Keeping Us Young? Grandchild Caregiving and Older Adults' Cognitive Functioning.

Objective: This study investigates longitudinal associations between providing care to grandchildren and cognitive functioning. It also examines heterogeneity in these relationships. Background: Grandchild caregiving may support older adults' cognitive functioning by providing social engagement and emotional meaning. However, studies caution that time- intensive or custodial grandchild caregiving can take a toll on grandparents. The cognitive health implications of grandchild caregiving may thus depend on contexts including time spent providing care and living arrangements. They may also vary across sociodemographic groups and have greater effects on older adults who are more vulnerable to cognitive decline. Method: Data came from the 1998-2016 waves of the Health and Retirement Study (HRS) and represented over 11,000 U.S. adults age 50+. Using linear growth curve and dynamic panel models, the analysis explored relationships between level of grandchild care and cognitive functioning over time and across sociodemographic, family, work and health characteristics. Results: Those providing 100-199, 200-499 or 500+ hours of care to grandchildren had better cognitive functioning than non-caregivers regardless of whether they lived with grandchildren. Positive links between grandchild caregiving and cognition were stronger for lower income, non-working, and unpartnered adults and grew with age and functional limitations. Conclusion: These findings suggest that providing care to minor grandchildren may help support cognitive functioning as adults age. They also support the hypothesis that more vulnerable or isolated groups of older adults may benefit the most from grandchild caregiving.

Corrigendum: Momentary loneliness among older adults: Contextual differences and their moderation by gender and race/ethnicity.

Studies suggest that loneliness is associated with age. Among older adults, women and Black adults may be at greater risk than men and White adults, respectively. Social and physical contexts are also linked with loneliness. However, little is known about whether and how those of different genders and racial/ethnic groups may experience social and physical contexts differently in terms of their real-time loneliness, and the extent to which these differences may be explained by differential exposure or reactivity to such contexts. We examine (1) how momentary loneliness relates to (a) gender and race/ethnicity and (b) social and physical context; and the extent to which gender and racial/ethnic groups may be (2) differentially exposed to loneliness-related contexts and/or (3) differentially reacting to these contexts. Using multilevel regressions, we analyzed ecological momentary assessments from 342 community-dwelling U.S. older adults from the Chicago Health and Activity Space in Real Time study. In each of three waves of data collection, smartphone "pings" (five per day for 21 days; n = 12,744 EMAs) assessed loneliness, social context (e.g., alone, with a spouse/partner), and location/physical context (e.g., home, at work). Results revealed that men consistently reported greater loneliness intensity than women, including after adjusting for momentary physical and social context. In addition, those momentarily outside the home and/or not alone were less likely to feel lonely than their counterparts. However, the protective effect of being outside of the home (vs. home) was weaker among women and Black and Hispanic older adults, and the protective effect of being with one or more others (vs. alone) was weaker among women. Results are among the first to identify contextual effects on real-time loneliness in older adults and how these associations vary by gender and race/ethnicity. Knowledge regarding momentary variation in loneliness may inform future just-in-time adaptive loneliness interventions in older adulthood.

Comparative assessment of the feasibility and validity of daily activity space in urban and non-urban settings.

Activity space research explores the behavioral impact of the spaces people move through in daily life. This research has focused on urban settings, devoting little attention to non-urban settings. We examined the validity of the activity space method, comparing feasibility and data quality in urban and non-urban contexts. Overall, we found that the method is easily implemented in both settings. We also found location data quality was comparable across residential and activity space settings. The major differences in GPS (Global Positioning System) density and accuracy came from the operating system (iOS versus Android) of the device used. The GPS-derived locations showed high agreement with participants' self-reported locations. We further validated GPS data by comparing at-home time allocation with the American Time Use Survey. This study suggests that it is possible to collect daily activity space data in non-urban settings that are of comparable quality to data from urban settings.

Under Different Roofs? Coresidence With Adult Children and Parents' Mental Health Across Race and Ethnicity Over Two Decades.

Many U.S. parents share a household with an adult child in later life. However, the reasons parents and adult children coreside may vary over time and across family race/ethnicity, shaping relationships with parents' mental health. Using the Health and Retirement Study, this study investigates the determinants and mental health correlates of coresidence with adult children from 1998 to 2018 among White, Black, and Hispanic parents under age 65 and aged 65+. Findings show that the predictors of coresidence shifted with increasing odds that parents lived with an adult child, and several varied by parents' age group and race/ethnicity. Compared with White parents, Black and Hispanic parents were more likely to live with adult children, especially at older ages, and to indicate that they helped their children with household finances or functional limitations. Living with adult children was associated with higher depressive symptoms among White parents, and mental health was negatively related to living with adult children who were not working or were helping parents with functional limitations. The findings highlight increasing diversity among adult child-coresident parents and underscore persistent differences in the predictors and meaning of coresidence with adult children across race/ethnicity.

Resilience and Social Support-Giving Scales: Conceptual and Empirical Validation.

OBJECTIVES: This report introduces National Social Life, Health, and Aging Project (NSHAP) data users to 2 new measures-one that assesses older adults' resilience, defined as personal attributes that indicate an adaptive reserve that can be drawn on during adversity, and a second that expands on existing measures of social support received from others to also assess social support given to close others. METHOD: Data from 4,604 NSHAP respondents born 1920-1965 were used to conduct psychometric analyses and validation of our measures of resilience and social support-giving. RESULTS: Scale reliabilities were acceptable for the 4-item resilience scale, and the 2-item scales for family support-giving and friend support-giving. The 2 spousal support-giving items did not cohere well as a single scale. The resilience scale exhibited significant correlations with criterion validation variables, even after adjusting for correlated personality traits. The support-giving scales, and the spousal support-giving items, also exhibited significant correlations with criteria, and with the resilience scale, even after adjusting for social support receipt. Scale means exhibited demographic differences. DISCUSSION: The resilience and social support-giving measures have acceptable psychometric characteristics (with the exception of spousal support-giving), convergent validity, and predictive utility net of related variables. NSHAP data users are offered several suggestions (key points) in the use of these measures in future research.

Novel Insights From Interviewer Assessments of Personal Attributes, Home Environment, and Residential Context in NSHAP.

OBJECTIVES: This study was aimed to describe the interviewer-assessed measures present in the 2015/2016 Round of National Social Life, Health, and Aging Project (NSHAP), outline strengths of interviewer-assessed measures, and explore how interviewer assessments in the domains of home environment and personal characteristics are associated with older adult health. METHOD: Data come from the 2015/2016 Round of the NSHAP. RESULTS: We provide descriptive results from the interviewer assessments of personal attributes, indoor home environment, and outdoor residential context. We present an illustrative analysis of reports of falls, a health outcome that might be predicted by characteristics assessed by the interviewer, and we suggest directions for further research. DISCUSSION: Interviewer assessments collected in NSHAP are useful as proxy measures and can be used in combination with respondent's reports and ecological measures to generate insights into healthy aging.

Momentary loneliness among older adults: Contextual differences and their moderation by gender and race/ethnicity.

RATIONALE: Studies suggest that loneliness is associated with age. Among older adults, women and Black adults may be at greater risk than men and White adults, respectively. Social and physical contexts are also linked with loneliness. However, little is known about whether and how those of different genders and racial/ethnic groups may experience social and physical contexts differently in terms of their real-time loneliness, and the extent to which these differences may be explained by differential exposure or reactivity to contexts. OBJECTIVE: We examine (1) how momentary loneliness relates to (a) gender and race/ethnicity and (b) social and physical context; and the extent to which gender and racial/ethnic groups may be (2) differentially exposed to loneliness-related contexts and/or (3) differentially reacting to these contexts. METHODS: Using multilevel regressions, we analyzed ecological momentary assessments from 342 community-dwelling U.S. older adults from the Chicago Health and Activity Space in Real Time study. In each of three waves of data collection, smartphone "pings" (five per day for 21 days; n = 12,793 EMAs) assessed loneliness, social context (e.g., alone, with a spouse/partner), and location/physical context (e.g., home, at work). RESULTS: Men consistently reported greater loneliness intensity than women, including after adjusting for momentary physical and social context. Older adults momentarily outside the home and/or not alone were less likely to feel lonely than their counterparts. However, the protective effect of being outside of the home (vs. home) was weaker among women and Black and Hispanic older adults, and the protective effect of being with one or more others (vs. alone) was weaker among women. CONCLUSIONS: Results are among the first to identify contextual effects on real-time loneliness in older adults and how these associations vary by gender and race/ethnicity. Knowledge regarding momentary variation in loneliness may inform future just-in-time adaptive loneliness interventions in older adulthood.

The Foreclosure Crisis, Community Change, and the Cognitive Health of Older Adults.

OBJECTIVES: While home foreclosures are often thought of as a household-level event, the consequences may be far-reaching, and spill over to the broader community. Older adults, in particular, could be affected by the spiral of community changes that result from foreclosures, but we know very little about how the foreclosure crisis is related to older adult health, in particular cognition. METHOD: This article uses growth curve models and data from the Health and Retirement Study matched to Census and county-level foreclosure data to examine whether community foreclosures are related to older adults' cognitive health and the mechanisms responsible. RESULTS: We find that higher rates of county-level foreclosures are associated with a faster decline in individual cognition at older ages. Although we examined an extensive number of individual and community mechanisms, including individual housing wealth and depressive symptoms, community structural factors, social factors, and perceptions of physical disorder and cohesion, none of the mechanisms examined here explained this relationship. DISCUSSION: This study shows that the adverse consequences of home foreclosures spill over to the local community, with implications for the cognitive health of older adults.

Racial/Ethnic Inequities in Access to High-Quality Dialysis Treatment in Chicago: Does Neighborhood Racial/Ethnic Composition Matter?

OBJECTIVES: Blacks and Hispanics face a higher incidence rate of end-stage renal disease (ESRD) and tend to experience poorer access to quality health care compared with Whites. Income, education, and insurance coverage differentials are typically identified as risk factors, but neighborhood-level analyses may provide additional insights. We examine whether neighborhood racial composition contributes to racial/ethnic inequities in access to high-quality dialysis care in Chicago. METHODS: Data are drawn from the United States Renal Data System merged to the ESRD Quality Incentive Program file and the American Community Survey (2005-2009) for facility and neighborhood characteristics (N = 2797). Outcomes included (1) spatial access (travel time to dialysis facilities) and (2) realized access (actual use of quality care). Neighborhood racial/ethnic composition was categorized into four types: predominantly White, Black, and Hispanic neighborhoods, and racially integrated neighborhoods. RESULTS: Blacks lived closer to a dialysis facility but traveled the same distance to their own dialysis compared with Whites. Hispanics had longer travel time to any dialysis than Whites, and the difference between Hispanics and Whites became no longer significant after adjusting for neighborhood racial/ethnic composition. Blacks and Hispanics had better access to a high-quality facility if they lived in integrated neighborhoods (OR = 1.85 and 3.77, respectively, p < 0.01) or in neighborhoods with higher concentrations of their own race/ethnicity (OR = 1.68 for Blacks in Black neighborhoods and 1.92 for Hispanics in Hispanic neighborhoods, p < 0.05) compared with Whites in predominantly White neighborhoods. CONCLUSION: Expanding opportunities for Blacks and Hispanics to gain access to racially integrated and minority neighborhoods may help alleviate racial/ethnic inequities in access to quality care among kidney disease patients.

Social Isolation, Loneliness, And Violence Exposure In Urban Adults.

Social isolation is a key predictor of mortality in the US and may be heightened in communities affected by violence. Qualitative studies have documented that people living in high-crime neighborhoods often report being confined to their homes because of safety concerns. However, few quantitative studies have empirically assessed relationships between violence exposure and social isolation. In 2018 we conducted hour-long, in-person surveys with 504 adults in Chicago, Illinois. Prior exposure to community violence was associated with a 3.3-point reduction (on a 100-point scale) in the frequency of interaction with network confidantes, a 7.3-point reduction in perceived social support from friends, and a 7.8-point increase in loneliness. At a time when public health and policy leaders are calling for solutions to the "epidemic of loneliness," identifying populations at higher risk because of violence could help target interventions and ensure equitable access to social and medical support.

Disablement in Context: Neighborhood Characteristics and Their Association With Frailty Onset Among Older Adults.

OBJECTIVES: Frailty, an aggregate expression of risk resulting from age- or disease-associated physiologic accumulation, is responsible for large economic and societal costs. Little is known about how the context in which older adult's live may contribute to differences in frailty. This study clarifies the role of neighborhood structural characteristics and social processes for understanding declines in health status. METHOD: Data from two waves of the National Social Life, Health and Aging Project were linked to tract-level information from the 2000 Census (n = 1,925). Frailty was measured with in-home assessments and self-report. Ordered logistic regressions were employed to estimate the role of tract-level structural and social process indicators at baseline on frailty at follow-up. RESULTS: Living in a neighborhood characterized with a higher density of African Americans and with more residential instability was associated with higher odds of frailty. Adults in neighborhoods with increasing levels of physical disorder had higher odds of frailty (adjusted odds ratio [AOR]: 1.20, 95% confidence interval [CI]: 1.03, 1.39), while those exposed to more social cohesion had lower odds (AOR: 0.87, CI: 0.78, 0.97). DISCUSSION: For older adults, both neighborhood structural and social process characteristics appear to be independently associated with frailty.

The impact of marital status on health care utilization among Medicare beneficiaries.

To explain prior literature showing that married Medicare beneficiaries achieve better health outcomes at half the per person cost of single beneficiaries, we examined different patterns of healthcare utilization as a potential driver.Using the Medicare Current Beneficiary Survey (MCBS) data, we sought to understand utilization patterns in married versus currently-not-married Medicare beneficiaries. We analyzed the relationship between marital status and healthcare utilization (classified based on setting of care utilization into outpatient, inpatient, and skilled nursing facility (SNF) use) using logistic regression modeling. We specified models to control for possible confounders based on the Andersen model of healthcare utilization.Based on 13,942 respondents in the MCBS dataset, 12,929 had complete data, thus forming the analytic sample, of whom 6473 (50.3%) were married. Of these, 58% (vs. 36% of those currently-not-married) were male, 45% (vs. 47%) were age >75, 24% (vs. 70%) had a household income below $25,000, 18% (vs. 14%) had excellent self-reported general health, and 56% (vs. 36%) had private insurance. Compared to unmarried respondents, married respondents had a trend toward higher odds of having a recent outpatient visit (unadjusted odds ratio (OR) 1.11, 95% confidence interval (CI) 1.04-1.19, adjusted odds ratio (AOR) 1.10, (CI) 0.99-1.22), and lower odds in the year prior to have had an inpatient stay (AOR 0.84, CI 0.72-0.99) or a SNF stay (AOR 0.55, CI 0.40-0.75).Based on MCBS data, odds of self-reported inpatient and SNF use were lower among married respondents, while unadjusted odds of outpatient use were higher, compared to currently-not-married beneficiaries.

Crime, Perceived Danger, and Adiposity: The Role of Gender.

Objectives: We examine whether police-reported crime is associated with adiposity and examine to what extent the association between crime and adiposity is explained by perceived neighborhood danger with a particular focus on gender differences. Method: Data are drawn from the wave of 2010-2011 National Social Life, Health, and Aging Project merged with information on neighborhood social environment and Federal Bureau of Investigation (FBI) crime report. We use burglary as a main predictor. Waist circumference (WC) and body mass index (BMI) are used to assess adiposity. Results: Living in neighborhoods with higher levels of burglary is associated with a larger WC, a higher BMI, and greater adiposity risk for women, but not for men. These associations are partially explained by perceived danger among women. Discussion: Our findings identify neighborhood burglary rates as a contextual risk in later-life adiposity and highlight that perceived neighborhood safety contributes to gender differences in health outcomes.

Spatial Context and Health Inequity: Reconfiguring Race, Place, and Poverty.

Intimate connections among race, place, and poverty are increasingly featured in the health disparities literature. However, few models exist that can guide our understanding of these interconnections. We build on the Chicago School of Sociology's contributions in urban research and one of its contemporary elaborations, often described as the "neighborhood effects approach," to propose a three-axis model of health inequity. This model, in alignment with Chicago School theory, postulates a dynamic and adaptive relationship between spatial context and health inequity. Compositional axes of race and poverty form the foundation of the model. These compositional axes then intersect with a third axis of place to compose the built and social environment planes. We develop this model to provide conceptual guidance for clinical, policy, and public health researchers who aim to examine how these three features, taken together, have important implications for urban health.

The Role of Primary Care for the Oral Health of Rural and Urban Older Adults.

CONTEXT: Rural populations often have restricted access to dental care and poor oral health. These problems may disproportionately affect older blacks in rural areas. Little is known about how access to primary health care may improve the oral health of rural seniors. PURPOSE: This study examines whether the relationship between having a usual source of health care and oral health varies for white and black older adults in rural and urban areas in the United States. METHODS: We draw on cross-sectional data of adults (50 years+) from the nationally representative Health and Retirement Study (n = 15,473). Multivariate logistic regression examined the role of a usual source of health care in conditioning racial differences in complete tooth loss and a dental visit in the past 2 years. A usual source of health care is a place, not including an emergency room, where a person goes when he or she is sick or needs health advice. FINDINGS: In rural areas, blacks had high rates of tooth loss (28%) and low rates of dental visits (34%). Having a usual source of health care was associated with higher odds of a dental visit for all adults. In rural areas, the association between a usual source of health care and tooth loss varied by race (P < .001); blacks had more tooth loss than whites even with a usual source of health care. CONCLUSIONS: Access to primary health care was associated with improved oral health outcomes, but it did not close the gap between whites and blacks in rural areas.

Aging in Activity Space: Results From Smartphone-Based GPS-Tracking of Urban Seniors.

OBJECTIVES: Prior research emphasizes the importance of the residential neighborhood context during later life but little attention has been afforded to other areas that older adults encounter as they move beyond their residential environments for daily activities and social interactions. This study examines the predominance of the residential context within older adults' everyday lives. METHOD: We provided 60 older adults in four New York City neighborhoods with iPhones, which captured Global Positioning Systems (GPS) locations at 5-min intervals over 1 week (n = 55,561) and 17 ecological momentary assessments (EMAs) over 4 days (n = 757) to assess real-time activities. RESULTS: Older adults in our sample spent nearly 40% of their time outside of their residential tracts and they visited 28 other tracts, on average. Exercising, shopping, socializing, and social activities were especially likely to take place outside of residential tracts. Differences in residential and nonresidential poverty exposure vary across gender, race/ethnicity, education, car ownership, and residential areas. DISCUSSION: Measuring activity space, rather than relying on residential tracts, allows examination of the social environments that are relevant for older adults' everyday lives. Variation in characteristics of activity spaces may be an underexplored source of differences in health and well-being during later life.

Neighborhood age structure and cognitive function in a nationally-representative sample of older adults in the U.S.

Recent evidence suggests that living in a neighborhood with a greater percentage of older adults is associated with better individual health, including lower depression, better self-rated health, and a decreased risk of overall mortality. However, much of the work to date suffers from four limitations. First, none of the U.S.-based studies examine the association at the national level. Second, no studies have examined three important hypothesized mechanisms - neighborhood socioeconomic status and neighborhood social and physical characteristics - which are significantly correlated with both neighborhood age structure and health. Third, no U.S. study has longitudinally examined cognitive health trajectories. We build on this literature by examining nine years of nationally-representative data from the Health and Retirement Study (2002-2010) on men and women aged 51 and over linked with Census data to examine the relationship between the percentage of adults 65 and older in a neighborhood and individual cognitive health trajectories. Our results indicate that living in a neighborhood with a greater percentage of older adults is related to better individual cognition at baseline but we did not find any significant association with cognitive decline. We also explored potential mediators including neighborhood socioeconomic status, perceived neighborhood cohesion and perceived neighborhood physical disorder. We did not find evidence that neighborhood socioeconomic status explains this relationship; however, there is suggestive evidence that perceived cohesion and disorder may explain some of the association between age structure and cognition. Although more work is needed to identify the precise mechanisms, this work may suggest a potential contextual target for public health interventions to prevent cognitive impairment.

Social Resources and Community Resilience in the Wake of Superstorm Sandy.

Recovery efforts after natural disasters typically focus on physical infrastructure. In general less attention is paid to the social infrastructure that might impact the capacity of the community to rebuild. We examine perceptions of preparedness and recovery (markers of resilience at the community level) in the wake of Superstorm Sandy with a novel data set that includes a multi-mode survey of twelve neighborhoods severely affected by the storm. With these data, we suggest that social resources are associated with beliefs about neighborhood resilience. People who live in communities with higher social cohesion (coefficient = .73, p <.001), informal social control (coefficient = .53, p <.001), and social exchange (coefficient = .69, p <.001) are more likely to believe their neighborhoods are well prepared for a disaster. Likewise, people living in communities with higher social cohesion (coefficient = .35, p <.01), informal social control (coefficient = .27, p <.05), and social exchange (coefficient = .42, p <.001) are more likely to be confident their neighborhoods will recover quickly from a disaster. However, the effects of social resources on beliefs about resilience vary based on neighborhood socioeconomic status (SES) and the impact of the storm. Informal social control and social exchange lead to a greater increase in confidence in recovery in low, as compared to high, SES neighborhoods. Social resources tend to have more impact on perceptions of recovery in communities less affected by the storm. In sum, these findings suggest the potential value of various forms of social intervention to better equip communities to respond when disaster strikes.

Racial Differences in the Effects of Neighborhood Disadvantage on Residential Mobility in Later Life.

OBJECTIVES: Past research on the residential mobility of older adults has focused on individual-level factors and life course events. Less attention has been paid to the role of the residential environment in explaining residential mobility in older adults. We sought to understand whether neighborhood disadvantage had predictive utility in explaining residential relocation patterns, and whether associations differed between Whites and non-Whites. METHOD: Data are from the National Social Life, Health and Aging Project, a nationally representative sample of community-dwelling older adults. Neighborhoods were defined at the census tract level. Local movers (different census tract, same county) and distant movers (different county) were compared with stayers. RESULTS: After adjusting for individual-level factors, neighborhood disadvantage increased the likelihood of a local move, regardless of race/ethnicity. For non-Whites, higher neighborhood disadvantage decreased the likelihood of a distant move. Among local movers, Blacks and Latinos were less likely to improve neighborhood quality than Whites. DISCUSSION: Neighborhood disadvantage may promote local mobility by undermining person-environment fit. Racial differences in access to better neighborhoods persist in later life. Future research should explore how older adults optimize person-environment fit in the face of neighborhood disadvantage when the possibility of relocation to a better neighborhood may be restricted.