Self-Reported Sensory Impairments in Older Adults and their Association with Self-Rated Health and Mortality Outcomes.

OBJECTIVES: This study assessed the relationship between self-reported impairments of vision, hearing, and dual sensory impairment, and change in self-rated health/mortality status over a 5-year period. METHODS: Data came from the National Health and Aging Trends Study, a nationally representative survey of Medicare beneficiaries ages 65 and older. Analyses consisted of a series of ordinal logistic regressions stratified by sex. RESULTS: For both women and men, self-reported sensory impairments were not statistical predictors of self-rated health/mortality, when other dimensions of health, such as physical functioning, participation, and activities of daily living functioning were included in models. DISCUSSION: Understanding how self-reported sensory impairments impact self-rated health could assist in targeting rehabilitation strategies to older adults who experience sensory impairments.

Family dynamics and their association with elder family financial exploitation in families with appointed powers of attorney.

Powers of attorney (POA), widely used in end-of-life planning, give authority, often to relatives, to manage elders' affairs if they become incapacitated. Unfortunately, family members are frequently perpetrators of elder family financial exploitation (EFFE). To understand possible EFFE precursors, the Elder Family Financial Exploitation Survey (EFFES) collected hierarchical data (individual relatives nested within families) including respondent and elder demographics, financial exploitation details if it occurred, and family dynamics (general family functioning, fairness conflict, resource exchange patterns, entitlement attitudes, and communication/problem-solving). Multilevel logistic regression models found positive association with greater fairness conflict and entitlement attitudes, and negative association with general family function, resource exchange expectations, and communication patterns when growing up, but no association with current communication. Findings can prompt families to proactively address negative family dynamics to reduce the risk of EFFE. Results may also inform decisions about appointing other fiduciaries, e.g., trustees, and personal representatives (executors).

Visual Acuity and Self-Reported Vision Status.

OBJECTIVES: This study examined the associations of two measures of vision impairment (i.e., a clinical measure of visual acuity and self-reported vision status) and social isolation in a nationally representative sample of Americans aged 60 and older. METHOD: Five cycles of the National Health and Nutrition Examination Survey (NHANES IV; 1999-2008) were used to estimate successive logistic regression models, holding constant demographic characteristics, chronic illness, functional limitations, and disability. RESULTS: Effects of both measures of vision impairment in predicting social isolation were substantially reduced or eliminated in adjusted models. Where significant effects of vision impairment on social isolation remained, a strong effect was found for self-reported poor vision (odds ratio = 1.53; 95% confidence interval = [1.08, 2.16]). DISCUSSION: As one of the better vision-related predictors of social isolation, self-reported vision is among the easiest and inexpensive to assess. The use of self-reported vision as a screening criterion for social isolation is discussed.

Health Status and Social Networks as Predictors of Resilience in Older Adults Residing in Rural and Remote Environments.

Purpose. Health status and social networks are associated with resilience among older adults. Each of these factors may be important to the ability of adults to remain in rural and remote communities as they age. We examined the association of health status and social networks and resilience among older adults dwelling in a rural and remote county in the Western United States. Methods. We selected a random sample of 198 registered voters aged 65 years or older from a frontier Wyoming county. Hierarchical linear regression was used to examine the association of health status as well as social networks and resilience. We also examined health status as a moderator of the relationship between social networks and resilience. Results. Family networks (p = 0.024) and mental health status (p < 0.001) significantly predicted resilience. Mental health status moderated the relationship of family (p = 0.004) and friend (p = 0.021) networks with resilience. Smaller family and friend networks were associated with greater resilience when mental health status was low, but not when it was high. Conclusion. Efforts to increase mental health status may improve resilience among older adults in rural environments, particularly for those with smaller family and friends networks.

Functional limitations as potential mediators of the effects of self-reported vision status on fall risk of older adults.

OBJECTIVE: To test whether limitations in mobility and large-muscle functioning mediate self-reported vision status to increase fall risk among respondents age 65 and above. METHOD: This study used two waves from the Health and Retirement Study. We conducted binary logistic and negative binomial regression analyses to test indirect paths leading from self-reported vision status to falls, via indices of mobility and large-muscle functioning. RESULTS: Limited evidence was found for a mediating effect among women; however, large-muscle groups were implicated as partially mediating risk factors for falls among men with fair self-reported vision status. DISCUSSION: Implications of these findings are discussed including the need for prioritizing improved muscle strength of older men and women with poor vision as a preventive measure against falls.

Home care program for patients at high risk of hospitalization.

OBJECTIVE: To assess the efficacy of a home care program designed to improve access to medical care for older adults with multiple chronic conditions who are at risk for hospitalization. STUDY DESIGN: Randomized controlled trial in which participants were assigned to the home care intervention (Choices for Healthy Aging [CHA]) program or usual care. METHODS: The intervention group consisted of 298 older adults at risk of hospitalization as determined by a risk stratification tool. Measures included satisfaction with medical care, medical service use, and costs of medical care. RESULTS: The intervention group reported significantly greater satisfaction with care than usual care recipients (t test = 2.476; P = .014). CHA patients were less likely than usual care patients to be admitted to the hospital (25.6% and 37.1%, respectively; P = .02). There were no differences in terms of costs of care between the home care and usual care groups. CONCLUSIONS: Provision of home care to older adults at high risk of hospitalization may improve satisfaction with care while reducing hospitalizations. Lack of difference in medical costs suggests that managed care organizations need to consider targeting rather than using risk stratification measures when designing programs for high-risk groups.

Aging in place: evolution of a research topic whose time has come.

Over the past 30 years, policy makers and professionals who provide services to older adults with chronic conditions and impairments have placed greater emphasis on conceptualizing aging in place as an attainable and worthwhile goal. Little is known, however, of the changes in how this concept has evolved in aging research. To track trends in aging in place, we examined scholarly articles published from 1980 to 2010 that included the concept in eleven academic gerontology journals. We report an increase in the absolute number and proportion of aging-in-place manuscripts published during this period, with marked growth in the 2000s. Topics related to the environment and services were the most commonly examined during 2000-2010 (35% and 31%, resp.), with a substantial increase in manuscripts pertaining to technology and health/functioning. This underscores the increase in diversity of topics that surround the concept of aging-in-place literature in gerontological research.

Assessing and Adapting the Home Environment to Reduce Falls and Meet the Changing Capacity of Older Adults.

Falls in older adults are a serious problem for individuals, their families, and the health care system. This article describes research regarding fall risk assessment, risk reduction interventions, and public policy aimed at reducing the risk of falls for older adults in home settings. Assessments for frail older adults should include observations of not only the physical environment, but also the interactions among the environment, behavior, and physical functioning so that interventions are tailored to the specific situation of the individual. Home modification and technology can prove useful when designing interventions aimed at reducing fall risks. Problems such as cost, reluctance to adopt or implement suggestions, and a lack of knowledge may present barriers to effective home modification. Program and policy options for the future include improved training for service personnel who visit the homes of older adults, increased awareness of and coordination between programs or interventions aimed at reducing the risk of falls in older adults, new sources of funding, and building more housing that follows the principles of universal design.

Self-reported vision impairment and its contribution to disability among older adults.

OBJECTIVE: To examine contributions of self-reported vision impairment to disability by persons 65 years and older. METHOD: We used data from the National Health and Nutrition Examination Survey (NHANES IV; 1999-2008; weighted N = 6,550). The four-staged Nagi model of the disability process, incorporating biomarkers, disease, and physical functioning, was used as a framework to guide variable selection. An unadjusted ordinal logistic regression model testing effects of vision on daily-life activities was compared with models that controlled covariates associated with each stage of the disability model. RESULTS: Where significant effects of poor vision remained, the strongest effect was found for doing leisure activities at home (OR = 5.29; 95% CI [3.14, 8.90]). DISCUSSION: Results suggest the importance of considering multiple health factors when formulating comprehensive vision rehabilitation interventions.

Falls-Prevention Interventions for Persons Who Are Blind or Visually Impaired.

The purpose of this article is to describe four main areas of falls-prevention intervention for older adults who are blind or visually impaired. When integrated into multifactorial programs, interventions pertaining to education, medical assessment, exercise and physical activity, and environmental assessment and modification have been shown to be effective in falls reduction. These areas of intervention are discussed with respect to specific concerns of older adults who are blind or visually impaired. In describing these areas of intervention, the increasing need for cross-disciplinary falls-prevention programs designed specifically for older persons with vision loss, as well as research demonstrating the efficacy of multidisciplinary programs designed for this group, are emphasized.

Environmental assessment and modification as fall-prevention strategies for older adults.

This article discusses the role of home assessment and environmental modification in reducing the risk of falls and helping older adults and persons with disabilities live in the community. This article reviews the research on the efficacy of home environmental assessment and modification. Researchers agree that integrated risk-management programs that emphasize on multiple interventions, including professional home-hazard assessment, along with home modifications are most effective for improving function and reducing falls. Important steps for implementing home modifications for persons at risk of falling are discussed, including exploring fall-risk factors and the effects of home modifications, identifying what changes are needed through home assessments, identifying sources of payment, and finding qualified installers and products.

Fall risk in older adults: roles of self-rated vision, home modifications, and limb function.

Objective. To assess direct effects of self-rated vision, home modifications, and limb functioning, and moderating effects of self-rated vision on change in functioning of upper and lower limbs on fall risk in older adults. Method. Logistic regression was used to analyze 2004 and 2006 waves of the Health and Retirement Study. Results. Effects of self-rated vision and home modifications in predicting falls decreased after controlling functioning in upper and lower extremities. Declines/gains in functioning across short periods of time superseded self-rated vision in predicting falls. No evidence was found for a moderating effect of vision status on limb functioning. Discussion. Poor self-rated vision may not be a good indicator of fall risk in older adults. Thus, for older adults with visual impairments, preserving residual limb functioning through exercise and activity has the important potential to reduce fall risk in addition to improving muscle and bone strength as well as improving balance and gait.

Crafts and generative expression: a qualitative study of the meaning of creativity in women who make jewelry in midlife.

The purpose of this study was to examine beliefs about creative activity and its psychological and spiritual benefits among middle-aged women who make jewelry, using qualitative measures. Twenty-nine female participants aged 31 to 64 answered questions about the effects of jewelry making on their lives. Qualitative responses provided phenomenological evidence to indicate the role that creative activities play in achieving generativity needs, such as validation from others, and social connection (with God or to others). Creative activities were also said to reduce stress and increase self-esteem. These benefits are discussed from a developmental perspective.

Vision and hearing loss in older adults: "Double trouble".

Recent studies indicate that by age seventy, 21% of the people living in the United States have both vision and hearing loss. Dual sensory loss in the elderly has a significant effect on an individual's ability to socialize, communicate with others, and live independently. This article addresses the issues faced by older individuals who are hard of hearing and blind or visually impaired. Common causes and behavioral signs of hearing and vision loss are discussed. An emphasis is placed on the functional implications of the dual sensory impairment and possible accommodations and communication strategies are outlined