Journal of Aging and Health

Objective:We studied the association of childhood adversity with adult functional status. Method: With data from the Panel Study of Income Dynamics and the 2014 Childhood Retrospective Circumstances Study (1992-2013; N = 6,705; 62,885 person-years), we estimated functional status transition probabilities associated with childhood adversity, with multinomial logistic Markov models adjusted for age, sex, race/ethnicity, and education. Microsimulation then estimated functional status outcomes throughout adulthood for African American, Hispanic, and non-Hispanic White women and men. Results: Adversity was significantly associated with functional status. Of White women without adversities, 2.3% had difficulty doing activities of daily living at age 30, compared with 8.2% with high adversity; comparable results were 3.7% and 8.7% for African Americans, 0.9% and 11.5% for Hispanics (all p < .01). Patterns were similar at other ages, for men, and when adjusted for midlife health conditions and health behavior. Discussion: Childhood adversity may substantially increase functional impairment throughout adult life.

Objective:To examine factors associated with visual impairment (VI) and eye care in the International Mobility in Aging Study (IMIAS). Method: IMIAS data were analyzed (N = 1,995 with ages 65-74). Outcomes were VI defined as presenting visual acuity worse than 6/18 in the better eye and eye care utilization assessed by annual visits to eye care professionals. The Hurt–Insult–Threaten–Scream (HITS) questionnaire requested information on domestic violence. Results: Among men, VI varied from 24% in Manizales (Colombia) to 0.5% in Kingston (Canada); among women, VI ranged from 20% in Manizales to 1% in Kingston; lifetime exposure to domestic violence was associated with VI (odds ratio [OR] = 1.87; 95% confidence interval [CI] = [1.17, 3.00]). Eye care utilization varied from 72% in Kingston’s men to 25% in Tirana’s men; it was associated with domestic violence (prevalence ratio [PR] = 1.3; 95% CI = [1.1, 1.6]). Discussion: VI is more frequent where eye care utilization is low. Domestic violence may be a risk factor for VI.

Objective: To quantify longitudinal change in financial and health literacy and examine the associations of declining literacy with incident Alzheimer’s disease (AD) dementia and mild cognitive impairment (MCI). Method: Data came from 799 participants of an ongoing cohort study. Literacy was measured using a battery of 32 questions. Clinical diagnoses were made annually following uniform structured procedures. The associations of declining literacy with incident AD dementia and MCI were tested using a joint model for longitudinal and time-to-event data. Results: We observed an overall decline in total literacy score over up to 6 years of follow-up (p < .001). Faster decline in literacy was associated with higher risks for incident AD dementia (hazard ratio = 4.526, 95% confidence interval = [2.993, 6.843], p < .001) and incident MCI (hazard ratio = 2.971, 95% confidence interval = [1.509, 5.849], p = .002). Discussion: Declining literacy among community-dwelling older persons predicts adverse cognitive outcomes and serves as an early indicator of impending dementia.

Objective: To examine activities of daily living (ADL) disability outcomes among racially/ethnically diverse elders receiving home care (HC) after hospitalization. Method: We conducted a retrospective cohort analysis of single-agency, 2013-2014 Outcome and Assessment Information Set data from older adults who received post-hospitalization HC (n = 20,674). We measured overall change in ADL disability by summing the difference of standardized admission and discharge scores from nine individual ADL. Associations between race/ethnicity and overall ADL change scores were modeled using general linear regression, adjusting for covariates consistent with the Disablement Model. Results: Overall, patients experienced improvement in ADL disability from HC admission to discharge. However, Asian, African American, and Hispanic patients experienced significantly less improvement compared with non-Hispanic Whites (all p < .001), even after controlling for covariates. Discussion: Racial/ethnic disparities exist in ADL disability improvement among HC patients. Research is needed to clarify mechanisms underlying these disparities. Disablement Model factors may be targets for clinical intervention.

Objective:We document differential prevalence of need for assistance with personal, instrumental, and mobility tasks and adverse consequences of unmet needs, nursing home relocation, and mortality among Black and White older adults. Method: Data are from the National Health and Aging Trends Study. Using logistic and multinomial logistic regression, we determine whether race is predictive of reporting need or adverse consequence and test the role of race as a moderator of the relationship between baseline need and three 1-year outcomes. Results: Black older adults are more likely to experience a consequence of unmet need (35.33% vs. 29.97%, p = .028) in unadjusted models. In adjusted models, we find no moderating effect of race on baseline need on nursing home placement (0.00, 95% confidence interval [CI] = [−2.43, 2.42], p = .991), mortality (0.73, 95% = [−1.58, 0.11], p = .089), or a Round 2 consequence of unmet (−0.51, 95% CI = [−1.15, 0.14], p = .121). Discussion: This work highlights the complex relationship between race, need, unmet need, mortality, and nursing home entry.

Objective: The objective of this is to examine whether pain is associated with the onset of loneliness in a sample of community-dwelling older adults. Methods: We used data from the 2008 and 2012 Health and Retirement Study. We limited the sample to community-dwelling persons aged 60 years and over who were not lonely in 2008 in order to predict the risk of onset of loneliness (incidence) in 2012. Our analytic sample included 1,563 observations. Results: Approximately 31.7% of participants reported loneliness at follow-up (2012). Logistic regression models showed that the odds of loneliness onset was 1.58 higher for those with pain at both time points, compared with those who had pain at neither time point, even after controlling for other covariates. Discussion: The results indicate that pain may increase the risk of loneliness in older adults. This suggests that appropriate pain interventions could prevent future loneliness, which in turn could prevent functional decline, disability, and premature mortality.

Objectives: Self-reported physical activity has shown to affect muscle-related parameters. As self-report is likely biased, this study aimed to assess the association between instrumented assessment of physical activity (I-PA) and muscle-related parameters in a general population. Method: Included were 156 young-to-middle-aged and 80 older community-dwelling adults. Seven days of trunk accelerometry (DynaPort MoveMonitor, McRoberts B.V.) quantified daily physical activity (i.e., active/inactive duration, number and mean duration of active/inactive periods, and number of steps per day). Muscle-related parameters included muscle mass, handgrip strength, and gait speed. Results: I-PA was associated with handgrip strength in young-to-middle-aged adults and with gait speed in older adults. I-PA was not associated with muscle mass in either age group. Discussion: The association between I-PA and muscle-related parameters was age dependent. The lack of an association between I-PA and muscle mass indicates the relevance of muscle function rather than muscle mass.

Objective: To evaluate the relationship between back pain severe enough to restrict activity (restricting back pain) and subsequent disability in essential (e) and instrumental (i) activities of daily living (ADL) among community-living older adults. Method: In this prospective cohort study, we evaluated 754 adults, aged ≥70 years who were initially nondisabled in eADL. Restricting back pain and disability were assessed during monthly interviews for up to 159 months. Associations between restricting back pain and subsequent eADL and iADL disability were evaluated using recurrent events Cox models, adjusted for fixed-in-time and time-varying covariates. Results: Strong associations were found between restricting back pain and eADL and iADL disability, with hazard ratios (95% confidence intervals) of 3.47 [3.01, 3.90] and 2.33 [2.08, 2.61], respectively. Discussion: Restricting back pain was independently associated with subsequent disability in eADL and iADL. Interventions focused on decreasing restricting back pain in older adults may have the potential to reduce the subsequent burden of disability.