Influence of Care Network Characteristics on Physician Visit Experiences for Black, White, and Hispanic Older Adults With Dementia

Size and Composition of Caregiver Networks Who Manage Medications for Persons Living With Dementia: Cross-Sectional Analysis of the 2011-2022 National Health and Aging Trends Study

Background

Family caregivers commonly help manage medications taken by persons living with dementia. Recent work has highlighted the importance of caregiver networks, which are multiple caregivers managing care for a single person, on managing care for persons living with dementia, especially medication management. However, less is known about the composition of caregiver networks.

Objective

The objective of this analysis was to describe the composition of caregiver networks that manage medications, the factors associated with helping with medications within caregiver networks, and whether racial or ethnic differences exist in caregiver network composition.

Methods

This cross-sectional secondary analysis used data from the National Health and Aging Trends Study (NHATS) "other person" files from 2011 to 2022. Descriptive statistics were calculated for caregivers who were identified as helping manage medications for a person with dementia. Mixed-effect logistic regression was used to determine factors associated with helping with medications among caregiver networks, with odds ratios converted to predicted probabilities using marginal standardization. A P value of .05 or less was considered statistically significant. Secondary analysis was stratified by race and ethnicity due to identified cultural differences in living situation and overall caregiver network composition.

Results

A total of 15,809 caregivers were analyzed. Of those, 3048 (19.2%) managed medications for persons living with dementia. Caregiver networks that manage medications tend to include a spouse or partner and child, at least one of whom has a college degree. Every person with dementia reported at least 1 person who managed their medications. White persons with dementia had an average of 2.4 (range 1-9) people who managed medications, while Black or African American persons with dementia had an average of 2.8 (range 1-9) and Hispanic or Latino persons with dementia had an average of 2.9 (range 1-8) people who managed medications. Spouses were most likely to manage medications across all racial and ethnic groups. In regression modeling, female gender (predicted probability [PP] 15%, 95% CI 13%-17%; P<.001), Black or African American race (PP 7%, 95% CI 4%-10%; P<.001), and Hispanic ethnicity (PP 4%, 95% CI 1%-9%; P=.04) were associated with an increased probability of helping with medications.

Conclusions

The size and composition of caregiver networks that manage medications for persons living with dementia differ by race and ethnicity but typically includes at least 2 people, one of whom has a college degree. Helping with medications was more likely among non-White family caregivers, while White patients with dementia were more likely to use paid help to manage medications.

Association of Caregiving Receipt With Mental Health Utilization in a National Cohort of Older Adults

OBJECTIVE

There exist significant age disparities in mental health (MH) utilization, such that older adults, including older veterans, are much less likely to use MH services. In-home caregivers represent a novel, yet understudied, pathway to increase appropriate utilization. We sought to examine the association between receiving caregiving assistance and MH utilization and test moderation effects of cognitive status and depression severity in a sample of older veterans.

METHODS

Cross-sectional, mixed effects logistic regression with moderation analyses was used with a unique data resource combining survey data from the 2000-2012 U.S. Health and Retirement Study with Veterans Affairs (VA) healthcare administrative records. The analytic sample included N=1,957 Community-dwelling veterans (mean age 68.2 [9.7]), primarily male (96.5%) and non-Hispanic white (77.0%). Measures included MH utilization extracted from VA records or self-report; CESD-8 for depressive symptoms; and the Langa-Weir cognitive status classification using the modified TICS.

RESULTS

After accounting for demographics, spousal caregiver availability, health factors, and socioeconomic status, caregiving receipt was associated with two-fold odds of MH utilization, compared to receiving no assistance (8,839 person-year observations; OR = 2.02; 95% CI 1.54-2.65) and remained similar following VA policy changes to enhance MH access. Exploratory analyses revealed that categories of cognition and depressive symptoms may moderate the association.

CONCLUSION

Receipt of any in-home caregiving is associated with increased likelihood of MH use by older adults. Caregivers may represent an underutilized resource to reduce age-related mental health access disparities.

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

Background and Objectives

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.

Research Design and Methods

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.

Results

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.

Discussion and Implications

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.

Association Between Pain and Fall Worry Among Community-Dwelling Older People With Cognitive Impairment in the United States

Background and Objectives

Previous studies have found that pain is associated with fall worry among community-dwelling older people. However, both pain and fall worry are poorly understood and underaddressed among community-dwelling older people with cognitive impairment (CI). It is essential to examine the association between pain and fall worry, and how sociodemographic and health characteristics may shape fall worry among this subgroup.

Research Design and Methods

We used data from the 2015 National Health and Aging Trends Study (analytic sample: n = 1150 community-dwelling older people with CI; were self-interviewed; mean age: 81; age range: 65-107). The number of pain sites in the prior month was assessed by presenting a card listing common pain sites (eg, back, knees). Two questions assessed past-month fall worry, "did you worry about falling down" and "did this worry ever limit your activities." Following descriptive statistics, we fit multinomial logistic regression models to examine the associations between different pain characteristics (number of sites, severity, location) and non-activity-limiting and activity-limiting fall worry.

Results

Non-activity-limiting fall worry was endorsed by 21.1% and activity-limiting fall worry by 13.6% of community-dwelling older people with CI. After adjusting for sociodemographic characteristics and fall-worry-related covariates, multinomial logistic regression analysis found that a greater number of pain sites (relative risk ratio [RRR] = 1.22, 95% Confidence Interval [95% CI] = 1.12-1.33, p <.001) and severe pain (RRR = 2.05, 95% CI = 1.12-3.75, p = .020) was associated with activity-limiting fall worry. Both lower body (knee, foot, and leg) and upper body (hand, wrist, shoulder, neck, and stomach) pain were found to be associated with a high risk of activity-limiting fall worry.

Discussion and Implications

These findings suggest pain and fall worry are common among community-dwelling older people with CI and can be elicited directly from those who are communicative. Fall prevention for this population should prioritize pain management to mitigate activity-limiting fall worry because activity limitation increases the risk of falls.