Journal of Aging and Health

Objective: We examine ownership differences in the use of technology in long-term care facilities. Method: We analyze two nationally representative surveys of administrators collected by the Centers for Disease Control (CDC): the 2004 National Nursing Home Survey and the 2010 National Survey of Residential Care Facilities. Results: We find that nonprofit nursing homes are more likely to use some computerized administrative functions and digital laboratory reports, and report use rates similar to for-profit organizations in other areas of health IT. Nonprofit residential care facilities are more likely to use electronic medical records and information exchange systems than their for-profit counterparts. In addition, nonprofit residential care facilities are more likely than for-profit facilities to digitize more types of information and use larger health information exchange networks. Discussion: The reasons for which nonprofit long-term care organizations report higher levels of some types of technology utilization are explored, and future research is recommended.

Objectives: This study assesses (a) the reciprocity between mental and physical health pre- and postretirement, and (b) the extent to which these associations vary by race. Method: Data are from the 1994 to 2008 waves of the Health and Retirement Study. Results: Analyses based on structural equation modeling reveal that depression and physical health exert reciprocal effects for Whites pre- and postretirement. For Blacks preretirement, physical limitations predict changes in depression but there is no evidence of the reverse association. Further, the association between physical limitations and changes in depressive symptoms among Blacks is no longer significant after retirement. Discussion: The transition into retirement alleviates the translation of physical limitations into depressive symptoms for Blacks only. The findings underscore the relevance of retirement for reciprocity between mental and physical health and suggest that the health implications associated with this life course transition vary by race.

Objectives: We examined the (a) influence of nursing facility characteristics on resident quality of life and (b) the impact of cognitive impairment and residence on a dementia special care unit(SCU) on QOL after controlling for resident and facility characteristics. Method: Multilevel models (resident and facility) were estimated for residents with and without cognitive impairment on conventional units and dementia SCU. Data came from the 2007 Minnesota Nursing Home Resident Quality of Life and Consumer Satisfaction Survey (N = 13,983). Results: Level of resident CI was negatively related to QOL, although residing on a dementia SCU was positively related to QOL. Certified Nursing Assistant and activity personnel hours per resident day had a positive relationship with resident QOL. Discussion: Our results highlight the need to ensure adequate levels of paraprofessional direct care staff and the availability of dementia-focused (SCU)s despite current constraints on long-term care funding.

Objective: To summarize existing evidence on the effect of serum folate and vitamin B12 levels on cognitive impairment among elders via a meta-analysis, also including unpublished data from a cross-sectional study of seniors ( > 65 years) residing in Velestino, Greece. Method: Serum measurements and Mini-Mental State Examination (MMSE) assessments were available for 593 Velestinians. In addition, 12 studies availing data on folate blood levels (N = 9,747) and 9 on B12 (N = 8,122) were identified following a search algorithm; pooled effect estimates were derived. Results: Cognitive impairment (MMSE < 24) among Velestenians was associated with lower education level in both genders; decreased social activity, depressive symptoms and low folate levels in males; older age in females. Meta-analyses showed an adverse effect of low-folate levels on cognition (OR: 1.66, 95% CI: 1.40-1.96); B12 was nonsignificantly associated (OR: 1.11, 95% CI: 0.88-1.40). Discussion: Low folate levels are associated with cognitive impairment of seniors; underlying pathophysiological mechanisms should be further explored.

Objective: To examine cross sectional associations between mobility with or without disability and social engagement in a community-based sample of older adults. Methods: Social engagement of participants (n = 676) was outside the home (participation in organizations and use of senior centers) and in home (talking by phone and use of Internet). Logistic or proportional odds models evaluated the association between social engagement and position in the disablement process (no mobility limitations, mobility limitations/no disability, and mobility limitations/disability). Results: Low mobility was associated with lower level of social engagement of all forms (Odds ratio (OR) = 0.59, confidence intervals (CI): 0.41-0.85 for organizations; OR = 0.67, CI: 0.42-1.06 for senior center; OR = 0.47, CI: 0.32-0.70 for phone; OR = 0.38, CI: 0.23-0.65 for Internet). For social engagement outside the home, odds of engagement were further reduced for individuals with disability. Discussion: Low mobility is associated with low social engagement even in the absence of disability; associations with disability differed by type of social engagement.

Objectives: This study examined previous mental health service use among low-income homebound middle-aged and older adults who participated in a study testing the feasibility and efficacy of telehealth problem-solving therapy for depression. Method: The sample consisted of 188 homebound adults aged 50 years or older. Data on mental health service use were collected at baseline. We used multivariable logistic regression analysis to examine correlates of different types of outpatient service use within the preceding 12 months. Results: Of the subjects, 56% reported mental health service use. Of the users, 80% had made at least one primary care mental health visit, 21% had visited a psychiatrist, and 25% had received counseling. Higher depressive symptom severity scores were positively associated with a psychiatrist visit only. Discussion: The need to improve low-income homebound older adults’ access to psychotherapy was clearly evident.

Objective: To determine whether (a) late-life pain predicts growth in older adults’ use of alcohol, and elevated risk of drinking problems; and (b) sociodemographic characteristics moderate these relationships. Method: Five times over an 8-year interval, N = 5,446 Health and Retirement Study (HRS) participants provided information about their pain and alcohol use. Two-part latent growth modeling and logistic regression were used to analyze these data. Results: Participants with more pain at baseline had lower initial levels and a faster rate of decline over the next 8 years in alcohol consumption, but they also were at elevated risk of having drinking problems. Income and African American background interacted with pain to predict 8-year change in alcohol consumption and presence of drinking problems. Discussion: Late-life pain does not predict growth in older adults’ alcohol consumption, but is nonetheless linked to elevated risk of drinking problems, especially among African Americans.

Objectives: A cohort of older people living in a low-resource setting in Nairobi is followed to understand the transitions in caregiving status and trajectories in health over a 3-year period. Methods: Three categories of older people comprising 65 AIDS caregivers, 102 Other caregivers and 1,322 noncaregivers identified at baseline were assessed at end-line based on two self-reported health outcome measures, a functionality score and having a severe health problem. Results: A majority of caregivers were still providing care at the end of the study, and or had taken on new care recipients. Compared with noncaregivers, AIDS caregivers reported poor health, with men more likely to report poor health than women. New caregivers also reported poorer health compared with noncaregivers. Discussion: The results indicate improvement in health over time among male caregivers supporting the adaptation model. We recommend timely programs to support caregivers particularly at the onset of caregiving.

Objective: This study estimates the prevalence of disability among late middle-aged women and identifies important correlates of disability among this population. Method: Disability was assessed among 376 participants of the Michigan Study of Women’s Health Across the Nation cohort at the 2011 follow-up using the World Health Organization Disability Assessment Schedule. Demographic and health measures were related to disability status using logistic regression models (none or mild vs. moderate, severe, or extreme disability). Results: Nearly 25% of women reported moderate to extreme global disability. African American race/ethnicity, economic strain, peripheral neuropathy, and depressive symptomatology were associated with global disability. Obesity, knee osteoarthritis, and hypertension were only associated with disability for the mobility domain (getting around). Discussion: The prevalence of disability is relatively high among this population of late middle-aged women. Efforts to prevent or forestall disability should be extended to include middle-aged populations as they may be most amenable to intervention.