Dementia Prevalence, Incidence and Mortality Trends Among US Adults Ages 72 and Older, 2011-2021

BACKGROUND

U.S.-focused studies have reported decreasing dementia prevalence in recent decades, but have not yet focused on the implications of the COVID-19 pandemic for trends.

METHODS

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 pre-pandemic periods. To minimize classification error, individuals must meet dementia criteria for two consecutive rounds.

RESULTS

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). Declines over the 2011-2021 period were concentrated among those ages 80-89 and non-Hispanic White individuals. Declines in dementia incidence were stronger for the 2011-2021 period than for the pre-pandemic 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 (28%) than over the pre-pandemic period (45%).

CONCLUSIONS

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.

Exposure to childhood maltreatment predicts adult physiological dysregulation, particularly inflammation

Although a growing literature describes the effects of negative childhood experiences on biological outcomes, it is difficult to compare results across studies because of differences in measures of childhood experiences, biological markers, sample characteristics, and included covariates. To ensure comparability across its analyses, this study used a single national survey of adults in the United States-the Midlife in the United States (MIDUS) study-to examine comprehensively the association between adverse childhood experiences, operationalized as childhood maltreatment (CM), and biological markers of risk for poor health and to assess whether these associations differ by type of maltreatment, sex, or race. The sample included 1254, mostly White (78%), adults aged 34-86 years (mean age 57 years), 57% of whom were female. We present incidence rate ratios (IRR) from negative binomial and Poisson regressions to examine the relationships between exposure to CM (emotional, physical, and sexual abuse; emotional and physical neglect; and a CM-index reflecting frequency across all five types of maltreatment) and four biological risk summary scores (overall physiological dysregulation, cardiometabolic risk, inflammation, and hypothalamic pituitary axis/sympathetic nervous system (HPA/SNS) function). We also tested whether the effect of each type of CM varied by sex and by race. The CM-index was associated with higher overall physiological dysregulation and inflammation, but the associations were weaker and not statistically significant for cardiometabolic risk and HPA/SNS function. With the exception of a possible sex difference in the association between sexual abuse and overall physiological dysregulation, there was little evidence that the associations varied systematically by type of CM or by sex or race. We conclude that exposure to CM predicts adult biological risk, particularly inflammation. Inconsistency with previous research suggests that additional research is needed to confirm findings regarding sex and race differences.

Work as Overload or Enhancement for Family Caregivers of Older Adults: Assessment of Experienced Well-Being Over the Day

Objective

This study examines work and care patterns and their association with experienced well-being over the course of the day and tests a moderating effect of gender.

Background

Many family and unpaid caregivers to older adults face dual responsibilities of work and caregiving. Yet little is known about how working caregivers sequence responsibilities through the day and their implications for well-being.

Method

Sequence and cluster analysis is applied to nationally representative time diary data from working caregivers to older adults in the U.S. collected by the National Study of Caregiving (NSOC) (N=1,005). OLS regression is used to test the association with well-being and a moderating effect of gender.

Results

Among working caregivers, five clusters emerged, referred to as: Day Off, Care Between Late Shifts, Balancing Act, Care After Work, and Care After Overwork. Among working caregivers, experienced well-being was significantly lower among those in the Care Between Late Shifts and Care After Work clusters relative to those in the Day Off cluster. Gender did not moderate these findings.

Conclusion

The well-being of caregivers who split time between a limited number of hours of work and care is comparable to those who take a day off. However, among working caregivers balancing full-time work - whether day or night - with care presents a strain for both men and women.

Implications

Policies that target full-time workers who are balancing care for an older adult may help increase well-being.

The Strength of Parent-Adult Child Ties in Biological Families and Stepfamilies: Evidence From Time Diaries From Older Adults

We examine older partnered parents' time spent with adult children in biological and step families, treating time together as an indication of relationship strength. Using a unique national sample of U.S. time diaries from the Panel Study of Income Dynamics, we investigate time with all adult children combined and with each adult child. We find that time together depends on family structure and parent-adult child dyadic relationship type embedded in family structure. In analyses of all adult children combined, an older parent is more likely to spend time with adult children in biological families than in stepfamilies only when there is no shared biological child in the stepfamily. In dyadic analyses, a parent's tie with an adult child who is a biological child of both partners is stronger in stepfamilies than in biological families. Moreover, among stepfamilies, ties are not uniformly stronger with biological children relative to stepchildren; differences emerge only in more complex families when each partner has biological children from previous relationships. Our findings challenge the view that ties with older parents are always weaker with stepchildren in stepfamilies and point to the importance of considering parent-child relationships in the broader family context.

A day in the life of caregivers to older adults with and without dementia: Comparisons of care time and emotional health

INTRODUCTION

How care-related time and emotional health over the day differ for those assisting older adults with and without dementia is unclear.

METHODS

Using 2134 time diaries from the National Study of Caregiving, we compared emotional health and care time for caregivers of older adults with and without dementia.

RESULTS

Caregivers to older adults with dementia experienced worse (higher scores) on a composite measure of negative emotional health (4.2 vs 3.3; P < .05) and provided more physical/medical care (33.7 vs 16.2 minutes; P < .05) and less transportation assistance (12.6 vs 24.8 minutes; P < .05) than other caregivers. In models, providing physical/medical care was associated with worse emotional health (β = 0.15; P < .01) and socializing with the care recipient was associated with worse emotional health when the recipient had dementia (β = 0.28; P < .01).

DISCUSSION

Findings highlight the opportunity for targeted interventions to address the emotional consequences of different types of care time in the context of dementia.

Incident Care Trajectories for Older Adults with and without Dementia

OBJECTIVE

Despite cross-sectional evidence that persons living with dementia receive disproportionate hours of care, studies of how care intensity progresses over time and differs for those living with and without dementia have been lacking.

METHODS

We used the 2011-2018 National Health and Aging Trends Study to estimate growth mixture models to identify incident care hour trajectories ("classes") among older adults (N=1,780).

RESULTS

We identified four incident care hour classes: "Low, stable," "High, increasing," "24/7 then high, stable," and "Low then resolved." The high-intensity classes had the highest proportions of care recipients with dementia and accounted for nearly half of that group. Older adults with dementia were 3-4 times as likely as other older adults to experience one of the two high-intensity trajectories. A substantial proportion of the 4 in 10 older adults with dementia who were predicted to be in the "Low, stable" class lived in residential care settings.

DISCUSSION

Information on how family caregiving is likely to evolve over time in terms of care hours may help older adults with and without dementia, the family members, friends, and paid individuals who care for them, as well as their health care providers assess and plan for future care needs.

Change in Mobility: Consistency of Estimates and Predictors Across Studies of Older Adults

OBJECTIVES

This study compares estimates and determinants of within-individual changes in mobility across surveys of older U.S. adults.

METHODS

Data come from the Health and Retirement Study (HRS) and the Midlife in the United States (MIDUS) study. Measures of mobility comprise self-reported level of difficulty with walking several blocks, going up several flights of stairs, lifting and carrying 10 pounds, and stooping. Predictors include sociodemographic characteristics and indicators of health and health behaviors. We pool the datasets and estimate weighted lagged dependent variable logistic regression models for each activity, assessing cross-study differences using interaction terms between a survey indicator and relevant variables.

RESULTS

Estimates of declines in mobility differ substantially across surveys for walking, lifting and carrying, and stooping, but there are no between-survey differences in the probability of (not) recovering from a limitation. With the exception of age, determinants of change are similar between studies. For lifting/carrying and stooping, the age-related increase in developing limitations is less steep at younger ages for HRS respondents than MIDUS respondents, but steeper at older ages.

DISCUSSION

To compare estimates of mobility change across surveys, mobility measures would need to be harmonized. Determinants of mobility change, however, are more comparable.

Time Use and Experienced Wellbeing of Older Caregivers: A Sequence Analysis

BACKGROUND AND OBJECTIVES

The diminished wellbeing of caregivers is well documented, but studies typically draw upon coarse measures of time use and thus provide limited understanding of the role of specific care activities in the daily lives of care providers. This study uses time diary data to explore whether there are signature care patterns throughout the day and whether these care patterns have implications for caregivers' experienced wellbeing.

RESEARCH DESIGN AND METHODS

Using a national sample of 511 time diaries from older caregivers in the Disability and Use of Time supplement to the Panel Study of Income Dynamics, we examine minutes of care provided on the prior day, overall and for four broad care categories (household, personal care, transportation, and visiting), and patterns of care over the day, the latter based on sequence and cluster analysis.

RESULTS

Older caregivers spend on average 2.3 hr providing care to another adult on care days. Caregiving follows a roller-coaster pattern over the day, peaking at mealtimes. Sequence analysis suggests five distinctive caregiving patterns, which vary by both demographic characteristics of the caregiver (gender, work status) and care arrangement type (relationship to recipient, whether sole caregiver to recipient). The 40% who provide only marginal assistance of about 1 hr report lower experienced wellbeing than the 28% who provide sporadic assistance with a mix of activities for about 2 hr.

DISCUSSION AND IMPLICATIONS

A substantial share of older caregivers provides only 1 hr of assistance on a given day but appears to be at risk for reduced wellbeing. Better understanding of the reason for their marginal involvement and reduced wellbeing is warranted.

Do Family Relationships Buffer the Impact of Disability on Older Adults' Daily Mood? An Exploration of Gender and Marital Status Differences

OBJECTIVE

We evaluate whether non-spousal family support and strain moderate the effect of disability on two daily emotions (happiness and frustration) among older adults, and whether these patterns differ by gender among married persons, and by marital status among women.

BACKGROUND

Stress buffering perspectives predict that harmful effects of stress on well-being are buffered by family support, whereas stress proliferation models suggest these effects are intensified by family strain. The extent to which family relationships moderate associations between stress and well-being may vary on the basis of gender and marital status, as non-spousal family ties are considered especially salient for women and those without a romantic partner.

METHOD

Daily diary data are from the 2013 Disability and Use of Time supplement to the Panel Study of Income Dynamics (n=1,474), a national sample of adults ages 60+. Multivariate regression models are estimated for married/partnered men and women, and formerly married women.

RESULTS

Neither family support nor strain moderated the effect of severe impairment on married men's daily emotions. Family support buffered the effect of severe impairment on frustration among divorced and widowed women, but not their married counterparts. Counterintuitively, family arguments mitigated against frustration and increased happiness among married women with severe impairment.

CONCLUSION

Consistent with stress buffering perspectives, family support was most protective for the vulnerable population of formerly married older women with severe impairment.

IMPLICATIONS

This study underscores the importance of family support for the large and growing population of formerly married women managing health-related challenges in later life.

Late life disability and experienced wellbeing: Are economic resources a buffer?

BACKGROUND

Disablement has been linked to compromised wellbeing in later life, but whether material resources buffer these negative effects is unclear.

OBJECTIVE

Drawing upon conceptual models of stress and coping, we analyze experienced wellbeing data from time diary interviews with adults ages 60 and older. We expect that experienced wellbeing will be influenced by each stage of the disablement process and that higher income and wealth will buffer the negative effects of disability on experienced wellbeing. Because income is a better reflection of one's liquid resources while assets reflect lifetime accumulation, we expect income to be a more substantial buffer than assets.

METHODS

We use the Disability and Use of Time Supplement to the Panel Study of Income Dynamics (N = 1607). We consider several measures of the disablement process (activity limitations, impairment severity, duration of limiting condition) and history of work limitation and evaluate both pre-tax income and net worth quartiles. We estimate a series of multi-level regression models that account for clustering of individuals within couples. We calculate the marginal effects of disability on wellbeing at different quartiles of economic resources.

RESULTS

We find that impairment severity is associated with worse experienced wellbeing before and after adjusting for covariates, and income buffers these negative effects for those in the middle-income quartiles.

CONCLUSIONS

Future research should further explore the mechanisms through which income buffers the negative effects of impairment severity and specify the accommodations that enable economically disadvantaged and advantaged older adults alike to withstand physical declines while maintaining wellbeing.

The short-term stability of life satisfaction judgments

Life satisfaction judgments are thought to reflect people's overall evaluation of the quality of their lives as a whole. Because the circumstances of these lives typically do not change very quickly, life satisfaction judgments should be relatively stable over time. However, some evidence suggests that these judgments can be easily manipulated, which leads to low stability even over very short intervals. The current study uses a unique data set that includes multiple assessments of life satisfaction over both long (up to 4 years) and short (over the course of a single interview) intervals to assess whether information that is made salient during the course of an interview affects life satisfaction judgments at the end of the interview. Results suggest that this intervening information has only small effects on the final judgment and that placement within an interview has little influence on the judgment that people provide. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Disability and Activity-related Emotion in Later Life: Are Effects Buffered by Intimate Relationship Support and Strain?

We use daily diary data from the Disability and Use of Time supplement to the 2013 Panel Study of Income Dynamics ( n = 1,162) to evaluate (1) the extent to which marital/partner support and strain moderate the effects of disability on five activity-related emotions (happiness, calm, sadness, frustration, worry) and overall negative and positive emotion among older married, cohabiting, and dating persons and (2) whether such patterns differ significantly by gender. Marital support buffers against negative emotions and increases feelings of calm among severely impaired women. By contrast, support intensifies negative emotions and decreases feelings of calm among severely impaired men. Relationship strain also intensifies the effect of severe impairment on men's frustration, sadness, worry, and negative mood but has negligible effects on the negative emotions of men with low impairment and women. Frequent support and criticism may threaten highly impaired older men's sense of autonomy and emotional well-being.

Disability and Activity-related Emotion in Later Life: Are Effects Buffered by Intimate Relationship Support and Strain?

We use daily diary data from the Disability and Use of Time supplement to the 2013 Panel Study of Income Dynamics ( n = 1,162) to evaluate (1) the extent to which marital/partner support and strain moderate the effects of disability on five activity-related emotions (happiness, calm, sadness, frustration, worry) and overall negative and positive emotion among older married, cohabiting, and dating persons and (2) whether such patterns differ significantly by gender. Marital support buffers against negative emotions and increases feelings of calm among severely impaired women. By contrast, support intensifies negative emotions and decreases feelings of calm among severely impaired men. Relationship strain also intensifies the effect of severe impairment on men's frustration, sadness, worry, and negative mood but has negligible effects on the negative emotions of men with low impairment and women. Frequent support and criticism may threaten highly impaired older men's sense of autonomy and emotional well-being.

Aging, mobility impairments and subjective wellbeing

BACKGROUND

Wellbeing is often described as U-shaped over the life course, suggesting an apparent paradox that wellbeing remains high at older ages despite increases in impairments.

OBJECTIVE/HYPOTHESES

We explore associations among age, lower body impairments-one of the most common late-life impairments-and three measures of wellbeing: life satisfaction, emotional wellbeing and somatic wellbeing. We hypothesize that age effects are positive, become stronger once lower body impairments are controlled, and are concentrated among those who have maintained their mobility. Net of confounding factors, we hypothesize that lower body impairments are associated with worse wellbeing and these effects diminish with advancing age.

METHODS

We analyze the 2013 Disability and Use of Time supplement to the Panel Study of Income Dynamics (N = 1607 adults ages 60 and older). We estimate nested regression models that include age, severity of lower body impairments and confounding demographic, psychological, and socioeconomic factors and activities; test age-impairment interactions; and estimate age- and impairment-stratified models.

RESULTS

Positive age effects were observed after controlling for lower body impairments for life satisfaction (β = 0.90; p < 0.05), although statistical significance weakened (p = 0.07) in fully adjusted models. For emotional wellbeing, adjusted age effects were negative (β = -0.05; p < 0.05) and were concentrated among those with limitations (β = -0.14; p < 0.01). For all three outcomes, severity of impairments reduced wellbeing in adjusted models. These effects were strongest for somatic wellbeing, especially for 65-74 year olds.

CONCLUSIONS

Our study challenges the notion that wellbeing is U-shaped throughout the life course and underscores the critical role of mobility across wellbeing domains in later life.

Impairment Severity and Evaluative and Experienced Well-being Among Older Adults: Assessing the Role of Daily Activities

Background and Objectives

Physical impairments affect a substantial number of older adults in the United States, with rates increasing with advancing age. Impairment is linked with compromised well-being, although the reasons are not fully understood. We explore the extent to which linkages between impairment severity and well-being are accounted for by older adults’ daily activities. We speculate that activities may influence global appraisals of well-being by offering the opportunity to fulfill productive and social roles and may influence daily emotions by shaping the context (places, people) in which life occurs.

Research Design and Method

We examine the effects of impairment severity on life satisfaction and four diary-based experienced well-being measures (happiness, frustration, worry, and sadness). Data are from the Disability and Use of Time supplement to the Panel Study of Income Dynamics (n = 1,606), a national sample of adults ages 60 years and older in the United States. We estimate nested regression models, taking into account within-person correlations for experienced well-being.

Results

Impairment severity is associated with poorer assessments of life satisfaction and all four dimensions of experienced well-being. Activity measures, which encompass eight productive (e.g., household chores) and three leisure (e.g., socializing) activities, account for 10% of the association between impairment and life satisfaction, and virtually none of the association between impairment and experienced well-being. However, psychosocial factors including higher neuroticism, lower self-efficacy, and poorer quality social relationships account for a sizeable share of the associations.

Discussion and Implications

Role-fulfilling aspects of activities appear to be more central than contextual aspects of activities to the impairment-well-being relationship. However, potentially modifiable psychosocial factors account for a much greater share of this relationship. Further research is needed on whether interventions targeting these psychosocial factors might bolster emotional well-being for older adults experiencing impairments.

Physiological Dysregulation, Frailty, and Risk of Mortality Among Older Adults

This study examines whether frailty is associated with mortality independently of physiological dysregulation (PD) and, if so, which is the more accurate predictor of survival. Data come from the Social Environment and Biomarkers of Aging Study. We use Cox proportional hazard models to test the associations between PD, frailty, and 4- to 5-year survival. We use Harrell's concordance index to compare predictive accuracy of the models. Both PD and frailty are significantly, positively, and independently correlated with mortality: Worse PD scores and being frail are associated with a higher risk of dying. The overall PD score is a more accurate predictor of survival than frailty, although model prediction improves when both measures are included. PD and frailty independently predict mortality, suggesting that the two measures may be capturing different aspects of the same construct and that both may be important for identifying individuals at risk for adverse health outcomes.

Marital Quality and Negative Experienced Well-Being: An Assessment of Actor and Partner Effects Among Older Married Persons

OBJECTIVES

We evaluate (a) associations between marital quality (emotional support, strain, and overall appraisal) and three negative aspects of experienced well-being (frustration, sadness, and worry) among older husbands and wives and (b) the relative importance of own versus spouse's marital quality assessments for understanding experienced well-being in later life.

METHOD

Data are from the 2009 Disability and Use of Time daily diary supplement to the Panel Study of Income Dynamics (N = 722). We estimate actor-partner interdependence models, using seemingly unrelated regression.

RESULTS

Own reports of marital strain are associated with own frustration, sadness, and worry among wives and are associated with frustration only among husbands. Own reports of marital support are associated with negative emotion among husbands only: higher levels of marital support are associated with less worry. Results from partner effects analyses also are mixed. Husbands' reports of marital strain are associated with wives' elevated frustration levels, whereas wives' reports of greater marital support are associated with their husbands' higher frustration levels.

DISCUSSION

One's own and spouse's marital appraisals play a complex role in shaping negative emotions among older adults. Findings suggest that frustration is a particularly complex emotion and a promising area for further study among older married couples.

Psychological and cognitive determinants of mortality: Evidence from a nationally representative sample followed over thirty-five years

Growing evidence suggests that psychological factors, such as conscientiousness and anger, as well as cognitive ability are related to mortality. Less is known about 1) the relative importance of each of these factors in predicting mortality, 2) through what social, economic, and behavioral mechanisms these factors influence mortality, and 3) how these processes unfold over long periods of time in nationally-representative samples. We use 35 years (1972-2007) of data from men (ages 20-40) in the Panel Study of Income Dynamics (PSID), a nationally representative sample in the United States, and discrete time event history analysis (n = 27,373 person-years) to examine the importance of measures of follow-through (a dimension of conscientiousness), anger, and cognitive ability in predicting mortality. We also assess the extent to which income, marriage, and smoking explain the relationship between psychological and cognitive factors with mortality. We find that while follow-through, anger, and cognitive ability are all associated with subsequent mortality when modeled separately, when they are modeled together and baseline demographic characteristics are controlled, only anger remains associated with mortality: being in the top quartile for anger is associated with a 1.57 fold increase in the risk of dying at follow-up compared with those in the bottom quartile. This relationship is robust to the inclusion of income, marriage, and smoking as mediators.

Socioeconomic status and biological markers of health: an examination of adults in the United States and Taiwan

OBJECTIVE

The study documents whether socioeconomic status (SES) differentials in biological risk are more widely observed and larger in the United States than Taiwan.

METHOD

Data come from the Social Environment and Biomarkers of Aging Study in Taiwan and the Midlife in the United States study. We use regression analyses to test whether four summary measures of biological risk are significantly related to categorical measures of education, income, and subjective social status among four country-sex-specific subgroups.

RESULTS

Physiological dysregulation is significantly, negatively related to SES in both the United States and Taiwan, especially for males. The prevalence and magnitude of the relationships are similar in the two countries: 12 of 24 possible SES-biological summary score relationships are significant in the United States and 11 of 24 are significant in Taiwan.

DISCUSSION

Overall, SES differentials in biological risk do not appear to be more widely observed or larger in the United States than in Taiwan.

Happy Marriage, Happy Life? Marital Quality and Subjective Well-Being in Later Life

The authors examined associations between marital quality and both general life satisfaction and experienced (momentary) well-being among older husbands and wives, the relative importance of own versus spouse's marital appraisals for well-being, and the extent to which the association between own marital appraisals and well-being is moderated by spouse's appraisals. Data are from the 2009 Disability and Use of Time daily diary supplement to the Panel Study of Income Dynamics (N = 722). One's own marital satisfaction is a sizable and significant correlate of life satisfaction and momentary happiness; associations do not differ significantly by gender. The authors did not find a significant association between spouse's marital appraisals and own well-being. However, the association between husband's marital quality and life satisfaction is buoyed when his wife also reports a happy marriage, yet flattened when his wife reports low marital quality. Implications for understanding marital dynamics and well-being in later life are discussed.

Cohort Profile: The Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan

The Social Environment and Biomarkers of Aging Study (SEBAS) is a nationally representative longitudinal survey of Taiwanese middle-aged and older adults. It adds the collection of biomarkers and performance assessments to the Taiwan Longitudinal Study of Aging (TLSA), a nationally representative study of adults aged 60 and over, including the institutionalized population. The TLSA began in 1989, with follow-ups approximately every 3 years; younger refresher cohorts were added in 1996 and 2003. The first wave of SEBAS, based on a sub-sample of respondents from the 1999 TLSA, was conducted in 2000. A total of 1023 respondents completed both a face-to-face home interview and, several weeks later, a hospital-based physical examination. In addition to a 12-h (7 pm-7 am) urine specimen collected the night before and a fasting blood specimen collected during the examination, trained staff measured blood pressure, height, weight and waist and hip circumferences. A second wave of SEBAS was conducted in 2006 using a similar protocol to SEBAS 2000, but with the addition of performance assessments conducted by the interviewers at the end of the home interview. Both waves of SEBAS also included measures of health status (physical, emotional, cognitive), health behaviours, social relationships and exposure to stressors. The SEBAS data, which are publicly available at [http://www.icpsr.umich.edu/icpsrweb/NACDA/studies/3792/version/5], allow researchers to explore the relationships among life challenges, the social environment and health and to examine the antecedents, correlates and consequences of change in biological measures and health.

Is spousal caregiving associated with enhanced well-being? New evidence from the panel study of income dynamics

OBJECTIVES

We explore whether spousal caregiving is associated with enhanced well-being for older husbands and wives.

METHOD

We use time diary data from the 2009 Panel Study of Income Dynamics and Disability and Use of Time supplement. We measure experienced well-being as ratings of happiness and frustration during activities recalled for the previous day. We estimate separately for husbands and wives 3 distinct effects on experienced well-being: having a spouse with a disability; doing household or personal care tasks ("chores") for someone other than a spouse with a disability; and doing such tasks for a spouse with a disability ("care").

RESULTS

For husbands, neither care status nor spouse's disability status are associated with experienced well-being. In contrast, for wives, carrying out chores is associated with lower reports of happiness compared with other activities and providing care to one's husband is associated with greater reports of happiness than carrying out chores.

DISCUSSION

For women, chores such as meal preparation, laundry, and cleaning--but not caregiving per se--are associated with worse experienced well-being than other activities. Findings underscore that there are positive aspects of spousal caregiving for older wives that offset the innately unpleasant nature of household tasks.

Interviewer and Respondent Interactions and Quality Assessments in a Time Diary Study

Systematic investigations of the cognitive challenges in completing time diaries and measures of quality for such interviews have been lacking. To fill this gap, we analyze respondent and interviewer behaviors and interviewer-provided observations about diary quality for a computer-assisted telephone-administered time diary supplement to the U.S. Panel Study of Income Dynamics. We find that 93%-96% of sequences result in a codable answer and interviewers rarely assist respondents with comprehension. Questions about what the respondent did next and for how long appear more challenging than follow-up descriptors. Long sequences do not necessarily signal comprehension problems, but often involve interviewer utterances designed to promote conversational flow. A 6-item diary quality scale appropriately reflects respondents' difficulties and interviewers' assistance with comprehension, but is not correlated with conversational flow. Discussion focuses on practical recommendations for time diary studies and future research.

Reliability and validity of self-care and mobility accommodations measures in the National Health and Aging Trends Study

PURPOSE OF THE STUDY

Comprehensive measures of disability accommodations have been lacking in national health and aging studies. This article introduces measures of accommodations developed for the National Health and Aging Trends Study, evaluates their reliability, and explores the validity and reliability of hierarchical classification schemes derived from these measures.

DESIGN AND METHODS

We examined test-retest reliability for questions about assistive device use, doing activities less often, and getting help from another person with both percentage agreement and kappa (N = 111). Summary measures across activities and several hierarchical classification schemes (e.g., no accommodation, devices/activity reductions only, help) were developed. For the latter, we also evaluated validity by examining correlations with measures of capacity and demographic characteristics (N = 326).

RESULTS

Items about assistive device use and help in the last month were robust (most kappas 0.7-0.9). Activity reduction measures were moderately reliable (around 0.5) but still showed reasonable agreement. Reliabilities for summary measures were good for device use (0.78-0.89) and help (0.62-0.67) but lower, albeit acceptable, for activity reduction (0.53). Hierarchical classifications had acceptable reliability and levels demonstrated hierarchical properties.

IMPLICATIONS

National Health and Aging Trends Study's self-care and mobility accommodation measures offer ample reliability to study adaptation to limitations and can be used to construct a reliable and valid hierarchy.

Trends in late-life activity limitations in the United States: an update from five national surveys

This article updates trends from five national U.S. surveys to determine whether the prevalence of activity limitations among the older population continued to decline in the first decade of the twenty-first century. Findings across studies suggest that personal care and domestic activity limitations may have continued to decline for those ages 85 and older from 2000 to 2008, but generally were flat since 2000 for those ages 65-84. Modest increases were observed for the 55- to 64-year-old group approaching late life, although prevalence remained low for this age group. Inclusion of the institutional population is important for assessing trends among those ages 85 and older in particular.

Assessing Time Diary Quality for Older Couples: An Analysis of the Panel Study of Income Dynamics' Disability and Use of Time (DUST) Supplement

Using same-day diaries from 394 older couples in the Panel Study of Income Dynamics (PSID), this paper develops and explores several new measures of diary quality. Two overarching questions are explored: 1) How do diary quality measures reflecting the data collection process enhance understanding of time use in later life? and 2) How well do same-day diaries from couples match up in terms of husbands' and wives' reports of time spent (actively engaged) together? We found a summary measure of diary quality indicated only 13.8% of diaries were lower quality. Lower quality diaries were more likely to be obtained from older adults (ages 70+ vs. 50-69) and first (vs. second) interviews. Joint activities from diaries of lower quality were less likely than those from higher quality diaries to be matched to an activity on a spouse's same-day diary. However, such a measure did not predict time spent in common activities nor did its inclusion have any effect on predictors of time use. We also found that among activities described as joint by at least one respondent, up to 76% had a matching record in the spouse's diary. The quality of matches appeared to be quite good, with the majority of matched activities having overlapping times reported by spouses and being described as joint by both spouses. Very similar estimates of joint time were reported by husbands and wives (about 5-5½ hours). Implications of findings for future methodological and substantive investigations are discussed.

Disability, participation, and subjective wellbeing among older couples

This paper investigates the link between disability and subjective wellbeing, using data from the 2009 Disability and Use of Time supplement to the Panel Study of Income Dynamics, the longest running national panel study in the United States. Disability is construed broadly to include both the presence of any physical, cognitive, or sensory impairment or activity limitation and also the severity of underlying impairments. Subjective wellbeing is measured using two distinct approaches: reports of life satisfaction and of moment-to-moment wellbeing-both positive and negative-on the previous day. The latter, collected through 24-h time diaries, also offers for the first time the ability to explore the role of participation in particular kinds of activities linking disability to subjective wellbeing. The analytic sample included married persons ages 60 and older and their spouses (n = 751 married individuals) who completed 1498 diaries. Several new findings emerged: no matter what the measure of wellbeing, older married adults with disability report worse subjective wellbeing than those without, and neither different demographic and socioeconomic profiles nor differences in participation fully account for these disparities. Influences of disability on global life satisfaction and episodic reports of happiness were relatively small and of comparable size. However, notably sizeable differences were identified in the cumulative number of pleasant minutes experienced yesterday by disability status - on the order of 71 fewer minutes on average for those with a disability of average severity. Differences appear to be more strongly linked to somatic symptoms of pain and feeling tired than to differential intensity of experiencing happiness, sadness, frustration, or worry. We also found limited support for the notion that participation partially mediates the relationship between disability and global, but not episodic, subjective wellbeing.

Validation of new measures of disability and functioning in the National Health and Aging Trends Study

BACKGROUND

Measurement gaps continue to hamper fuller understanding of late-life disability trends and dynamics. This article reports findings that validate the self-reported components of the disability protocol to be used in the new National Health and Aging Trends Study. The protocol was designed to redress existing measures by attending to environmental aspects of disability, capturing a broader range of capacity to perform tasks and including participation restriction items.

METHODS

We undertook an in-person validation study to determine the reliability, validity, and initial measurement properties of the National Health and Aging Trends Study self-reported disability protocol (n = 326). A random subset (n = 111) was readministered the protocol within 2-4 weeks. The interview and reinterview included new self-reported measures of physical capacity, activity limitations, and participation restrictions, as well as established performance and cognitive tests. We calculated percent agreement and kappa between interviews for all self-reported items and summary measures. We also assessed the construct validity of summary measures through correlations with demographic characteristics, frailty, memory, and performance-based mobility and confirmed whether activity limitations and participation restrictions were distinct domains.

RESULTS

New items and derived summary measures demonstrate robustness over a short time period, with kappas for retained/recommended items in the .60-.80 range. The summary measures correlate as expected with age, sex, residential status, and established performance-based constructs. Two factors, representing activity limitations and participation restrictions, were confirmed.

CONCLUSIONS

The National Health and Aging Trends Study protocol preserves the ability to examine more traditional measures of functioning while offering new insights into how activities are performed and preserving key conceptual distinctions.

Demographic and socioeconomic status differences in perceptions of difficulty with mobility in late life

OBJECTIVES

This study assesses whether socioeconomic and demographic differences in reported mobility limitations are attributable to differential perceptions of mobility difficulty that result in the differential use of response categories.

METHODS

Data come from the Social Environment and Biomarkers of Aging Study and its parent study, the Taiwan Longitudinal Study of Aging. Ordered probit models with person-specific cut-points are used to test whether, after controlling for underlying mobility using objective performance measures, cut-points for reporting mobility limitations vary across groups defined by demographic and socioeconomic characteristics.

RESULTS

Age is the only characteristic that is consistently associated with the location of the cut-points for reporting mobility difficulty: At the same level of underlying mobility difficulty, older adults are more likely than younger adults are to report difficulty with all tasks except short walks. Other variables showed differences but only for one specific activity, for example, urban residents are more likely to report difficulty running than are rural residents with the same underlying level of mobility function.

DISCUSSION

For most mobility activities, there are no systematic differences in the perception of difficulty by individual characteristics. Thus, for older Taiwanese adults, differences in mobility limitations associated with socioeconomic status are more likely to reflect underlying differences in function than differences in how these groups report the same capacity. The usual loss of mobility with age, however, reflects both a decrease in capacity and a lowering of the threshold for reporting difficulty.

Racial and ethnic disparities in mobility device use in late life

OBJECTIVE

Although racial and ethnic disparities in disability are well established and technology is increasingly used to bridge gaps between functional deficits and environmental demands, little research has focused on racial and ethnic disparities in device use. This study investigated whether use of mobility devices differs by race and ethnicity and explored several reasons for this difference.

METHODS

The sample included community-dwelling adults aged 65 and older from the 2002 and 2004 waves of the Health and Retirement Study. We used predisposing, need, and enabling factors to predict mobility device use alone and combined with personal care.

RESULT

Blacks had the highest rates of using mobility devices, followed by Hispanics and then Whites. Need and enabling factors explained differences between Blacks and Whites in wheelchair use but not cane use or use of devices without personal care. Other predisposing factors explained most differences between Hispanics and Whites.

DISCUSSION

Because minorities appear to be using mobility devices in proportion to underlying need, increasing device use by minorities may not reduce disparities in mobility disability. Efforts to address racial/ethnic disparities in mobility disability in late life, therefore, may need to focus on differences in underlying functional decline rather than the accommodation of it.

Declines in late-life disability: the role of early- and mid-life factors

Investigations into the reasons for declines in late-life disability have largely focused on the role of contemporaneous factors. Adopting a life-course perspective as a backdrop, in this paper we ask whether there also has been a role for selected early- and mid-life factors in the decline, and if so whether these factors have been operating through changes in the risks of disability onset or recovery. Drawing on five waves from 1995 to 2004 of the U.S. Health and Retirement Study, we found for the 75 years and older population in the United States that the prevalence of difficulty with activities of daily living (ADL) declined from 30.2% in 1995 to 26.0% in 2004, whereas the trend in difficulty with instrumental activities of daily living (IADL) was flat. Onset of ADL limitations also was reduced during this period while recovery increased. Changes in the educational composition of the older population were linked to declines in the prevalence of ADL limitations, but there were also modest contributions of changes in mother's education, self-rated childhood health, and lifetime occupation. Declines in late-life vision impairments and increases in wealth also contributed substantially to the downward trend, and had chronic conditions not increased, it would have been even larger. Reductions in the onset of ADL limitations were partly driven by changes in educational attainment of respondents and their mothers and, in late-life, better vision and wealth. In contrast, the recovery trend was not accounted for by changes in early- or mid-life factors. We conclude that early- and mid-life factors have contributed along with late-life factors to U.S. late-life disability trends mainly through their influence on the onset of, rather than recovery from, limitations.

Chronic conditions and the decline in late-life disability

Using data from the 1997-2004 National Health Interview Survey (NHIS), we examine the role of chronic conditions in recent declines in late-life disability prevalence. Building upon prior studies, we decompose disability declines into changes in the prevalence of chronic conditions and in the risk of disability given a condition. In doing so, we extend Kitigawa's (1955) classical decomposition technique to take advantage of the annual data points in the NHIS. Then we use respondents' reports of conditions causing their disability to repartition these traditional decomposition components. We find a general pattern of increasing prevalence of chronic conditions accompanied by declines in the percentage reporting disability among those with a given condition. We also find declines in heart and circulatory conditions, vision impairments, and possibly arthritis and increases in obesity as reported causes of disability. Based on decomposition analyses, we conclude that heart and circulatory conditions as well as vision limitations played a major role in recent declines in late-life disability prevalence and that arthritis may also be a contributing factor. We discuss these findings in light of improvements in treatments and changes in the environments of older adults.

Measuring subjective social status: a case study of older Taiwanese

Despite widespread use of measures of social status and increasing interest in the relationship between social status and health, the variables used to denote social status are often inappropriate for use with older populations. This article examines responses to a recently developed measure of subjective social position, known as the MacArthur Scale of Subjective Social Status. The instrument asks respondents to use ten rungs of a ladder to position themselves socioeconomically relative to other people in their country and, separately, in their community. These questions were incorporated into a recent national survey of middle-aged and older adults in Taiwan. The objectives of the analysis were to gain a better understanding of how such subjective assessments are formed (i.e., to explore the contribution of social, economic, and cultural factors in the determination of position within a social hierarchy) and to assess the potential utility of the ladder instrument in social science and health research. This article compares results from Taiwan with those derived from subjective measures of social status in Western populations. The findings support use of the MacArthur Scale of Subjective Social Status as a measure of subjective social status among the older population and suggest that using it may provide further insights into the social gradient in health.

Trends in the use of assistive technology and personal care for late-life disability, 1992-2001

We describe national trends during the 1990s in late-life difficulty and assistance with self-care activities. Among older Americans living in the community and experiencing difficulty with self-care activities, assistive-technology use increased substantially whereas use of personal care declined. Using a decomposition technique, we demonstrate that these shifts in assistance toward technology account for half the decline in the number of people dependent on personal care.

Reconsidering substitution in long-term care: when does assistive technology take the place of personal care?

OBJECTIVE

Assistive technology (AT) may improve quality of life and reduce dependence for older persons with disabilities. In this article, we examine tradeoffs between the use of AT and reliance on personal care, with attention to factors that may influence those relationships.

METHODS

We jointly modeled hours of formal and informal care with use of AT in order to address the interdependence of these outcomes in ways not taken into account in previous studies. We analyzed a national sample of older persons with difficulty in activities of daily living drawn from Phase 2 of the 1994-1995 National Health Interview Survey (NHIS) Disability Supplement.

RESULTS

Our findings show that the use of AT was associated with reductions in informal care hours, especially for those who were unmarried, better educated, or had better cognitive abilities, but appeared to supplement formal care services for these groups. Individuals with cognitive impairment were less likely than others to substitute AT with either type of personal care.

DISCUSSION

These models raise the possibility that reductions of informal care hours may be accomplished with a combination of formal care and assistive devices, rather than from either alternative alone.

Measurement of Assistive Device Use: Implications for Estimates of Device Use and Disability in Late Life

PURPOSE

This study systematically reviews approaches that national surveys have used to measure the use of assistive devices and examines the implications of these different approaches for prevalence estimates of device use and disability in late life.

DESIGN AND METHODS

Cross-sectional data from six national surveys are used to compare rates of assistive device use and disability among community-dwelling adults aged 65 and older.

RESULTS

Estimates of the use of any device are similar across surveys, ranging from 14% to 18% for the population of adults aged 65 and older. However, one survey design element-the restriction of device-use questions to those reporting difficulty with daily activities-omits a potentially sizeable group: those who use devices but report no difficulty. Including this group of device users significantly increases the prevalence estimates of both device use and disability.

IMPLICATIONS

The use of assistance and perceptions of difficulty are inextricably interwoven, and attention to the measurement of these concepts is needed. Survey designers may want to consider asking questions about assistive device use independent of questions about difficulty. In addition, researchers who study disability may want to consider including those who report using devices but no difficulty, a group that may become more prevalent as new cohorts age.

Stability and Change in the Perceived Social Support of Older Taiwanese Adults

OBJECTIVE

The purpose of this study is to examine stability and change in Taiwanese elders' perceptions about the availability of social support and the sociodemographic and cultural factors associated with change.

METHODS

This study uses data from four waves of the Survey of Living Status of the Elderly in Taiwan that spans a 10-year period and employs latent growth curve models to examine trajectories of perceived support and the sociocultural factors that may explain variability in baseline levels of support and variability in changes in support as respondents age.

RESULT

Perceptions about social support appear to follow a linear trajectory across age, with significant variation in baseline perceptions and in patterns of change in perceived support across the sample. Sociocultural factors primarily explain differences in initial levels of support but also have some effect on changes in support.

DISCUSSION

Despite the increasing pressures and demands on adult children's time that are associated with social and economic development, the elderly in Taiwan on average feel supported by their social networks, with the perceived availability of support increasing with age.

Social ties and perceived support: two dimensions of social relationships and health among the elderly in Taiwan

OBJECTIVES

Assess the effects of social relationships on physical and mental health among the elderly in Taiwan.

METHODS

Using 4 waves of a survey of the elderly, we examine the relationship between social ties and perceived support and four health outcomes--mortality, functional status, self-assessed health, and depression.

RESULTS

Perceived support and social ties are related to health, but many of the apparent effects are attenuated in the presence of controls for prior health. However, positive perceptions about support are protective of mental (but not physical) health.

DISCUSSION

If baseline health is ignored, estimates of the effects of social relationships on health at a given stage of life are likely to be inflated by reverse causality or by effects occurring prior to baseline. Inclusion of controls for initial health reveals that, in general, the relationship between social support and health at the older ages in Taiwan is relatively modest.

Labor force status transitions at older ages in the Philippines, Singapore, Taiwan, and Thailand, 1970-1990

While there is considerable evidence of a trend toward earlier retirement in the United States and Europe, trends in rapidly growing economies in other parts of the world have not been closely examined. This paper traces the labor force participation rates of older men and women in four Asian countries, the Philippines, Singapore, Taiwan, and Thailand, over the period of 1970 to 1990. Aggregate census data are used to calculate net transitions into and out of the labor force so as to permit the analysis of differences by country and cohort as well as change over time. Results show that, although men exhibit a general trend toward earlier net labor force exit, labor force participation rates at older ages remain high. Older women are found to be increasingly engaged in economic activity, especially in Singapore and Taiwan.