Marital Quality and Depressive Symptoms Among Older Hispanic Adults in the United States.

OBJECTIVES: Despite the cultural importance of marriage as a social support system and its well-established link to mental health, older Hispanic adult populations, which are the largest racial and ethnic minoritized groups, remain understudied. The current study examined how positive and negative dimensions of marital quality are associated with depressive symptoms. METHODS: Data from Hispanic adults aged 51 years and older (n = 1,012) were obtained from the 2016 and 2018 Health and Retirement Study waves. The Center for Epidemiological Studies-Depression scale (0-8 symptoms) was modeled as a function of positive and negative marital quality measures (1-4), as well as the relevant covariates. RESULTS: Results from a negative binomial regression model showed that a 1-unit change in positive and negative marital quality was associated with a 23.61% reduction and a 23.74% increase, respectively, in depressive symptoms. The interaction terms with marital quality and gender, as well as marital quality and religion, were not statistically significant. DISCUSSION: In the United States, a large percentage of older Hispanic adults are immigrants, and their extended family tends to reside in their countries of origin. As such, older Hispanic adults may have smaller social networks, and marital quality most likely represents a culturally important social support network in later life. Significant associations between depressive symptoms and marital quality among older Hispanic adults should receive more attention in family and public health policy discussions, particularly given the increasing diversity in U.S. society.

Urban and Rural Differences in Trajectories of Depressive Symptoms in Later Life in the United States.

OBJECTIVE: This research has two primary goals: to examine the relationship between urban residence and trajectories of depressive symptoms and to investigate whether this relationship differs by social isolation and loneliness. METHOD: Data are from 2006, 2008, 2010, 2012, 2014, and 2016 waves of the Health and Retirement Study (HRS), a nationally representative sample of U.S. adults aged 51+ (n = 3,346 females and 2,441 males). We conduct latent growth curve analysis to predict both baseline and trajectories of depression based on urban or rural residency. RESULTS: Residing in urban or rural areas is neither significantly associated with baseline nor the development of late-life depressive symptoms. For females, the relationship between urban residence and baseline depressive symptoms is explained by socioeconomic factors. DISCUSSION: Findings of this study serve to better understand how social and geographic contexts shape long-term well-being of older adults.

Childhood Socioeconomic Status and Physical Activity in Later Life: The Role of Perceived Neighborhood Cohesion and Wealth in Adulthood.

The literature indicates that perceived neighborhood social cohesion is related to later life physical activity. However, there is no research that examines the role of childhood socioeconomic status (SES) in shaping this relationship. We use data from the Health and Retirement Study (2006-2016; N = 8,754) and a structural equation modeling approach to examine whether perceived neighborhood social cohesion and adulthood wealth mediate the relationship between childhood SES and physical activity. Perceived neighborhood social cohesion and adulthood wealth have small but statistically significant mediational effects in the relationship between childhood SES and physical activity. Research on the relationship between health and place should consider the potential impact of childhood circumstances on the neighborhood one lives in during adulthood.

Depression, functional disability, and accessing health care among older Ghanaians and South Africans: a comparative study based on WHO study on global ageing and adult health (SAGE).

OBJECTIVES: The study explored the association and variabilities between mild depression, functional disability, and healthcare access among older Ghanaians and South Africans. METHOD: The data used in this study was based on the Cross-sectional wave 1 (2007-2010) data from WHO's Study on Global Ageing and Adult Health (SAGE). Using multiple binary logistic regression, responses from a sample of 4558 Ghanaians and 3076 South Africans were analyzed to investigate hypothesized patterns. RESULTS: The proportion of mild depression (MD) is 6.0 % and 7.53% for older Ghanaians and older South Africans, respectively. At 95% Confidence Interval, increased severity (mild and high levels) of functional disability are associated with increased odds of MD in Ghanaian and South African older adults. Apart from South African older adults, older Ghanaians in the study who do not receive healthcare when needed have increased odds of MD than those who do. Sociodemographic and socioeconomic factors are also associated with MD. DISCUSSION: An untreated, persistent MD may lead to worse conditions with fatal outcomes. Since mental health care is lacking in both countries, this study may inform policies directed towards support for formal and informal long-term care, and healthcare access to reduce the risks of depression.

What could be influencing older Ghanaians outpatient care utilization rate?

OBJECTIVES: Ghana's population is rapidly aging and there may be healthcare access and utilization issues. This study investigates some of the issues that may influence outpatient care utilization rate among older Ghanaians. METHODS: Cross-sectional wave 1 (2007-2010) data from WHO's Study on Global Ageing and Adult Health are used, and a sample of 1408 are analyzed. After multiple imputations of missing values, a negative binomial regression model is used to identify the association between outpatient care utilization rate and lifestyle activities. RESULTS: The rate of outpatient care utilization is negatively associated with the rate of eating vegetables (ß =0.0830, p < .001), fruits (ß =0.0033, p < .05), moderate-exercise (ß =0.4010, p < .001), moderate-work (ß =0.2049, p < .001), walking/biking (ß = 0.0436, p < .001), and positively associated with leisure hours ((ß =0.0194, p < .001). CONCLUSION: To promote better aging situations of older adults in Ghana, poverty and poor education should be addressed as potential barriers to healthcare access. There is a need for policies that encourage healthier lifestyles for older Ghanaian's health. FUNDING: The study was self-funded by the authors.

Mistrust in Physicians does not Explain Black-white Disparities in Primary Care and Emergency Department Utilization: The Importance of Socialization During the Jim Crow era.

PURPOSE: Compared to whites, blacks under-utilize primary care (PC) and over-utilize emergency department (ED) services. The aim of this study is to determine whether mistrust in physicians explains these black-white disparities, and the potentially modifying influence of socialization under racially segregated health care (i.e., raised in the U.S. South during the Jim Crow era). METHODS: Data come from the nationally representative Americans' Changing Lives Study (n=1,578). Poisson regression techniques are utilized to respectively model PC and ED utilization among a sample of non-Hispanic black and white adults aged forty-years and older. CONCLUSION: Mistrust in physicians does not explain black-white disparities in PC or ED utilization. Blacks under-utilize PC services compared to whites, net of predisposing, need, and enabling factors, but this is especially apparent among blacks who were raised in the U.S. south during the Jim Crow era and continue to reside in the South. Blacks greatly over-utilize ED services compared to whites, but this is greatest among those raised in the south during the Jim Crow era and/or those currently residing in the South.

Does cohort matter in the association between education, health literacy and health in the USA?

Summary: Growing empirical evidence supports the generally positive relationship between education, health literacy and health outcomes. However, little is known about cohort in this relationship. This study examined the role of cohort defined by 10-year age period in the association between educational attainment, health literacy and self-rated health. The data were obtained from the 2003 National Assessment of Adult Literacy survey restricted file. Focusing on nationally representative community-dwelling adults age 25 years and older, self-rated health was modeled as a function of health literacy, educational attainment, cohorts (defined by 10-year age periods), other demographic characteristics and socio-economic status. While the youngest cohort was positively associated with self-rated health, middle-age cohorts were more likely to have lower self-rated health (compared with the age 65 years and older cohort). Interestingly, age was no longer statistically significant after adjusting for cohort and other covariates. Recognition of possible cohort effects in education, health literacy and health should be reflected in future health literacy research and intervention programs for addressing health disparities in the USA.

INITIAL EXPLORATION OF NEWLY IMPLEMENTED PUBLIC HEALTH POLICY USING GEOGRAPHIC INFORMATION SYSTEMS: THE CASE OF A U.S. SILVER ALERT PROGRAM.

CONTEXT: Public health policies are designed for specific subsets of the population. Evidence that a policy is effectively designed should be based on whether it effectively addresses its mission. A critical factor is determining whether utilization patterns reflect the mission and the efficacy of public health policies, particularly during early stages of implementation. We assert that utilization patterns can be effectively assessed using geographic information systems (GIS). OBJECTIVE: This paper uses the Silver Alert program, a recently implemented public health policy, as a case for how and why GIS can be used to examine utilization patterns. DESIGN: GIS are employed to visualize and spatially analyze a new health policy--North Carolina's Silver Alert policy. We use visualized data and spatial statistics to assess utilization patterns and mission adherence. RESULTS: Results show disproportionate utilization patterns of the Silver Alert policy. In particular, an outstanding number of Silver Alerts were used in Wake County and its surrounding counties, which are both the political and media center of North Carolina. Other counties, including populous counties, had few if any alerts. CONCLUSION: Findings suggest that the North Carolina's Silver Alert policy needs to be adjusted to more effectively address its mission. We identify several factors that need further examination prior to a statewide evaluation. From this case study, we propose ways future programs, particularly the introduction of the Affordable Care Act (ACA) in 2014, might use GIS to examine utilization patterns as a means to better understand whether and in what ways the health care needs of the public are being met with such a policy.

Programs to locate missing and critically wandering elders: a critical review and a call for multiphasic evaluation.

As America ages, greater numbers of older adults will be living with Alzheimer's disease or a related dementia, leading to increased incidence of wandering. Currently there are several initiatives to assist older adults who go missing. We describe and critically examine three prominent and widespread programs: Safe Return, Project Lifesaver, and Silver Alert. Despite their emergence, there has been little research on their effectiveness. More fundamentally, the nature and scope of the missing elder problem is understudied. We call for further research into this issue, as well as assessments of how well such programs balance individual liberties with safety concerns.

Silver alerts and the problem of missing adults with dementia.

In the months following the introduction of the National AMBER (America's Missing: Broadcast Emergency Response) Alert plan used to locate missing and abducted children, Silver Alert programs began to emerge. These programs use the same infrastructure and approach to find a different missing population, cognitively impaired older adults. By late 2008, 17 states had enacted Silver Alert policies, and several more planned to take advantage of National Silver Alert grant funding to initiate policies in 2009. To date, however, no research has examined the efficacy of such programs, which have widely varying parameters and criteria to initiate the alerts. In this study, we empirically examine the 17 existing state Silver Alert and related policies. The analysis includes an examination of the varieties of programs: dementia related and AMBER extension, the dates of enactment, the criteria for activation, and the process of activation. We conclude with two salient questions that emerged from the analysis. We examine these questions and make recommendations for future research, including examining whether Silver Alerts are an appropriate response to address the problem of missing adults with dementia or cognitive impairments and examining the costs and benefits of the programs including determining how best to balance efforts to keep cognitively impaired elders safe while keeping their basic human rights of autonomy and empowerment intact.

Race-ethnic inequality and psychological distress: depressive symptoms from adolescence to young adulthood.

Social inequality is well established in the mental health of race-ethnic groups, but little is known about this disparity from adolescence to young adulthood. This study examined differences in trajectories of depressive symptoms across 4 race-ethnic groups (Whites, Blacks, Hispanics, and Asians) using 3 waves of the National Longitudinal Study of Adolescent Health. Latent trajectory analyses showed race-ethnic variations among both females and males. Stressors were significantly related to depressive symptoms for all study members, but they accounted for symptom trajectories only among Black males and minority females. Persistent differences in trajectories for Blacks and Whites showed parallel slopes that did not converge over time. Neither background characteristics nor social resources (i.e., social support) altered this gap. However, social support represents a potential equalizer of these race-ethnic differences, owing to the ubiquitous nature of its protective effects.