Adverse childhood experiences, adult trauma, and depressive symptom trajectories.

OBJECTIVES: Associations among adverse childhood experiences prior to age 18 (ACEs), subjective reports of trauma during Hurricane Sandy, and trajectories of depressive symptoms reported by community-dwelling older people were examined. METHODS: We analyzed 6 waves of data from 5,688 people aged 50-74 recruited in 2006 and followed for 12-years using multilevel mixed effects models. RESULTS: We found that: (1) people who experienced ACEs had trajectories of depressive symptoms in late life that were higher than people not having these experiences, (2) people experiencing two or more ACEs were more likely to report fear and distress when Hurricane Sandy hit than people experiencing either one or no adverse childhood experiences, and (3) while both ACE exposure and peri-traumatic stress were associated with trajectories having higher levels of depressive symptoms, the risk associated with ACEs (especially multiple ACEs) was greater. CONCLUSION: Findings support life course stress theories including the cumulative inequality theory and stress proliferation theory, suggesting that inequalities are manifested over the life course and that people experiencing adversity during childhood are at increased risk of experiencing adversity in late life. By studying the relationship between adverse childhood experiences and response to Hurricane Sandy our findings demonstrate that adverse childhood experiences can alter the way traumatic events in adulthood are experienced. This finding in turn, has important implications for clinical practice, as it identifies a group of people likely to be at risk for adult trauma.

The Prospective Association of Personality Traits and Successful Aging.

We used data (N = 928) from ORANJ BOWL, a six-wave panel of adults (aged 50-74 at baseline) to address the association between personality and successful aging at two points in time, 8 years apart. Regressions examined the associations between Wave 2 neuroticism, extraversion, openness, agreeableness, and conscientiousness and Wave 3 subjective success, functional ability, pain, and chronic conditions. Models tested personality traits independently and then simultaneously, with interactions. Confirmatory analyses used Waves 5/6 data. All traits but openness were individually associated with successful aging at both time points. When testing traits simultaneously, only neuroticism and extraversion were consistently associated with subjective success, with an interaction at Waves 2/3. Neuroticism (Waves 2/3) and conscientiousness (Waves 5/6) were associated with functional ability. Neuroticism was associated with pain (Waves 2/3). Personality was not associated with chronic conditions. These analyses set up future work examining relationships between change in personality and change in successful aging.

Adult Children Living With Aging Parents: The Association Between Income and Parental Affect.

This study examined the moderating effect of parental income on the association between parent-child coresidence and parental affect. Secondary analysis was conducted with data from the ORANJ BOWL panel, a representative sample of adults in New Jersey, aged 50 to 74 years ( N = 5,688). Results indicated that income had a significant moderating effect on the association between the adult child's residential status and parents' positive and negative affect. Among parents with coresident adult children, an observed decline in positive affect and rise in negative affect were amplified as parental income level increased, suggesting differential strains on parental well-being across income levels.

Illness Representations of Multiple Chronic Conditions and Self-Management Behaviors in Older Adults: A Pilot Study.

This article explores the intraindividual variability in illness representations of people with multiple chronic conditions and examines how representations of hypertension and arthritis are associated with self-management. Intraclass correlations determined the proportion of within-person variability in illness representations including Timeline, Consequences, Personal Control, and Timeline-Cyclical for 25 adults aged 64 and older. Within-person consistency across illnesses was present for Timeline and Timeline-Cyclical, but variability across illnesses in Personal Control and Consequences. Correlations revealed associations of diet, exercise, and sleep with illness representations of people with arthritis and hypertension. Representations of hypertension (Personal Control, Timeline-Cyclical, and Consequences) were associated with adherence to a reduced fat diet, walking, and total sleep time. Representations of arthritis were not associated with health behaviors. Findings demonstrate that clinical practice must consider the illness representations patients have about each of their chronic illnesses to begin to sustain positive self-management behaviors.

Exposure to Hurricane Sandy, neighborhood collective efficacy, and post-traumatic stress symptoms in older adults.

OBJECTIVES: Older adults exposed to natural disasters are at risk for negative psychological outcomes such as post-traumatic stress disorder (PTSD). Neighborhood social capital can act as a resource that supports individual-level coping with stressors. This study explores the ability of perceived neighborhood collective efficacy, a form of social capital, to moderate the association between exposure to Hurricane Sandy and PTSD symptoms in older adults. METHOD: Data from 2205 older individuals aged 54-80 residing in New Jersey who self-reported exposure to Hurricane Sandy in October of 2012 were identified and extracted from the ORANJ BOWL™ research panel. Participants completed baseline assessments of demographic and individual-level characteristics in 2006-2008 and follow-up assessments about storm exposure, perceived neighborhood collective efficacy (social cohesion and social control), and PTSD symptoms 8-33 months following the storm. Zero-inflated Poisson regression models were tested to examine the association between exposure, neighborhood collective efficacy, and PTSD symptoms. RESULTS: After accounting for known demographic and individual-level covariates, greater storm exposure was linked to higher levels of PTSD symptoms. Social cohesion, but not social control, was linked to lower reports of PTSD symptoms and moderated the association between exposure and PTSD. The impact of storm exposure on PTSD symptoms was less for individuals reporting higher levels of social cohesion. CONCLUSION: Mental health service providers and disaster preparedness and response teams should consider the larger social network of individuals served. Building social connections in older adults' neighborhoods that promote cohesion can reduce the negative psychological impact of a disaster.

The Great Recession, Life Events, and Mental Health of Older Adults.

Historical events and personal experiences have the potential to alter the way people age. Using a life-course model, we examined how the Economic Recession of 2008 and experienced life events affected the mental health of 3,393 older adults in New Jersey. Data collected between 2006 and 2012 revealed a significant increase in mean depressive symptoms. Multinomial logistic regression analyses indicated that people with incident depression were more likely to have lost a job, become a caregiver, experienced a major illness, or have a family member with a major illness than people with no depression. Compared with the incident depression group, those with remitted depression were less likely to report having lost a job or experienced a major illness. Modeling the effects of individual life events and the economic recession on depression enriches understanding about the association between macro socioeconomic events, life events, and the mental health of older adults.

Neighborhood food environment and obesity in community-dwelling older adults: individual and neighborhood effects.

OBJECTIVES: We tested hypotheses about the relationship between neighborhood-level food sources and obesity, controlling for individual-level characteristics. METHODS: Data (collected November 2006-April 2008) derived from a random-digit-dial sample of 5688 community-dwelling adults aged 50 to 74 years residing in 1644 census tracts in New Jersey. Using multilevel structural equation models, we created latent constructs representing density of fast-food establishments and storefronts (convenience stores, bars and pubs, grocery stores) and an observed indicator for supermarkets at the neighborhood level, simultaneously modeling obesity and demographic characteristics (age, gender, race, education, household income) at the individual level. RESULTS: When we controlled for individual-level age, gender, race, education, and household income, densities of fast-food establishments and storefronts were positively associated with obesity. Supermarkets were not associated with obesity. CONCLUSIONS: Because people living in neighborhoods with a higher density of fast food and storefronts are more likely to be obese, these neighborhoods may be optimal sites for interventions.

Subjective Successful Aging Predicts Probability of Mortality Over 9 Years Among Adults Aged 50-74.

BACKGROUND AND OBJECTIVES: Although the relationship between mortality and objective successful aging (health, functional ability, social engagement) is clear, the relationship between subjective successful aging (SSA) and mortality is inconclusive. Building on the broader literature regarding psychological well-being, these analyses examine the relationship between SSA and mortality, adjusting for demographic, health, and lifestyle characteristics with known mortality risks. RESEARCH DESIGN AND METHODS: We analyzed self-report data collected between 2006 and 2008 from 5,483 people. In addition to demographic, health, and lifestyle variables, we measured SSA using a valid, reliable measure. Over the course of 3,285 days, 695 people died. We computed four sequential Cox proportional-hazard models to examine the association between SSA and time to death. The first model included only SSA; Model 2 added demographic characteristics; Model 3 added health characteristics; Model 4 added lifestyle characteristics. RESULTS: We found that SSA had a significant association with mortality, accounting for known mortality risk factors. Each one-point rise in SSA decreased the risk of mortality by three percent (0.97; 95% CI= 0.95-0.99; p<0.05). The probability of death within 9 years for persons with SSA scores from 0-5 was 45%; for persons with SSA scores from 25-30, risk of mortality was less than 10%. DISCUSSION AND IMPLICATIONS: Findings provide evidence that lower SSA scores reveal greater risk for mortality beyond demographic, health, and lifestyle variables. A brief assessment of SSA can provide unique clinical information and be used to identify people who might benefit from interventions to reduce mortality risk.

Balancing Caregiving and Work: Role Conflict and Role Strain Dynamics.

Positing role conflict as a bidirectional construct in which work interferes with caregiving (WIC) and caregiving interferes with work (CIW), this study investigated its antecedents (demands and support of caregiving and work) and consequences (role strain). A national sample of 583 women between the ages of 50 and 64 years identified using random-digit-dial procedures completed a telephone survey. Structural equation modeling revealed that caregiving demands were positively associated with CIW and caregiving burden; instrumental caregiving support reduced CIW and caregiving burden. Work demands were positively associated with WIC, CIW, caregiving burden, and work burden. Emotional workplace support reduced WIC, CIW, and work burden. CIW and WIC were positively associated with caregiving burden; only WIC was positively associated with work burden. Findings suggest that demands and supports related to the caregiving role do not influence work-related role strain; work demands and supports influence role strain experienced from both caregiving and work domains.

Peritraumatic Stress From a Disaster Increases Risk for Onset of Chronic Diseases Among Older Adults.

BACKGROUND AND OBJECTIVES: Our understanding of the impact of disaster exposure on the physical health of older adults is largely based on hospital admissions for acute illnesses in the weeks following a disaster. Studies of longer-term outcomes have centered primarily on mental health. Missing have been studies examining whether exposure to disaster increases the risk for the onset of chronic diseases. We examined the extent to which 2 indicators of disaster exposure (geographic exposure and peritraumatic stress) were associated with new onset of cardiovascular disease, diabetes, arthritis, and lung disease to improve our understanding of the long-term physical health consequences of disaster exposure. RESEARCH DESIGN AND METHODS: We linked self-reported data collected prior to and following Hurricane Sandy from a longitudinal panel study with Medicare data to assess time to new onset of chronic diseases in the 4 years after the hurricane. RESULTS: We found that older adults who reported high levels of peritraumatic stress from Hurricane Sandy had more than twice the risk of experiencing a new diagnosis of lung disease, diabetes, and arthritis in the 4 years after the hurricane compared to older adults who did not experience high levels of peritraumatic stress. Geographic proximity to the hurricane was not associated with these outcomes. Analyses controlled for known risk factors for the onset of chronic diseases, including demographic, psychosocial, and health risks. DISCUSSION AND IMPLICATIONS: Findings reveal that physical health effects of disaster-related peritraumatic stress extend beyond the weeks and months after a disaster and include new onset of chronic diseases that are associated with loss of functioning and early mortality.

Long-Term Impact of Hurricane Sandy Exposure on Positive and Negative Affect: The Role of Perceived Social Support.

OBJECTIVES: Natural disasters can have devastating, long-lasting effects on the mental health of older adults. However, few studies have examined associations among disaster exposure and positive and negative affect, and no longitudinal studies have investigated the extent to which predisaster perceived social support affects these associations. These analyses examine the associations among predisaster perceived social support, disaster exposure, and positive and negative affect experienced by community-dwelling older adults 4 years after Hurricane Sandy, controlling for predisaster affect. METHODS: Self-reported data collected before and after Hurricane Sandy from participants (aged 50-74 years) in the ORANJ BOWL panel (N = 2,442) were analyzed using linear regression models. RESULTS: Higher levels of peritraumatic stress experienced during Hurricane Sandy and greater hardship experienced after the storm were associated with more negative affect 4 years following the disaster. Higher perceived social support at baseline was related to more positive affect and less negative affect both before and after the hurricane. Social support did not moderate the effect of hurricane exposure on either positive or negative affect. DISCUSSION: Findings suggest that psychological effects may persist years after natural disasters and that more effective interventions may be needed during and after a disaster. While social support is critical to positive and negative affect in general, its buffering effects when disaster strikes may be limited.

Subjective Successful Aging: Measurement Invariance Across 12 Years.

BACKGROUND AND OBJECTIVES: Debates about how to define successful aging have dominated gerontology for over 60 years. Regardless of how successful aging is conceptualized, in order to accurately understand how the construct changes over time and how it differs between people of varying ages, successful aging must be measured with instruments that are valid, reliable, and have measurement invariance. These analyses focus on subjective successful aging and examine the extent to which a reliable, valid, 3-item scale has measurement invariance across 12 years for individuals aged 50-86. RESEARCH DESIGN AND METHODS: We analyzed 5 waves of data collected from a panel of 5,688 community-dwelling people aged 50-74 when recruited in 2006. We tested measurement invariance using the standard 4 nested steps,, introducing increasing parameter constraints at each step. Analyses were conducted using Mplus 7. RESULTS: Analyses revealed that the 3-item scale measuring subjective successful aging has adequate measurement invariance across time. We demonstrated that the scale has configural, metric, and scalar invariance by most standard metrics. Only residual invariance was not supported. However, because residuals are not part of the latent factor, invariance of the item residuals is inconsequential to interpretation of latent mean differences. DISCUSSION AND IMPLICATIONS: Findings provide the foundation needed for researchers to examine change in subjective successful aging over time, differences in subjective successful aging between people of varying ages, and predictors of subjective successful aging, confident that the scale has adequate measurement invariance.

Long term impact of Hurricane Sandy on hospital admissions of older adults.

RATIONALE: In the weeks and months following a disaster, acute illness and injuries requiring hospital admission increase. It is not known whether disaster exposure is associated with increased risk for hospitalization in the years after a disaster. OBJECTIVE: We examined the extent to which disaster exposure is associated with hospitalization two years after Hurricane Sandy. The analyses fill a clinical gap in our understanding of long-term physical health consequences of disaster exposure by identifying older adults at greatest risk for hospitalization two years after disaster exposure. METHOD: Survey data from a longitudinal panel study collectedbefore and after Hurricane Sandy were linked with Medicare inpatient files in order to assess the impact of Hurricane Sandy on hospital admissions two years following the hurricane. RESULTS: We found that people who reported experiencing a lot of fear and distress in the midst of Hurricane Sandy were at an increased risk of being hospitalized two years after the hurricane [Hazard Ratio = 1.75; 95% CI (1.12-2.73)]. Findings held after controlling for pre-disaster demographics, social risks, chronic conditions, hospitalizations during the year before the hurricane, and decline in physical functioning. CONCLUSIONS: These findings are the first to show that disaster exposure increases the risk for hospital admissions two years after a disaster. Controlling for known risk factors for hospitalization, older adults who experience high levels of fear and distress during a disaster are more likely to be hospitalized two years following the disaster than older adults who do not have this experience.

Change in Loneliness Experienced by Older Men and Women Living Alone and With Others at the Onset of the COVID-19 Pandemic.

Building on theory suggesting that loneliness is distinct from living arrangements, social isolation, and perceived social support, we examined change in loneliness for older people at the onset of the COVID-19 pandemic. Analyzing 14-years of data with multilevel mixed-effects models, we found higher levels of loneliness among people living alone, people more socially isolated, and people with less perceived support. Gender affected changes in loneliness, controlling for social isolation, perceived support, living arrangements, age, education, income, health, and marital status. Women, whether living alone or with others, experienced increases in loneliness; women living alone reported the greatest increase in loneliness. Men living alone reported high levels of loneliness prior to the pandemic, but only a slight increase over time. These analyses, which demonstrate that loneliness changed at the onset of the pandemic as a function of gender and living arrangement identify older people most likely to benefit from intervention.

Challenges Experienced by Older People During the Initial Months of the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has created unique stressors for older people to manage. Informed by the Stress Process Model and the Transactional Model of Stress and Coping, we examined the extent to which older people are adhering to physical distancing mandates and the pandemic-related experiences that older people find most challenging. RESEARCH DESIGN AND METHODS: From May 4 to May 17, 2020, a web-based questionnaire focused on the COVID-19 pandemic was completed by 1,272 people (aged 64 and older) who were part of an ongoing research panel in New Jersey recruited in 2006. Frequencies for endorsement of physical distancing behaviors were tabulated, and open-ended responses to the biggest challenge of the pandemic were systematically coded and classified using content analysis. RESULTS: More than 70% of participants reported adhering to physical distancing behaviors. Experiences appraised as most difficult by participants fell into 8 domains: Social Relationships, Activity Restrictions, Psychological, Health, Financial, Global Environment, Death, and Home Care. The most frequently appraised challenges were constraints on social interactions (42.4%) and restrictions on activity (30.9%). DISCUSSION AND IMPLICATIONS: In the initial weeks of the pandemic, the majority of older adults reported adhering to COVID-19 physical distancing mandates and identified a range of challenging experiences. Results highlight the factors having the greatest impact on older adults, informing quantitative modeling for testing the impact of the pandemic on health and well-being outcomes, and identifying how intervention efforts may be targeted to maximize the quality of life of older adults.

Effects of peri-traumatic stress experienced during Hurricane Sandy on functional limitation trajectories for older men and women.

BACKGROUND AND METHODS: Although the short-term effects of disasters on the physical health of mid-life and older people have been documented, little is understood about the long-term effects that disasters have on the physical health of these people. Based on the environmental docility hypothesis and research regarding gender effects on functional limitations and disaster, our analyses examined the effects of peri-traumatic stress experienced during Hurricane Sandy using longitudinal data from 5688 people aged 50 and older collected over six waves (2006-2019). RESULTS: We found that functional limitations follow three trajectories, with people in each group having a significant linear increase over time and all but the highest functioning people also having a significant quadratic effect, indicating that the linear increase peaked post-Hurricane and then slowed in later waves. CONCLUSION: Consistent with the environmental docility hypothesis, peri-traumatic stress had its greatest impact on people with more functional limitations before the hurricane. Men experiencing peri-traumatic stress during Hurricane Sandy were more likely to experience an increase in functional limitations than women. These findings, which identify people most likely to experience long-term health effects following a disaster, can be used to inform health policies before, during, and after disaster strikes.

Understanding Attrition and Bolstering Retention in a Longitudinal Panel of Older Adults: ORANJ BOWL.

BACKGROUND AND OBJECTIVES: Attrition from longitudinal studies can affect the generalizability of findings especially when studying developmental constructs such as successful aging. RESEARCH DESIGN AND METHODS: Using data from a 12-year (6-wave) panel of 5,688 older people (aged 50-74 at baseline), we compared people retained in the panel with people lost to follow-up on demographic characteristics and measures of successful aging. After instituting expanded retention strategies at Wave 6 (i.e., a team-based approach, social media, and paid web search engines), we compared different groups of people lost to follow-up (i.e., deceased and withdrawn due to lack of interest) and different types of completers (i.e., full completers vs. lost and reengaged completers). RESULTS: At baseline, Wave 6 completers were significantly younger, less likely to be African American, more likely to be married, reported higher levels of income and education, were more likely to be working full-time, had less pain and fewer chronic illnesses, and reported higher levels of subjective successful aging and functional ability than those lost to follow-up. Analyses demonstrated differences across groups based on the reason for loss (i.e., deceased, impaired, and not interested). Participants who missed an interview but returned to the panel were significantly different from those who participated in all waves of data collection. Expanded retention efforts improved generalizability, as people returning to the panel reported lower levels of education, lower levels of income, and were more likely to be African American. DISCUSSION AND IMPLICATIONS: Biased attrition within longitudinal research affects the interpretation of study findings, especially when studying developmental outcomes. However, expanded retention strategies can reduce bias and loss and should be used to enhance retention efforts in longitudinal work.

Impact of Upper and Lower Body Functional Ability on Affect in Older Couples.

Objective: We explore how upper and lower body functional ability of older adults and their partners relate to affect in later life. Methods: Data regarding own and partner's upper and lower body functional abilities were reported by 1767 married/partnered persons aged 57-83. Using multilevel modeling to account for nesting within couples, we examined the impact of a respondent's own functional abilities, their perception of their partner's abilities, and the interaction of respondent's and perceived partner's abilities on respondent's positive and negative affect. Results: Higher upper and lower body ability of both respondents and partners were associated with higher positive and lower negative affect. Moderating effects demonstrated a protective role of respondents' ability on affect when their partners experienced lower ability. Discussion: There is a potential compensatory relationship between older couples adapting to functional changes; it is important to support the functional abilities of both partners in couples to maximize psychological well-being.

Trajectories of Depressive Symptoms Experienced by Older People: Effects of Time, Hurricane Sandy, and the Great Recession.

OBJECTIVES: To examine depressive symptom trajectories as a function of time and exposure to Hurricane Sandy, accounting for the effects of the Great Recession. METHODS: We analyzed 6 waves of data from a 12-year panel using latent class growth models and multinomial logistic regression. RESULTS: We identified 4 groups of people experiencing different trajectories of depressive symptoms. The groups differed on baseline characteristics (gender, age, education, income, race), history of diagnosed depression, and initial level of depressive symptoms. The group with the highest levels of depressive symptoms reported greater levels of peri-traumatic stress exposure to Hurricane Sandy. DISCUSSION: Depressive symptoms increased as a function of the Great Recession, but exposure to Hurricane Sandy was not associated with subsequent increases in depressive symptoms for any of the 4 groups. People who consistently experienced high levels of depressive symptoms over time reported the highest levels of peri-traumatic stress during Hurricane Sandy. Findings highlight the importance of accounting for historical trends when studying the effects of disaster, identify people likely to be at risk during a disaster, and provide novel information about the causal relationship between exposure to disaster and depressive symptoms.

The Effects of Neighborhood Built Environment on Walking for Leisure and for Purpose Among Older People.

BACKGROUND AND OBJECTIVES: Characteristics of a neighborhood's built environment affect the walking behavior of older people, yet studies typically rely on small nonrepresentative samples that use either subjective reports or aggregate indicators from administrative sources to represent neighborhood characteristics. Our analyses examine the usefulness of a novel method for observing neighborhoods-virtual observations-and assess the extent to which virtual-based observations predict walking among older adults. RESEARCH DESIGN AND METHODS: Using Google Street View, we observed the neighborhoods of 2,224 older people and examined how characteristics of the neighborhood built environments are associated with the amount of time older people spend walking for leisure and purpose. RESULTS: Multilevel model analyses revealed that sidewalk characteristics had significant associations with both walking for purpose and leisure. Land use, including the presence of multifamily dwellings, commercial businesses, and parking lots were positively associated with walking for purpose and single-family detached homes were negatively associated with walking for purpose, but none of these characteristics were associated with leisure walking. Gardens/flowers were associated with walking for leisure but not purpose. Garbage/litter was not associated with either type of walking behavior. DISCUSSION AND IMPLICATIONS: Virtual observations are a useful method that provides meaningful information about neighborhoods. Findings demonstrate how neighborhood characteristics assessed virtually differentially impact walking for leisure and purpose among older adults and are interpreted within a social-ecological model.