Work and self-rated memory among native Hawaiian and other Pacific Islander older adults.

OBJECTIVES: Engagement in work has an important association with cognitive health in later life, yet little is known about this association among Native Hawaiian and other Pacific Islander (NHPI) older adults. This study assesses the associations between various work characteristics and memory problems among this population. DESIGN: Using data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (NHPI NHIS), the research question was explored among those who were aged 50+. RESULTS: Engagement in work, certain occupation types (e.g., clerical or professional occupations compared to blue-collar jobs), and the current/most recent job that is also the longest job held were associated with lower odds of having memory problems. CONCLUSION: The study's results suggest that work characteristics and opportunities to engage in work are important considerations in preventing memory problems in later life. As the NHPI population experiences cognitive health disparities earlier than other groups, timely interventions that focus on work engagement and a culturally relevant environment require further investigation.

Mattering and Self-Esteem as Bulwarks Against the Consequences of Financial Strain for Loneliness in Later Life: Differentiating Between- and Within-Person Processes.

Financial strain likely constitutes a principal risk for loneliness in later-life, but a strong sense of mattering and self-esteem may mitigate these consequences by both offsetting and buffering the influence of financial strain. We test these arguments using data from a national longitudinal survey of older adults gathered between 2021 and 2022 (N = 2384), as nations emerged from the COVID-19 pandemic. Application of a within-between modelling strategy facilitates differentiation of inter-individual (i.e., between-person) and intra-individual (i.e., within-person) factors. Between-person financial strain is associated with greater loneliness, but within- and between-person mattering and self-esteem offset this association by forestalling loneliness. Between-person mattering buffers between-person financial strain, but between-person self-esteem buffers within-person financial strain. Consequently, within-person financial strain is associated with greater loneliness only at low levels of between-person self-esteem. In summary, accruing a strong sense of worth contributes to protecting older adults from the adverse consequences of financial strain for loneliness.

Perceptions of Increases in Cost of Living and Psychological Distress Among Older Adults.

Objectives: This article examines whether older adults' perceptions of an increase in their cost of living during a time of rapid inflation are associated with multiple aspects of psychological distress, as well as whether mastery buffers these associations. Methods: Data were derived from a two-wave longitudinal survey of older adults gathered in 2021 and 2022 (N = 4,010). Multiple regression models examined symptoms of depression, anxiety, and anger. Results: Perceptions of moderate or large increases in cost of living were associated with higher levels of distress at follow-up. Taking baseline financial strain, mastery, and psychological distress into account weakened these associations, but perceptions of a large increase in cost of living were still substantially linked with anger and anxiety. Mastery also buffered associations with anxiety and anger. Discussion: Macroeconomically derived adversities can shape anxiety and anger in later-life, but these mental health consequences fall more heavily on individuals possessing lower levels of mastery.

Inequities in access to directly-funded home care in Canada: a privilege only afforded to some.

BACKGROUND: Directly-funded home care (DF) provides government funds to people who need assistance with the activities of daily living, allowing them to arrange their own services. As programs expand globally, many allow DF clients to hire home care agencies to organize their services rather than finding their own workers. In Canada, half of the DF home care programs allow users to purchase agency services. The goal of this research is to describe the role of agency providers in DF home care in Canada and consider potential equity implications for service access from the perspectives of clients and families. METHODS: Framed with intersectionality, the study included online focus groups with families and clients (n = 56) in the two Canadian provinces of Alberta and Manitoba between June 2021-April 2022. All transcripts underwent qualitative thematic analysis using open and axial coding techniques. Each transcript was analyzed by two of three possible independent coders using Dedoose qualitative analysis software. RESULTS: The article presents five thematic findings. First, the focus groups document high rates of satisfaction with the care regardless of whether the client uses agency providers. Second, agency providers mediate some of the administrative barriers and emotional strain of using DF home care, and this is especially important for family caregivers who are working or have additional care responsibilities. Third, there are out-of-pocket expenses reported by most participants, with agency clients describing administrative fees despite lower pay for the frontline care workers. Fourth, agencies are not generally effective for linguistic and/or cultural matching between workers and families. Finally, we find that DF care programs cannot compensate for a limited informal support network. CONCLUSIONS: Clients and families often intentionally choose DF home care after negative experiences with other public service options, yet the results suggest that in some Canadian contexts, DF home care is a privilege only afforded to some. Given the growing inequalities that exist in Canadian society, all public home care options must be open to all who need it, irrespective of ability to pay, degree of social support, or competence in the English language.

Mental Health Benefits and Detriments of Caregiving Demands: A Nonlinear Association in the Canadian Longitudinal Study on Aging.

OBJECTIVES: This study examines whether the association between caregiving demands and mental health is non-linear and also, whether this non-linear association is contingent on the marital status of the caregiver. METHODS: We analyze the data from the Canadian Longitudinal Study on Aging, applying OLS regression and quadratic interaction terms. RESULTS: A lower level of demands is salubriously associated with symptoms of depression and life satisfaction, but this association becomes deleterious at higher levels of demands. Moreover, a connection to a marital partner extends the benefits of caregiving demands and stems the adverse consequences. DISCUSSION: This research shows that acts of caregiving may not themselves be detrimental. Instead, the degree and way in which caregiving relates to mental health may vary by both the extent of the demands of the caregiving role and familial relationships in which caregivers are embedded.

Intersectionality, health equity, and EDI: What's the difference for health researchers?

Many countries adopted comprehensive national initiatives to promote equity in higher education with the goal of transforming the culture of research. Major health research funders are supporting this work through calls for projects that focus on equity, resulting in a proliferation of theoretical frameworks including "intersectionality," "health equity," and variations of equity, diversity and inclusion, or EDI. This commentary is geared at individual principal investigators and health research teams who are developing research proposals and want to consider equity issues in their research, perhaps for the first time. We present histories and definitions of three commonly used frameworks: intersectionality, health equity, and EDI. In the context of health research, intersectionality is a methodology (a combination of epistemology and techniques) that can identify the relationships among individual identities and systems of oppression; however, it should also be used internally by research teams to reflect on the production of knowledge. Health equity is a societal goal that operationalizes the social determinants of health to document and address health disparities at the population level. EDI initiatives measure and track progress within organizations or teams and are best suited to inform the infrastructure and human resourcing "behind the scenes" of a project. We encourage researchers to consider these definitions and strive to tangibly move health research towards equity both in the topics we study and in the ways we do research.

Preventive Care and Outcomes of Interprofessional Medicare Annual Wellness Visits for Older Adults.

As we anticipate a growing population of older adults, we will see an increase in chronic conditions such as dementia and falls. To meet these public health needs, we must systematically provide screening, education, preventive care, and supportive care for older patients and their caregivers in a primary care setting. This will require a workforce trained in providing for the complex medical and psychosocial needs of an older adult population in an interprofessional and collaborative fashion. By integrating geriatric screening tools into an interdisciplinary Annual Wellness Visit teaching clinic, we were able to successfully improve rates of geriatric screening for dementia, depression, falls, medication reconciliation and advance care planning. We also saw improvements in patient care and satisfaction and provided the opportunity for interprofessional collaboration and education for students in medicine, nursing, pharmacy and social work.

Work Demands and Cognitive Health Inequities by Race and Ethnicity: A Scoping Review.

BACKGROUND AND OBJECTIVES: This scoping review aimed to chart the scientific literature on the association between workplace demands with cognitive health, and whether race and ethnicity have a direct or indirect relationship between occupational complexity and cognitive health. RESEARCH DESIGN AND METHODS: PRISMA scoping review guided this study. Peer-reviewed articles were drawn from 5 databases. Inclusion criteria were populations aged 18 and older, U.S.-based studies, a comprehensive conceptualization of workplace demands, and cognitive health outcomes. All articles were screened by title and abstract; qualifying articles proceeded to full-text review. RESULTS: The majority of studies drew from theories that did not interrogate heterogeneity and minority aging experiences. Consequently, the majority of studies did not include race and ethnicity in their analyses. A small and growing body of research drew from critical perspectives and interrogated cognitive health inequities by race and ethnicity within the context of workplace demands. The association between workplace demands and cognitive health is not linear when race and ethnicity are examined. Emerging evidence suggests interventions to improve substantive complexity among racial and ethnic minorities, and individuals with low education are a promising avenue for intervention research. DISCUSSION AND IMPLICATIONS: We discuss integrating emerging theories, such as minority stress and revised social determinants of health frameworks, to sharpen the focus and broaden our understanding on racial and ethnic cognitive health inequities in an emerging area of prevention research. This research can advance our basic understanding of preventable health inequities as well as provide important information for interventions.

Neighborhood Social Cohesion and the Health of Native Hawaiian and Other Pacific Islander Older Adults.

Native Hawaiian and other Pacific Islander (NHPI) older adults experience various social and health challenges. There is a growing literature linking neighborhood conditions with health, yet few have focused on NHPI older adults. This study examines associations between neighborhood social cohesion and health outcomes (i.e., self-rated health, psychological distress, and memory) in this population. Data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (n=1,045 with respondents aged 50+) were analyzed with logistic regression models. The level of neighborhood social cohesion was determined by responses to items on perceptions of mutual help, dependability, trust, and close relationships within the neighborhood. Higher perceived neighborhood social cohesion was associated with lower odds of having serious psychological distress or memory problems. There was no statistical association of social cohesion with self-rated health. Socially cohesive neighborhoods are important to the health of NHPI. We discuss methods to improve neighborhood social cohesion as a way to promote health equity for NHPI older adults in the United States (U.S.).

Multifaceted Demands of Work and Cognitive Functioning: Findings From the Health and Retirement Study.

OBJECTIVES: The present study examines the associations between mental, social, and physical demands of work and cognitive functioning among older adults in the United States. METHOD: Data from 3,176 respondents in the Health and Retirement Study were analyzed using growth curve modeling (2004-2014). The study investigated differences by gender, race, ethnicity, and education. RESULTS: Higher mental and social demands of work were associated with higher levels of initial cognitive functioning, but were not significantly associated with slower cognitive decline over time. Physical demands of work were negatively associated with initial cognitive functioning and were also marginally associated with a slower rate of decline in cognitive functioning going into older adulthood. In stratified analyses, results varied by sociodemographic characteristics. DISCUSSION: The results partially support the environmental complexity hypothesis and the productive aging framework in that higher mental and social demands and lower physical demands relate to better cognitive functioning at baseline, with the differences appearing stable throughout older adulthood. The stratified results shed light on addressing disparities in cognitive aging and work environments.

Identifying Communities of Concern for Older Adults Using Spatial Analysis: Focusing on Accessibility to Health, Social, and Daily Services.

Ensuring accessibility to necessary services is critical for older adults. However, there often exist spatial disparities in the levels of accessibility to services. Because the application of Geographic Information System (GIS) has gained attention in the gerontology field, we used spatial analysis to identify communities of concern for older adults from the perspective of accessibility. We defined the communities of concern based on the proportion of older adults and the level of accessibility to health, social, and daily services via two specific modes of transportation-walking and public transit. Our findings show that newly developed communities tend to have less accessibility to necessary services, and aging communities are randomly distributed across the city. Our results call for interdisciplinary collaboration, between urban planning and gerontology professionals, to better understand the spatial pattern of aging communities and its implication for properly addressing the mobility needs of older adults in the communities.

A Longitudinal Assessment of Perceived Discrimination and Maladaptive Expressions of Anger Among Older Adults: Does Subjective Social Power Buffer the Association?

Objectives: We examine whether perceived discrimination in older adults is associated with external conflict (anger-out) and internally directed anger (anger-in), as well as how subjective social power-as indicated by a sense of personal control and subjective social status-modifies these associations while holistically controlling for time-stable confounds and the five major dimensions of personality. Method: The 2006 and 2008 psychosocial subsamples of the Health and Retirement Study were combined to create baseline observations, and the 2010 and 2012 waves were combined to create follow-up observations. Responses were analyzed with random-effects models that adjust for repeated observations and fixed-effects models that additionally control for all time-stable confounds. Results: Discrimination was significantly associated with anger-in and anger-out. Fixed-effects models and controls for personality reduced these associations by more than 60%, although they remained significant. Measures of subjective social power weaken associations with anger-out but not anger-in. Discussion: The mental health consequences of perceived discrimination for older adults may be over-estimated if time-stable confounds and personality are not taken into account. Subjective social power can protect victims of discrimination from reactions that may escalate conflict, but not from internalized anger that is likely to be wearing and cause further health problems.

Chronic Pain and Psychological Distress Among Older Adults: A National Longitudinal Study.

This research examines whether unobserved time-stable influences confound the association between chronic pain and psychological distress in older adults as well as how race and ethnicity combine with subjective social status (SSS) to modify the association. In a nationally representative longitudinal survey, holistically controlling for unobserved time-stable influences using fixed-effects models substantially reduces the pain-depression relationship and eliminates the overall pain-anxiety relationship. The association with depression is stronger for Black and Hispanic elders, illustrating a process of double-jeopardy. Black elders with severe pain experience lower anxiety, as do Black elders with moderate pain and low SSS, which we suggest may be due to the enervating effects of undermanaged pain. Black elders at high SSS experience greater anxiety with moderate pain. This research suggests that undermanagement of chronic pain among racial and ethnic minorities differentiates the association between pain and distress in late life and especially creates stronger associations with depression.

Back to Work? Not Everyone. Examining the Longitudinal Relationships Between Informal Caregiving and Paid Work After Formal Retirement.

OBJECTIVES: Research on unretirement (retirees who re-enter the workforce) is burgeoning. However, no longitudinal study has examined how informal care relates to unretirement. Utilizing role theory, this study aims to explore the heterogeneity of informal care responsibilities in retirement and to examine how informal care informs re-entering the workforce in later life. METHOD: Data were drawn from the Health and Retirement Study of fully retired individuals aged 62 years and older in 1998 (n = 8,334) and followed to 2008. Informal care responsibilities included helping a spouse/partner with activities of daily living (ADLs) or instrumental activities of daily living (IADLs); helping parent(s) or parent-in-law(s) with ADLs or IADLs; and single or co-occurrence of care roles. Covariates included economic and social factors. Cox proportional hazard models were utilized. RESULTS: When compared with noncaregivers, helping a spouse with ADLs or IADLs reduced the odds of returning-to-work in the subsequent wave by 78% and 55%, respectively (hazard ratio [HR]: 0.22, confidence interval [CI]: 0.06-0.87; HR: 0.45, CI: 0.21-0.97). There was no statistical difference to returning-to-work between noncaregivers and helping parents with ADLs/IADLs or multiple caregiving responsibilities. DISCUSSION: Role theory provided a useful framework to understand the relationships of informal care and unretirement. Aspects of role strain emerged, where, spousal caregivers were less likely to come out of retirement. Spousal caregivers may face challenges to working longer, and subsequently, opportunities to bolster their retirement security are diminished. Research and policy implications are discussed.

Financial Care for Older Adults With Dementia.

This article describes an examination of the sociodemographic characteristics of adult children, particularly Baby Boomer caregivers, who provide financial care to older parents with dementia. The sample including 1,011adult children dementia caregivers aged 50 to 64 years is selected from a nationally representative sample in the 2010 Health and Retirement Study. Exact logistic regression revealed that race, provision of financial assistance to caregiver children, and the number of their children are significantly associated with financial caregiving of parents. Non-White caregivers are more likely to provide financial care to their parents or parents-in-law with dementia; those who have more children and provide financial assistance to their children are less likely to provide financial care to parents with dementia. The current findings present valuable new information on the sociodemographic characteristics of adult children who provide financial assistance to parents with dementia and inform research, programs, and services on dementia caregiving.

The Vicious Cycle of Parental Caregiving and Financial Well-being: A Longitudinal Study of Women.

OBJECTIVES: This study examines the relationship between caring for older parents and the financial well-being of caregivers by investigating whether a reciprocal association, or vicious cycle, exists between female caregiver's lower household incomes and caring for elderly parents. METHOD: Data for women aged 51 or older with at least 1 living parent or parent-in-law were drawn from the Health and Retirement Survey 2006, 2008, and 2010 (N = 2,093). A cross-lagged panel design was applied with structural equation modeling. RESULTS: We found support for the reciprocal relationship between parental caregiving and lower household income. Female caregivers were more likely than noncaregivers to be in lower household income at later observation points. Also, women with lower household income were more likely than women with higher household income to assume caregiving at later observation points. DISCUSSION: This study suggests that there exists a vicious cycle of parental care and lower household income among women. A key concern for policy is female caregivers' financial status when care of older parents is assumed and care burden when women's financial status declines.

More caregiving, less working: caregiving roles and gender difference.

This study examined the relationship of caregiving roles to labor force participation using the nationally representative data from the Health and Retirement Study. The sample was composed of men and women aged 50 to 61 years (N = 5,119). Caregiving roles included caregiving for spouse, parents, and grandchildren; a summary of three caregiving roles was used to indicate multiple caregiving roles. Bivariate analysis using chi-square and t tests and binary logistic regression models were applied. Results show that women caregivers for parents and/or grandchildren were less likely to be in the labor force than non-caregivers and that caregiving responsibility was not related to labor force participation for the sample of men. Findings have implication for supporting family caregivers, especially women, to balance work and caregiving commitments.

Spousal caregiving and financial strain among middle-aged and older adults.

We examine whether spousal caregivers face difficulties in meeting their basic household expenses compared to nonspousal caregivers and whether social support mechanisms ameliorate any financial strain from caregiving responsibilities. We use data for caregivers aged 45 and over drawn from a nationally representative, cross-sectional Canadian Community Health Survey--Healthy Aging (N = 5,067). Spousal caregiving is associated with a 35% increase in the likelihood of experiencing difficulties in meeting basic expenses compared to other types of caregiving. Each of social support mechanisms (affectionate, emotional/informational, and positive social interaction), singularly and combined, lessens financial strain from caregiving. Our findings suggest that spousal caregivers are particularly vulnerable because they have fewer resources to draw on for support and perform much more intensive care. Our results highlight the importance of developing appropriate policies and programs to support caregivers.

Home- and community-based services utilization and aging in place.

This study examines the relationship between home- and community-based service (HCBS) utilization and perceived service needs for aging in place versus relocation, using the data from the Community Partnership for Older Adults Survey. Among the vulnerable, community-dwelling older adult sample (N = 2,001), users of adult day programs, housekeeping, senior lunch, helpline, or personal assistance services were more likely to indicate they would need regular help to remain living on their own. By contrast, users of senior centers, personal assistance, or visiting nurse services were more likely to indicate they would move out due to health problems. Home repair service users were less likely to perceive the need for relocation. Findings have implications for improving long-term care and supportive service systems to meet the current and future needs of community-dwelling older adults.