Location Matters: The Role of the Neighborhood Environment for Incident Cardiometabolic Disease in Adults Aging With Physical Disability

PURPOSE

People aging with disability may be limited in their ability to engage in healthy behaviors to maintain cardiometabolic health. We investigated the role of health promoting features in the neighborhood environment for incident cardiometabolic disease in adults aging with physical disability in the United States.

DESIGN

Retrospective cohort study.

SETTING

Optum's Clinformatics® Data Mart Database (2007-2018) of administrative health claims.

SUBJECTS

ICD-9-CM codes were used to identify 15 467 individuals with a diagnosis of Cerebral Palsy, Spina Bifida, Multiple Sclerosis, or Spinal Cord Injury.

MEASURES

Cardiometabolic disease was identified using ICD-9-CM/ICD-10-CM codes over 3 years of follow-up. Measures of the neighborhood environment came from the National Neighborhood Data Archive and linked to individual residential ZIP codes over time. Covariates included age, sex, and comorbid health conditions.

ANALYSIS

Cox regression models estimated hazard ratios (HR) for incident cardiometabolic disease. Using a 1-year lookback period, individuals with pre-existing cardiometabolic disease were excluded from the analysis.

RESULTS

Net of individual risk factors, residing in neighborhoods with a greater density of broadband Internet connections (HR = .88, 95% CI: .81, .97), public transit stops (HR = .89, 95% CI: .83, .95), recreational establishments (HR = .89, 95% CI: .83, .96), and parks (HR = .88, 95% CI: .82, .94), was associated with reduced risk of 3-year incident cardiometabolic disease.

CONCLUSION

Findings identify health-promoting resources that may mitigate health disparities in adults aging with disability.

Everyday Challenges for Individuals Aging with Vision Impairment: Technology Implications

BACKGROUND AND OBJECTIVES

There are growing numbers of older adults with long-term vision impairment who are likely to experience everyday activity challenges from their impairment in conjunction with age-related changes. Technology has potential to support activity engagement. To develop effective technologies and interventions, we need to understand the context of activity challenges and identify unmeet support needs.

RESEARCH DESIGN AND METHODS

The Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) study is a mixed-method approach to explore everyday challenges of people aging with long-term disabilities. Participants included 60 adults aging with long-term vision impairment (63% female; M age=67, SD=4.6) who completed in-depth, structured interviews exploring the nature of everyday challenges and their unmet support needs for activity engagement. We conducted a content analysis using a deductive and inductive approach to build a detailed coding scheme of challenge codes and subcodes.

RESULTS

The analyses provided detailed insights about the nature of challenges people aging with vision impairment experience when performing specific instrumental activities of daily living (IADLs) in the context of home maintenance, transportation, shopping/finance, and managing health. Vision-related challenges and participation restrictions were identified for several activities that require reading, navigation, and identification (e.g., shopping, medication management, public transportation). Emergent challenge themes for performing IADLs included personal limitations (e.g., physical, cognitive, financial) and environmental barriers (e.g., accessibility, technology, transportation).

DISCUSSION AND IMPLICATIONS

Contextual examples of IADL challenges among individuals aging with vision impairment highlight opportunities for technology design and innovation to support participation in everyday activities.

The Long-Term Impact of Childhood Disability on Mental Health Trajectories in Mid- to Late-Life

OBJECTIVES

We draw from the life course and stress process frameworks to examine how experiencing disability in early life influences mental health in adulthood.

METHODS

Data come from the Health and Retirement Study Cross-Wave Childhood Health and Family Aggregated Data file (2008-2018, n = 15,289). Childhood disability status is a retrospective self-report of whether respondents were disabled for six months or more because of a health problem before the age of 16 (n = 581). We used age-based growth curve models to construct trajectories of depressive symptoms by childhood disability status.

RESULTS

Respondents who experienced childhood disability exhibit more depressive symptoms at age 50 compared to those who did not experience this stressor. However, there is no difference in the growth of depressive symptoms with age between these groups, suggesting maintained inequality over the late adulthood life course.

DISCUSSION

Findings suggest that childhood disability has long-term implications for life course mental health.

Reducing the Shared Burden of Chronic Conditions among Persons Aging with Disability and Older Adults in the United States through Bridging Aging and Disability

Persons aging with long-term disabilities such as spinal cord injury or multiple sclerosis and older adults share similar chronic conditions in mid and later life in the United States. The rising general interest and more prevalent federal requirements for use of evidence-based practices (EBP) in health promotion and chronic condition interventions highlight the gap between demand and the availability of EBPs for persons aging with disability in particular. Addressing this gap will require focused efforts that will benefit substantially by bridging the fields of aging and disability/rehabilitation to develop new EBPs, translate existing EBPs across populations, and borrow best practices across fields where there are few current EBPs. Understanding distinctions between disability-related secondary conditions and age-related chronic conditions is a first step in identifying shared conditions that are important to address for both mid-life and older adults with disabilities. This review articulates these distinctions, describes shared conditions, and discusses the current lack of EBPs for both populations. It also provides recommendations for bridging activities in the United States by researchers, professionals, and consumer advocates. We argue that these can more efficiently move research and practice than if activities were undertaken separately in each field (aging and disability/rehabilitation).

Key focal areas for bridging the fields of aging and disability: findings from the growing older with a disability conference

Based upon research presented at the 2011 Festival of International Conferences on Caregiving, Disability, Aging and Technology (FICCDAT)-and specifically the Growing Older with a Disability (GOWD) conference, this paper identifies areas where bridging building between aging and disability is needed to support older adults aging into or with disabilities. Five focal areas emerged: 1) The Need to Forward Bridging Between Aging and Disability Sectors, 2) Theoretical Frameworks of Individual Aging that Facilitate Bridging, 3) Bridging through Consumer Participation and Involvement, 4) Bridging Through Knowledge Transfer and 5) Bridging Opportunities in Long-Term Supports and Services and Assistive Technologies. Discussion of themes is provided within both international and Canadian contexts, reflecting the interests of FICCDAT and GOWD organizers in discussing how to improve bridging in Canada. Findings from this report form the basis of the Toronto Declaration on Bridging Aging and Disability Policy, Practice, and Research.

Self-rated health among persons with spinal cord injury: what is the role of physical ability?

OBJECTIVES

Self-rated health (SRH) is a powerful concept that has greatly advanced our understanding of health and health outcomes. The SRH measure has become increasingly common in health research. Yet, puzzles remain about what shapes SRH ratings. The absence of knowledge is particularly acute in the context of disability. The aim of this study was to examine the relationship between SRH and self-rated physical ability in a sample of individuals with spinal cord injury (SCI).

METHODS

Data from 140 eligible participants drawn from a study of life in the community after SCI were analyzed. The study, cross-sectional in design, was conducted in a large urban city in the mid-western United States. Basic statistics such as ANOVA and chi-square tests were performed as appropriate, and a multiple linear regression analysis modeled the relationship between SRH and physical ability adjusting for potential confounding variables.

RESULTS

Self-rated physical ability was significantly associated with SRH after controlling for relevant covariates (P < 0.001). An analysis of the interaction between physical ability and level of injury revealed that the relationship was significant for persons with paraplegia but not for persons with tetraplegia.

CONCLUSIONS

This study provides evidence that self-rated physical ability is an important factor associated with SRH for persons with SCI, but that the strength of the relationship depends on level of injury (paraplegia vs. tetraplegia). The challenge for future research is to replicate the study using a more comprehensive measure of physical ability and to ask how beliefs in one's ability to do those activities that are most meaningful and desired shape SRH. Only in this way will our understanding of the physical ability-SRH relationship be clarified.

Health disparities among Latinas aging with disabilities

Latinas with disabilities report greater levels of disablement than non-Hispanic, White women with disabilities. Over the life course, Latinas experience increased numbers of functional limitations, more difficulties with activities of daily living, and more unemployment due to impairments. The reasons for this health disparity are unclear. The purpose of this article is to explore the empirical evidence surrounding health disparities in disablement among Mexican American women. From this exploration, recommendations are made, including moving beyond the correlational documentation of disparities, to building a knowledge base that provides theoretical reasons for disparities amenable to intervention.