Journal of Aging and Health

Objectives: Many studies have examined quality effects of nursing facility (NF) staffing, but few have examined effects of unionization. Concerned with possible effects of unionization on quality, we analyzed unionization and local market climate of unionization, predicting both complaints (reflecting either quality problems or better monitoring and advocacy) and the substantiation of serious complaints (indicating major quality problems). Method: Data were analyzed on California freestanding NFs in 1999 (N= 1,155). OLS regression was employed to predict both quality complaints and serious violations, the latter both controlling and not controlling for numbers of complaints. Results: Unionized NFs showed more complaints than did nonunionized NFs. Nonunionized NFs had more serious violations, particularly when the proportion of other county facilities unionized was higher. Discussion: These findings suggest that unionization enhances problem reporting while, especially in stronger union environments, reducing the incidence of serious quality violations.

Purpose: The purpose was to identify differences in gait characteristics between older fallers with a tendency to fall sideways compared to those who do not fall to the side. Method: The authors conducted a prospective, case control study of ambulatory adults older than 70 residing in retirement communities. Measurements included spatial and temporal gait parameters and prospective fall surveillance. Results: In all, 29 participants fell to the side, and 64 fell in other directions (forward, backward, straight down); 46 participants experienced no falls. Side-fallers exhibited narrower stride widths compared to other-directed fallers, and stepwise and discriminant analysis correctly classified 67% of side-fallers and other-directed fallers using only stride width. Discussion: This study suggests that side-fallers, who have narrower stride widths compared to those who fall in other directions, may not be adapting their gait to compensate for lateral instability. More research is needed to determine whether narrow gait contributes to unstable walking patterns.

Objective: The authors explored the effect of predisposing, enabling, and need characteristics on risk of nursing home placement (NHP) in participants with and without dementia. Method: Participants were 1,943 newly enrolled Medicare/Medicaid beneficiaries in Florida who were evaluated for health services by the Department of Elder Affairs. They were at least 65 years of age during fiscal year 1998-1999 and were followed for up to 4 years. Results: Cox proportional hazard regressions indicated that baseline characteristics including older age, White race, diabetes, incontinence, stroke, and difficulties with instrumental activities increased risk of NHP in those without dementia. Caregiver, widowed status, arthritis, and heart disease reduced the risk. Only age, race, and marital status were predictive among participants with dementia. Discussion: Dementia plays a central role in risk of NHP. Understanding risk factors for NHP in this relatively vulnerable population has important policy implications.

Objective: To assess influences from visual or hearing impairment on use of community support services and health-related quality of life in aged care clients. Method: The authors sampled 284 frail elderly individuals presenting for assessment in Sydney, Australia. Moderate to severe visual impairment was defined as visual acuity <20/80 (better eye), and moderate to severe hearing loss as hearing thresholds >40 decibels (better ear). Community support services included home-delivered meals, home help, and community nurse visits. Results: After adjusting for age, sex, and two or more comorbid conditions, moderate to severe visual impairment, but not moderate to severe hearing loss, was significantly associated with increased use of community services (adjusted odds ratio 2.8, 95% confidence interval = 1.0—7.8). Conclusion: Moderate to severe visual impairment was associated with an increased likelihood of community service utilization in this aged care client sample.

Objective: This study evaluated the protective role of physical activity (PA) against cognitive impairment (CI) in the oldest old (age ≥ 85). Method: Prospective data on 66 optimally healthy, oldest old adults (mean age 88.5) were analyzed using survival analysis. Results: In all, 12 men and 11 women reported exercising > 4 hours per week, and 38 participants developed CI (mean onset age 93; mean follow-up 4.7 years). The effect of exercise was modified by gender. In more active women (> 4 hours/week), the risk of CI was reduced by 88% (95% confidence interval 0.03, 0.41) compared to those less active. Less active women had 2 times the incidence rate of CI compared to less active men and almost 5 times the rate compared to active women. Discussion: This study demonstrates the beneficial effects of exercise on healthy brain aging even in the oldest old and emphasizes the importance of increasing PA in older women.

Objective: Residents' cognitive, psychiatric, and behavioral statuses were examined as part of a larger study of care in a nursing home (NH) owned and operated by a Northern Plains American Indian tribe. Method: Reviews of 45 medical records and semistructured interviews with 36 staff were completed. Results: Creekside residents had considerable psychiatric and behavioral morbidity. High prevalences of non-Alzheimer's disease dementia, cognitive impairment, anxious symptomatology, and resistance to care were met with psychopharmacotherapy, reorientation, and informal techniques for behavior management. Significant depressive, anxious, psychotic, and behavioral symptoms remained. Staff interpretations of resident problems consisted of an ethnopsychological schema emphasizing resident loneliness, grumpiness, and propensity to “fight” rather than formal psychiatric nosology. Discussion: Tribal NH residents were likely underdiagnosed for dementia and anxiety. Residual behavioral and psychiatric symptomatology suggest room for improvement in the NH's behavioral management regimen. Need for greater attention to conceptual, diagnostic, clinical, and documentation processes in the NH setting is noted.

Objective: The authors report the association of balding or graying with BMD in older adults. Method: BMD was measured at the spine, hip, and total body in 1,207 participants. Of these, 508 women and 380 men responded to a 1986 survey about balding patterns; in 1994, all participants answered questions about graying. Results: Among men, 10.7% reported graying, and 51.1%, balding; 9.9% of women reported graying, and 9.5%, balding. Models were adjusted for age, body mass index, alcohol consumption, smoking, exercise, calcium supplements, diuretics, glucocorticoids, thyroid hormone, and estrogen. Conclusion: Graying was not significantly associated with BMD in either group. Balding men averaged 5% lower total body BMD (p ≤ 0.05), and balding women had ~24% higher mean hip BMD (p ≤ 0.05). Graying and balding women reported a higher proportion of current estrogen use; balding women reported more use of glucocorticosteroids. Balding women using estrogen may explain the higher BMD.

Objective: This study examines the association between relative body weight (measured with body mass index; BMI) and multiple forms of psychological distress and whether those associations are contingent on gender and race. Method: Interviews were conducted in 2001-2002 with persons 65 years and older in the District of Columbia and adjoining Maryland counties (N = 1,152). BMI is associated (a) positively with depression, anger, and physical symptoms among White women; (b) positively with physical symptoms among Black women and men; and (c) negatively with anxiety among White men. Results: Tests for gender by race interactions find significant contrasts between White women and men when depression, anxiety, and physical symptoms are considered as outcomes; contrasts between White and Black women are significant for anger. Discussion: Results underscore the importance of gender by race interactions, multiple forms of distress in analyses of effects of BMI, and the role of negative self-evaluations and health difficulties as explanations.

Purpose: The authors examined epidemiology and sociodemographic predictors of spousal, nonspousal family, and friendship bereavement among African American and White community-dwelling older adults using longitudinal data from 839 participants of the University of Alabama at Birmingham Study of Aging, a prospective cohort study of a random sample of Alabama Medicare beneficiaries. Method: Authors calculated cumulative incidences of each type of loss and used logistic regression to identify factors significantly and independently associated with loss. Results: Of participants, 71% reported at least one loss; 50% reported nonspousal family loss, and 37% reported friendship loss. For married participants, the cumulative incidence of spousal loss was 8.1%. Female sex and income < $12,000 were predictors of spousal loss. Female sex and education ≥ 12 years were predictors of friendship loss. Higher educated African American women were at greater risk of nonspousal family loss. Discussion: Future research should examine bereavement burden and identify health outcomes of multiple losses.

Objective: To explore perceptions of well-being, family support, and economic resources in relation to level of contact with migration to the U.S. among a sample of elderly males from rural Mexico. Method: The snowballing technique was used to obtain a sample of 372 participants. Four groups were created according to the level of contact with migration among older adults and their children. Results: Greater level of contact with migration was associated with a higher likelihood that an older adult was literate, married or living with someone, self-employed, and retired or pensioned. In addition, greater level of contact with migration to the U.S. was associated with a higher level of perceived well-being, family support, and economic security. Discussion: Elderly, rural Mexican men with a greater degree of contact with migration to the U.S. seem to have more security and well-being in their old age.