Racial differences in future care planning in late life

Racial differences in the effect of verbal and nonverbal memory on concrete planning for future care needs among older adults: a multi-group structural equation modeling approach

Concrete planning for future care needs may positively impact older adults' subsequent mental health and quality of life. However, the cognitive factors that facilitate concrete planning among Black and White older adults are still poorly understood. We investigated whether there are significant differences between Black (n = 159) and White (n = 262) older adults in concrete planning and explored racial differences in the relationship between verbal and nonverbal episodic memory and concrete planning. Results revealed that Blacks showed lower engagement in concrete planning and lower scores than Whites on each verbal and nonverbal memory task. For Blacks, but not Whites, verbal memory and nonverbal memory performance predicted concrete planning with higher nonverbal memory relating to less concrete planning and higher verbal memory associated with more concrete planning. Our findings suggest racial differences exist in how episodic verbal and nonverbal memory affect concrete planning, a crucial factor for older adults' preparation for future care.

Educational Attainment and Perceived Need for Future ADL Assistance

The current study examined whether educational attainment was associated with perceived need of assistance with future activities of daily living (ADL) among middle-aged and early older-aged adults in the United States. Data for 54,946 adults aged 40-65 years from the 2011-2014 National Health Interview Survey (NHIS) were analyzed using ordered logistic regression. Adults with more education will on average need less ADL assistance than adults with less education. Paradoxically, this study found that higher levels of formal education were associated with perceiving more need for future ADL assistance. This association was also found to vary between males and females. Building knowledge of long-term care planning into existing public educational structures and providing this knowledge to adults no longer involved in the formal educational system through medical providers may lead to better anticipation of future care needs.

Serious About Getting Old?: Variability of Individual Old Age Risk Management in Czechia

The global trend of transferring responsibility for dignified aging from the state to individuals is conducive to a variability of alternative attitudes and strategies. Despite having important implications for both the state and individuals, the variability of old age risk management has not been fully appreciated by social policy. Social policy cannot adapt to every individual, but it can reflect various categories of citizens and their patterns of old age risk management. In this article, we navigate the plethora of individual choices by identifying patterns of strategic behavior in old age risk management in society. Based on our data from the original 2018 survey, representative for the Czech population, we identify four distinctive strategies: risk taking, risk avoiding, risk neglecting, and risk preventing. We conclude by discussing how the data gathered and analyzed through our research may help social policy actors better understand sources of variability and design more effective policy interventions.

PLAN: Preparing and Living for Aging Now; A descriptive study invesitigating older adults' readiness to plan for aging and frailty

OBJECTIVES

Many older adults want to age in place but do not make plans. Understanding how and under what conditions adults prepare/plan ahead is vital given population aging and increasing frailty. This study examines the stages of change and experiences (personal/others) related to readiness to plan for aging and frailty.

METHODS

Descriptive cross-sectional.

SETTING

Community-dwelling.

PARTICIPANTS

Adults aged 50-80(N = 252).

DATA COLLECTION

demographics, other characteristics, stages of change, experiences (personal/others) was assessed with survey questions.

DATA ANALYSIS

frequencies/percentages, McNemar test, Chi-square.

RESULTS

Among domains, participants' percentages in action/maintenance stages ranged from 28.2% (cognitive) to 68.7% (financial). Participants had increased experience with others across domains rather than self. Older participants (≥ 70) vs. younger (50-69) reported statistically significant greater planning in action/maintenance stages for all domains (p < .05) with the exception of cognitive.

DISCUSSION

Examining the concept of planning for aging and frailty provides a foundation for future work to develop/test interventions aimed at increasing readiness for aging.

A Decade of Studying Drivers of Disparities in End-of-Life Care for Black Americans: Using the NIMHD Framework for Health Disparities Research to Map the Path Ahead

OBJECTIVE

The purpose of this paper is to provide a review of the existing literature on racial disparities in quality of palliative and end-of-life care and to demonstrate gaps in the exploration of underlying mechanisms that produce these disparities.

BACKGROUND

Countless studies over several decades have revealed that our healthcare system in the United States consistently produces poorer quality end-of-life care for Black compared with White patients. Effective interventions to reduce these disparities are sparse and hindered by a limited understanding of the root causes of these disparities.

METHODS

We searched PubMed, CINAHL and PsychInfo for research manuscripts that tested hypotheses about causal mechanisms for disparities in end-of-life care for Black patients. These studies were categorized by domains outlined in the National Institute of Minority Health and Health Disparities (NIMHD) framework, which are biological, behavioral, physical/built environment, sociocultural and health care systems domains. Within these domains, studies were further categorized as focusing on the individual, interpersonal, community or societal level of influence.

RESULTS

The majority of the studies focused on the Healthcare System and Sociocultural domains. Within the Health Care System domain, studies were evenly distributed among the individual, interpersonal, and community level of influence, but less attention was paid to the societal level of influence. In the Sociocultural domain, most studies focused on the individual level of influence. Those focusing on the individual level of influence tended to be of poorer quality.

CONCLUSIONS

The sociocultural environment, physical/built environment, behavioral and biological domains remain understudied areas of potential causal mechanisms for racial disparities in end-of-life care. In the Healthcare System domain, social influences including healthcare policy and law are understudied. In the sociocultural domain, the majority of the studies still focused on the individual level of influence, missing key areas of research in interpersonal discrimination and local and societal structural discrimination. Studies that focus on individual factors should be better screened to ensure that they are of high quality and avoid stigmatizing Black communities.

Appraisal of Health States Worse Than Death in Patients With Acute Stroke

Objective

To identify health states that patients with acute stroke deem worse than death and to explore potential predictors for these ratings.

Methods

This was a cross-sectional study involving patients admitted to an urban comprehensive stroke center with acute stroke. Participants were asked to rate 10 possible health states/functional outcomes as better or worse than death using a 5-point Likert scale. Principal component analysis (PCA) was used to reduce clusters of correlated ratings to summary components (factors). These components were then analyzed using linear regression to identify possible predictive variables.

Results

Eighty patients participated. The states deemed equal to or worse than death by the majority of participants were relying on a breathing machine (66%) or feeding tube (66%), persistent confusion (62%), inability to communicate with others (58%), and bowel/bladder incontinence (50%). PCA revealed 2 factors of correlated variables: factor 1 composed primarily of relying on a feeding tube or breathing machine, incontinence, chronic pain, and persistent confusion, and factor 2 composed primarily of using a wheelchair, being bedbound, living in a nursing home, and requiring help for activities of daily living. The only significant predictor found was race for factor 1, with black participants finding these states more preferable to death than white participants.

Discussion

A substantial number of patients found multiple common outcomes of stroke to be the same as or worse than death. This highlights the importance of realistic discussions about expected functional outcomes with patients and/or their surrogate decision makers when considering goals of care after stroke.

Meeting Challenges of Late Life Disability Proactively

Discussions of disability in the gerontological and the disability studies literatures have seldom considered unique perspectives and needs of older adults. Disability has often been stigmatized and viewed as antithetical to successful aging. We call for expansion of prevailing paradigms of disability to address the resilience and continuing human potential of older adults living with disabilities. In addition to recognizing the environmental context of disability, we propose greater attention to adaptive potential of disabled older adults. We discuss 6 types of proactive adaptations that can contribute to empowerment, meaning, enhanced quality of life and psychological well-being among persons living with late-life onset disabilities. These include: (a) helping others, (b) planning for future care, (c) marshaling intergenerational support, (d) self-advocacy for responsive health care, (e) making environmental modifications to improve safety and comfort of the home, and (f) finding strength in spiritual pursuits. Enacting proactive adaptations can contribute to resilience in facing late life impairments and functional limitations. Such efforts can complement utilization of services and obtaining accommodations. Maintaining life satisfaction among older adults living with disabilities also involves focus on transcendent personal goals and acceptance of an altered self. We note how a more integrative view of medical and social dimensions of disability, infused with concepts of human agency, contributes to rapprochement between alternative disciplinary orientations to late life disability. Without negating society’s important responsibilities for accommodating to needs of older adults living with disability, we reaffirm their potential for greater control and self-determination through proactive adaptations.