, and (3) total number of days spent during hospitalizations per calendar year. Each participant with hearing loss was matched to a participant without hearing loss using a one-to-one propensity score matching to minimize confounding bias. Using generalized estimating equations, we found that among our matched sample those with hearing loss had 21% (Incidence Rate [IR]=1.21; 95% Confidence Interval [CI]= 1.06,1.37) higher rates of emergency department visits, and 48% (IR = 1.48; 95% CI: 1.20,1.82) higher number of days spent in a hospital over the 6-year period from 2011-2016. No association was found between hearing loss and the number of hospitalizations. These finding suggest that older adults with hearing loss may be at risk for increased healthcare utilization. Interventions for hearing loss, such as the use of hearing aids, might reduce healthcare utilization and associated expenditures among older adults in the U.S. Medicare program.

SOCIAL PARTICIPATION AMONG OLDER ADULTS WITH UNMET NEED CONSEQUENCES: FROM A DISABILITY PERSPECTIVE

Abstract This study examines the relationship between social participation and consequences arising from unmet ADL, IADL, and mobility needs using disability studies frameworks. The aging field has yet to fully incorporate theoretical perspectives from disability scholarship into our understanding of health, wellbeing, accessibility and inclusion. By situating the experience of aging, aging with care needs, and having unmet care needs within a disability studies lens we gain insight into the ways we are called to redesign the provision of supportive services to ensure meaningful inclusion in community. To illustrate this idea, we use Wave 5 from the National Health and Aging Trends Study (NHATS) (n=7,070) to examine the relationship between ADL, IADL, and mobility unmet need consequences and social participation. Both social participation and unmet need consequences among older adults have been explored from healthcare, quality of life, and economic perspectives. However, there is a lack of scholarship linking these two concepts using a disability lens. Preliminary results from a series of linear regressions show a significant, negative relationship between presence of unmet ADL and mobility need consequences and social participation (p < .001). These findings indicate that experiencing unmet care needs may not only have detrimental effects on health, but on overall adult wellbeing and may be infringing on the ability of older adults to engage with community to the extent they wish. By applying disability frameworks, aging researchers are called to reexamine the ways in which we consider accessibility and full inclusion of older adults with care needs.

THE RELATIONSHIP BETWEEN MOOD OF CAREGIVERS AND CARE RECIPIENTS WITH DEMENTIA

Abstract Anxiety and depression are common behavioral and psychological symptoms of dementia. Although there are many individual level factors related to their anxiety and depression, it is unknown whether caregivers’ mood influence anxiety and depression of their care recipients with dementia. Therefore, this study was conducted to examine the relationship between anxiety and depression of caregivers and that of care recipients with dementia. This study was a secondary data analysis using the National Health and Aging Trends Study (NHATS) Round 7 data and National Study of Caregiving (NSOC) III. This study used 553 dyads of older adults aged 65 years and older who had probable dementia at the time of the interview and their family caregivers. Anxiety and depression of both the caregivers and care recipients of dementia were measured with the Generalized Anxiety Disorder-2 (GAD-2) and Patient Health Questionnaire-2 (PHQ-2) respectively. Descriptive statistical analyses, chi-square tests, and logistic regression analyses were used. There were significant relationships between the caregivers’ anxiety and the care recipients’ anxiety presentation (Chi2=10.06, p< 0.01). Similar relationships were also found for depression (Chi2=5.22, p=0.02). Logistic regression analyses showed that when caregivers had anxiety or depression, it was more likely that their care recipients show anxiety (OR=2.25, p=0.002, 95% CI=1.35-3.74) or depression (OR=1.78, p=0.023, 95% CI=1.08-2.94). Because dementia caregivers’ negative mood can influence their care recipients’ mood, health care professionals should conduct early interventions for caregivers with negative moods.

THE ASSOCIATION OF HEARING LOSS AND FRAILTY AMONG OLDER ADULTS IN THE US

Abstract Frailty is common in older adults and increases the risk of functional limitations and death. Hearing loss affects ~2/3 of older adults in the U.S. and is associated with poorer physical and cognitive function and social isolation, which may increase the risk for frailty. We aimed to determine if hearing loss is associated with higher odds of being frail or pre-frail versus robust and if hearing aid use is protective. We analyzed data from 2,361 participants from the National Health and Aging Trends Study (NHTAS), a U.S. nationally representative sample of older adults, collected in 2021. Hearing was assessed by pure-tone audiometric testing, and we used a speech-frequency (0.5-4 kHz) better hearing ear’s pure-tone average (BPTA) to categorize participants into no hearing loss (BPTA≤25 dB HL), mild (26-40), and moderate or greater (>40) hearing loss. Physical frailty was categorized according to the presence of the frailty phenotype components (unintentional weight loss, exhaustion, low physical activity, weakness, slow walking speed) into robust (0), pre-frail (1-2), and frail (≥3). In our study population (mean age=81, 56% female, 19% Black), there were 1,724 (73%) participants with hearing loss. Using multinomial logistic regression, we found that participants with moderate or greater hearing loss (vs. those without) had higher odds of being frail versus robust (OR=1.82, 95% CI 1.11, 2.99, p-trend=0.016). Hearing loss may be a risk factor for frailty. Future studies on the impact of hearing interventions in preventing and managing frailty will have significant public health and clinical importance.

SOCIAL ISOLATION AS A RISK FACTOR FOR GRIP STRENGTH DECLINE: FINDINGS FROM THE NHATS STUDY

Abstract Low grip strength is associated with negative health outcomes among older adults, including poor physical performance, sarcopenia, and all-cause mortality. Social isolation has been also linked with decreased physical function and mortality. Limited studies examined whether social isolation is a risk factor for grip strength decline among older adults and whether race differences exist in this association using population-based longitudinal data. The aim of this study was to evaluate the relationship between social isolation and grip strength among older adults and whether the relationship varies by race and over time. We analyzed National Health and Aging Trends Study (NHATS) data (2015 - 2018) and the sample included 4877 adults > 65 years old. Grip strength was measured using a digital hand dynamometer. Social isolation was measured using six NHATS items from the literature and the composite score ranged from 0 to 6, with a higher score indicating more isolation. The sample mean age was 75 (SD = 22; 68 - 110 years). Repeated-measures analysis of variance showed significant differences in grip strength across social isolation scores (p = .001) indicating that socially isolated older adults have significantly lower grip strength. We also found that grip strength significantly decreased by 2.046 kg over the four-year period (p = < .001). The findings showed no significant difference in grip strength across race and change in grip strength across time did not differ by race and social isolation. Interventions to improve muscle strength and reduce social isolation among older adults are needed.