Pain Lowers Subjective Survival Probabilities Among Middle-Aged and Older Adults.

OBJECTIVES: Pain is a leading cause of disability and a limiting factor in individuals' assessments of their own subjective health; however, its association with subjective longevity has yet to be explored. Subjective survival probabilities (SSPs), or one's own perceived chances of living to a given age, can influence individuals' behavior as they plan for their futures. This study assesses whether pain correlates to lower SSPs. METHODS: We use a repeated cross-section of the 2000-2018 waves of the Health and Retirement Study, a longitudinal and nationally representative survey of Americans aged 51 and older (N = 31,773). RESULTS: Fractional logit regressions indicate that, across all age groups, respondents with severe and/or interfering pain reported significantly lower SSPs than those with no pain (Marginal Effect [ME] = -0.03 to -0.06, p < .05). Controlling for all covariates, mild or moderate noninterfering pain was only associated with a significant reduction in SSPs among the youngest group reporting their chances of living to age 75 (ME = -0.02, p < .001). Descriptively and in the model results, respondents with mild or moderate noninterfering pain appeared to more closely resemble pain-free respondents than those with severe or interfering pain. DISCUSSION: These findings highlight the importance of pain on SSPs, and contribute to the growing evidence that pain interference is uniquely important in predicting meaningful health outcomes.

Disabled life expectancy among older Colombian men and women.

Colombia's population is rapidly aging and older adults are living longer, however, we have limited information on the level of disability and number of years older Colombians spend with disability. We estimated age-and-gender specific ADL, IADL and mobility disability prevalence and disabled life expectancy (DLE) and to examined gender differences. Life tables came from the Colombian vital statistics and disability prevalence data came from the cross-sectional 2015 Colombia National Survey of Health, Well-being, and Aging. Disabled life expectancy (DLE) was calculated using Sullivan's method. About one-third to one-half of remaining years will be spent with IADL or mobility disability. The remaining years of life spent with ADL was relatively low at younger ages, but by age 85, about half of remaining life will be spent with disability. Compared to men, women had higher levels of disability and are estimated to spend more years with disability. Gender differences in ADL did not emerge until ages 70 and older. Older Colombians, in particularly women, are estimated to live a significant proportion of their life with disability, particularly IADL and mobility disability. High levels of disability are concerning because the country lacks adequate infrastructure and has limited options for long term care.

Cross-national differences in wealth inequality in health services and caregiving used near the end of life.

Background: Socioeconomic inequality in access to and use of health services and social care provided near the end of life, or end-of-life care (EOLC), is not well understood in many countries. We examined wealth inequality in EOLC-hospital, nursing home, and hospice use and receipt of formal and informal caregiving-in 22 countries in Europe, Asia (South Korea), and North America (United States, Mexico). Methods: We used harmonized data from nationally representative studies of people aged 50 and older that collected information on healthcare utilisation and caregiving receipt in the time preceding death. We categorized countries according to their level of public long-term care (LTC) spending and examined EOLC prevalence across countries. We used logistic regression models to estimate wealth inequality in each type of EOLC. Findings: In the USA the least wealthy had more hospital (OR 1.30, p = 0.008) and nursing home/care use (OR 1.88, p < 0.001). In South Korea the least wealthy had more nursing home/care use (OR 2.24, p = 0.003). The least wealthy in high LTC Europe had less hospice use (OR 0.56, p = 0.003). The least wealthy were also less likely to be hospitalized in European countries with low LTC spending (OR 0.81, p = 0.04), but more likely to receive informal caregiving (OR 1.25, p = 0.033). Formal care was more common among the least wealthy in high LTC Europe (OR 1.57, p = 0.002), the USA (OR 1.42, p < 0.001) and South Korea (OR 1.69, p = 0.028), but less common among the least wealthy in Mexico (OR 0.17, p < 0.001). Interpretation: Wealth inequality in EOLC exists across countries and reflects differences in the organization, financing, and delivery of care in different countries. The findings highlight the need to consider equity in current and future plans to improve EOLC access. Funding: United States National Institute on Aging Grant R01AG030153.

Motoric Cognitive Risk Syndrome: Prevalence and Cognitive Performance. A cross-sectional study.

Background: Motoric Cognitive Risk Syndrome (MCR) is a predementia stage where slow gait speed and subjective memory complaints are present. The purpose of this study was to estimate the prevalence of MCR and assess its relationship with sociodemographic factors and chronic conditions. Methods: This is a secondary analysis of the SABE Colombia study conducted in 2015. The analytic sample consisted of 17·577 participants. After determining MCR prevalence, logistic regression was performed to examine the correlates of MCR. Findings: The prevalence of MCR was 10·71 %. The median age was 71 years and women composed 74·63 % of the MCR group. After adjusting for confounding variables MCR was associated with increasing age (OR 1·69, CI 1·43 - 1·92), no or low education (OR 1·99, CI 1·67- 2·37), MMSE (OR 0·93, CI 0·91 - 0·95) and chronic conditions such as mental disorders (OR 1·36, CI 1·11-1·67), history of myocardial infarction (OR 1·24, CI 1·04 - 1·47), hypertension (OR 1·23, CI 1·08 - 1·40) and diabetes (OR 1.18, CI 1.01 - 1.37). Interpretation: This study found a prevalence of 10·71 % of MCR in Colombian older adults. Additionally, MCR was associated with chronic conditions and sociodemographic factors identified in prior studies. These results increase the awareness of a novel predementia stage whose identification can be performed by clinicians in the outpatient clinic, minimizing the cost of a full neuropsychologic evaluation performed in a memory clinic. Funding: Funded by the Administrative Department of Science, Technology and Innovation (Colciencias) and the Ministry of Health and Social Protection of Colombia.

Family Caregiving and Place of Death: Insights From Cross-national Analysis of the Harmonized End-of-Life Data.

OBJECTIVES: Family is largely overlooked in research on factors associated with place of death among older adults. We determine if family caregiving at the end of life is associated with place of death in the United States and Europe. METHOD: We use the Harmonized End of Life data sets developed by the Gateway to Global Aging Data for the Survey of Health, Ageing and Retirement in Europe (SHARE) and the Health and Retirement Study (HRS). We conducted multinomial logistic regression on 7,113 decedents from 18 European countries and 3,031 decedents from the United States to determine if family caregiving, defined based on assistance with activities of daily living, was associated with death at home versus at a hospital or nursing home. RESULTS: Family caregiving was associated with reduced odds of dying in a hospital and nursing home, relative to dying at home in both the United States and Europe. Care from a spouse/partner or child/grandchild was both more common and more strongly associated with place of death than care from other relatives. Associations between family caregiving and place of death were generally consistent across European welfare regimes. DISCUSSION: This cross-national examination of family caregiving indicates that family-based support is universally important in determining where older adults die. In both the United States and in Europe, most care provided during a long-term illness or disability is provided by family caregivers, and it is clear families exert tremendous influence on place of death.