Economic Fragility of Older Adults: Factors Contributing to a Continuing Crisis.

With rapid population aging in the U.S. a greater number of older adults now experience economic insecurity, a situation disproportionately affecting older people of color. The COVID pandemic, rising inflation, and increasing economic inequality have reduced the purchasing power of both wages and fixed incomes. Compared with prior cohorts, the current cohort of adults at or nearing retirement age faces higher levels of secured and unsecured debt burden from mortgages, home equity loans, student loans, credit cards, and out-of-pocket medical costs. Long-standing disparities in opportunities and generational wealth have resulted in more outstanding debt for Black older adults than their white counterparts. This "financial fragility" may result in older people foregoing proper nutrition, doctor's visits, needed medications, or home or car repairs, while stress about finances may contribute to chronic health and mental health conditions. Along with programs to educate and advise older adults on their pressing financial concerns, practitioners who interact with older people in many settings should incorporate needed financial assessment and referrals into their work with this population. Professional and continuing education should ensure financial literacy and awareness of financial fragility for those working with older adults.

Self-regulatory driving behaviors: gender and transportation support effects.

This study examined the relationship between transportation support and self-regulatory driving behaviors of 566 community-dwelling older adults living in retirement communities, with a focus on gender differences. The results of logistic regression analysis showed that older women were more likely to avoid driving at night or on the highway than their male counterparts. Transportation support from peer friends was found to increase the likelihood of self-regulatory driving behaviors. The findings of this study imply that transportation policy and driving safety programs for older adults need to be developed, considering available transportation alternatives and gender differences in driving behaviors.

The Risk for Loneliness and Major Depression among Solo Agers.

Solo agers may be vulnerable to social isolation and mental health sequelae, particularly if they lack close family or friendship ties. This study examined associations among indicators of solo aging, frequency of loneliness, and Major Depressive Disorder among adults aged 60+. Depressed participants were diagnosed by a geriatric psychiatrist and control participants were not depressed. We hypothesized that older adults with more indicators of solo aging (i.e., living alone, being unmarried, not having family or friends nearby) would be more often lonely and more likely to be depressed. In multivariate analyses controlling for health comorbidities and financial difficulty, each additional solo aging indicator significantly increased the likelihood of frequent loneliness, 95% CI OR [1.50, 2.80], and having a depression diagnosis 95% CI OR [1.04, 2.07]. Solo agers may be vulnerable to loneliness and depression, reinforcing the need for assessment and intervention for social isolation among older adults.

Examining the aging process through the stress-coping framework: application to driving cessation in later life.

The aging process is marked by a series of transitions that influence multiple domains of well-being. One important transition for older adults is the process of driving cessation. Numerous studies have examined risk factors for driving cessation among older adults to identify at-risk older drivers for road safety. Recent research has focused on the consequences of driving cessation in later life for health and well-being. However, these reports have been largely empirical and are not drawn from a defined conceptual framework. Establishing a theoretical model of 'how driving cessation interacts with other processes and domains of aging' will promote synthesis of seemingly disparate findings and also link the empirical research on cessation to the broader field of gerontology. This article describes a conceptual model for articulating and examining the components of the driving cessation process based on the stress-coping paradigm. This model situates driving cessation within the context of exogenous stressors, individual vulnerabilities and coping strategies, and environmental hazards and buffers over the lifespan. This model could assist in guiding intervention strategies aimed at reducing premature driving cessation in older drivers with ameliorable impairments while assisting at-risk older drivers to reduce or stop driving in a less stressful way.

Do the GDS and the GDS-15 adequately capture the range of depressive symptoms among older residents in congregate housing?

BACKGROUND: In light of inconsistencies in cut points for identifying non-major depression, this study examined the classification efficiency of the Geriatric Depression Scale (GDS and GDS-15) total scores and individual items, and four additional depressive symptoms for identification of subthreshold, minor, or criterion depression among 166 vulnerable residents of congregate housing. METHODS: Depression (combined categories of major depressive episode, minor, or subthreshold depression) was determined by the Mini-International Neuropsychiatric Interview (MINI) diagnostic interview depression module administered by telephone to 166 older residents of congregate housing facilities who also completed the 30-item GDS and four other yes/no potential indicators of geriatric depression. Classification agreement and ROC curve analysis for the full and 15-item GDS scale scores were calculated. Individual item hit rates for MINI criterion were calculated for GDS items and four new items. RESULTS: GDS and GDS-15 at standard cut points had 70-75% agreement with MINI. Best sensitivity and specificity were obtained at lower than standard cut points. Some GDS Withdrawal, Apathy, lack of Vigor (WAV) and cognitive items obtained very low hit rates. New items "I just don't feel like myself" and "I feel I am a burden to others" better discriminated MINI depression than most GDS items and had good item-to-total correlations with the GDS. CONCLUSIONS: Diagnostic criteria and GDS screen had partial agreement. Some GDS items did not adequately represent depression among functionally impaired or oldest old older adults. Feeling one is a burden and the sense of feeling "different" from usual may be useful indicators of depression among vulnerable older adults.

Reported coping strategies and depressive symptoms among African American and white residents of congregate housing.

Chronic health conditions and living in congregate housing, both stressors and losses, are risk factors for late life depressive symptoms. We examined self-reported coping strategies and their associations with depressive symptoms among residents of congregate living facilities. Despite demographic differences between the African American and the White participants, reported coping for the 2 groups was similar, though more African Americans reported spiritual coping. Participants who reported coping through either positive attitude and adaptations or activity participation had fewer depressive symptoms, after controlling for demographics, health, functioning, and other types of coping.

The Predictors of and Motivations for Increased Family Involvement in Nursing Homes.

BACKGROUND AND OBJECTIVES: Quantitative and qualitative data from a statewide survey of family members of nursing home residents were analyzed to determine the predictors of, and motivations for, family involvement. RESEARCH DESIGN AND METHODS: We examined 3 types of involvement: visiting, providing personal care, and family-staff communication. Our mixed methods approach used (a) multilevel regression models to examine predictors of family involvement, including family member perceptions and resident, family member, and facility characteristics, and (b) a thematic analysis of qualitative data regarding the experiences of family members and their motivations for involvement. RESULTS: Families were more involved when a short-term stay (<3 months) was expected, and when residents were in poorer physical condition. Spouses and female family members were more involved than others, yet the effect of gender varied by relationship type. At the facility level, families of residents in rural facilities reported less family involvement. Aside from these commonalities, predictors of each type of involvement varied. Themes from the qualitative data identify unique motivations for each type of involvement-to enhance residents' identity, care, or quality of life. DISCUSSION: Families visit more and provide more hands-on assistance when they are not confident in the care being provided or the well-being and stability of their resident loved one. Receiving adequate information, perceiving staff as friendly, and residents as looking well cared for promote greater family-staff communication. IMPLICATIONS: Findings can inform strategies to increase meaningful family involvement in nursing homes.

Subthreshold depression: characteristics and risk factors among vulnerable elders.

OBJECTIVES: This study examines symptoms of subthreshold depression among older adults in congregate housing, compared with their nondepressed peers, and tests a conceptual model of subthreshold depression. Hypotheses included that subthreshold depression would be characterized and distinguished by low energy, social withdrawal, and depletion, rather than sadness, and that subthreshold depressed elders would be distinguished by poorer health and functioning, loneliness, and grieving a recent loss. METHOD: A self-administered survey was followed by a diagnostic interview by telephone to (N = 166) white and African-American residents of independent and assisted living apartments from six retirement communities, average age 82.9 years. The Mini International Neuropsychiatric Interview (MINI) determined depression status. The 30-item Geriatric Depression Scale was used to measure symptoms. RESULTS: Forty-six individuals (27.7%) were identified as subthreshold depressed, seven as suffering from major depression, and 113 as non-depressed. Subthreshold depression was characterized by low energy, difficulty with initiative, worries about the future, lack of positive affect, sadness and irritability. Negative affect symptoms such as sadness and irritability best discriminated the subthreshold group from the nondepressed. Risk factors for subthreshold depression in this sample included less education, lower socio-economic status, African-American race, grieving, and social loneliness. CONCLUSION: Subthreshold depression in this group of residents of congregate housing was similar to the depletion experienced by many nondepressed elders, but further characterized by negative affect and lack of hope for the future. Social factors, such as socioeconomic status and personal losses, constituted greater risks for subthreshold depression than did health and functioning.

Coping Resources, Loneliness, and Depressive Symptoms of Older Women With Chronic Illness.

Chronic illness with its accompanying physical stressors poses a risk factor for loneliness and depression in later life. Testing a model of stress and coping, we examined the effects of three types of coping resources (religious coping; Selection, Optimization, and Compensation [SOC] adaptive strategies; and perceived social support) on the deleterious effects of chronic illness among older women. Community-dwelling older women (N = 138) with at least one chronic illness (M = 3.9, SD = 2.1) completed mailed questionnaires. Respondents reported multiple morbidities and 90% reported interference with daily life. Social support was associated with less loneliness and depression and mediated the relationship between physical health and loneliness. Our study demonstrates two distinct pathways to depressive symptoms: one through physical symptoms, pain, and disability, and another through the experience of loneliness. Findings support intervention approaches that address disability-related issues and loneliness, and assist older women with chronic illness in identifying and marshaling social support.

Factors affecting usage patterns of memantine in Alzheimer disease.

Memantine is approved by the US Food and Drug Administration for the treatment of moderate to severe Alzheimer disease (AD). We investigated the frequency and variables associated with its use in mild to moderate/severe AD as defined by criteria involving the Mini-Mental Status Examination (MMSE) and Clinical Dementia Rating (CDR) scale. Consecutive possible and probable AD patients seen at our research center from November 2003 to December 2006 were included. Individuals were classified as mild dementia either by CDR=1 or MMSE >or=15, using criteria derived in part from the pivotal trials of memantine used for its approval by the Food and Drug Administration. Of 117 patients, 37% of those with mild AD by MMSE criterion (total N=94), and 38% of those with mild AD by CDR criterion (total N=86) used memantine. Logistic regression was used to simultaneously estimate the odds ratios (ORs) of the likelihood of memantine usage associated with a set of predictor variables. Lower MMSE was associated with a greater likelihood of using memantine independent of CDR [ORMMSE=7.45, 95% confidence interval (CI)=1.50-37.05]; CDR was not significantly related to memantine use. Controlling both MMSE and CDR, Whites were more likely to use memantine than African Americans (OR=6.47, 95% CI=1.25-33.39). Patients who used other antidementia medications were more likely to use memantine than those who did not (OR=3.15, 95% CI=0.995-9.97). Eight other patient characteristics were not significant predictors. Use of memantine in mild AD was common. Patterns of memantine usage are complex and deserve further study in a larger sample because of their implications for medical system cost, equitable access to care, and risk of drug interactions.

Quality of Life Trajectories of Older Adults Living in Senior Housing.

Quality of life (QoL) in the face of declining health, mobility, and social losses is a central issue for older adults. Our study examined changes in QoL over time for older adults residing in independent senior housing within continuing care retirement communities (CCRCs) and estimated how residents' social engagement during their first year influenced QoL over the next 4 years. Data were drawn from a 5-year panel study of 267 older adults who moved into senior housing within four CCRCs. Although initial QoL varied between individuals, QoL declined for the group over time. One component of early social engagement-participating in a greater number of formal social activities organized by the CCRC-significantly slowed the rate of decline in QoL. Findings suggest that senior housing residents may benefit from early participation in organized social and leisure activities soon after move-in to forestall declines in QoL over the long term.

Confirmatory factor analysis of the geriatric depression scale.

PURPOSE: The Geriatric Depression Scale (GDS) is widely used in clinical and research settings to screen older adults for depressive symptoms. Although several exploratory factor analytic structures have been proposed for the scale, no independent confirmation has been made available that would enable investigators to confidently identify scores for the subdimensions of depression represented in the scale. DESIGN AND METHODS: This article describes a confirmatory factor analysis of the 30-item GDS, with the factor structure based on an exploratory principal components analysis that was published earlier. The original study sample consisted of 327 community-dwelling adults aged 65-94 years. The confirmatory factor analysis was performed on data from an independent sample of 294 adults aged 60-98 years who resided in retirement facilities. RESULTS: The proposed final measurement model uses 26 of the items from the GDS in five factors and obtains a goodness-of-fit index of.90. The resulting distinct subdimensions are Dysphoric Mood, Withdrawal-Apathy-Vigor, Hopelessness, Cognitive, and Anxiety. IMPLICATIONS: Although results should be considered preliminary, the use of these five subdimensions as subscales for scoring purposes may improve the precision and utility of the GDS as an assessment tool for older adults in health, mental health, and research contexts.

The effectiveness of dyadic interventions for people with dementia and their caregivers.

The need for dyadic intervention is enhanced with increasing numbers of older adults with early-stage dementia. The purpose of this paper is to review the effects of dyadic interventions on caregivers (CGs) and care recipients (CRs) at the early stage of dementia. Four databases, AgeLine, Medline, EBSCO, and PyscINFO were searched and relevant literature from 2000 onwards was reviewed. The twelve studies identified used a variety of intervention approaches including support group, counseling, cognitive stimulation, skill training, and notebook-keeping. This review suggests that intervention programs for early-stage dementia caregiving dyads were feasible and well accepted by participants. The reviewed studies provided rich evidence of the significance of mutual understanding and communication to partners' well-being and relationship quality within the caregiving process. The findings suggest that these intervention approaches improved cognitive function of the CRs, social relations, and the relationship between the primary CG and the CR, although evidence of long-term effectiveness is lacking.

The impact of transportation support on driving cessation among community-dwelling older adults.

OBJECTIVES: This study longitudinally examines the impact of transportation support on driving cessation among community-dwelling older adults residing in retirement communities. METHOD: Data came from 3 waves of the Florida Retirement Study (1990-1992), a population-based cohort study. Analysis was limited to participants who drove at baseline and were reinterviewed in 1992 (N = 636). Transportation support from a spouse, family members, friends/neighbors, agencies/organizations (e.g., church), or hired assistants was included. Discrete-time multivariate hazard models were estimated to examine the impact of transportation support on driving cessation while controlling for demographic and health characteristics. RESULTS: Participants were more likely to stop driving if they had received at least some transportation support from friends/neighbors (Hazard Ratio = 2.49, p = .001) as compared with those with little or no support. Transportation support from organizations/agencies or hired assistants was also significantly associated with the likelihood of driving cessation, but only a small number of participants reported to have received such support. Receiving some or more transportation support from a spouse or family members did not have a statistically significant relationship with driving cessation. DISCUSSION: The findings suggest that available nonkin transportation support, particularly support from peer friends, plays an important role in driving cessation for older adults living in retirement communities.

Improving the well-being of couples facing cancer: a review of couples-based psychosocial interventions.

The purpose of this review article is to assess the available scientific evidence on the effects of couples-based psychosocial interventions for couples when one spouse faces cancer. For the present study, we conducted an extensive search of three electronic databases using a comprehensive search strategy. The literature search identified 14 studies evaluating couples intervention where one partner is facing cancer. Among them, eight studies concluded there was overall improvement for patients and eight studies reported overall improvement for partners, whereas an additional five studies showed partial improvement for patients and three demonstrated partial improvements for partners. Taken in the aggregate, these studies illustrated partial effectiveness--most had some positive results--but with clear limitations in terms of how many aspects of psychosocial well-being changed, lack of equal effectiveness for both patients and their partners, or limited maintenance of improvements over time, a common concern with brief psychosocial interventions. Although couples-based interventions may facilitate emotional support and dyadic coping, how these psychosocial interventions should be delivered, at what point in the illness and treatment they should be delivered, and how long they should continue remain as future challenges.

Changes in activity and interest in the third and fourth age: associations with health, functioning and depressive symptoms.

This study examines the changes in activity investment among older adults and the role of these changes in the relationship between health limitations and depression. Residents of six senior living facilities (N = 178) completed questionnaires including the Geriatric Depression Scale, health and functioning measures and the Revised Change in Activity and Interest Index (CAII-R) which measures self-perceived changes in the level of investment in social and leisure activities among older adults. Respondents indicated more disengagement from CAII-R subscales Active Instrumental (AI) and Active Social (AS) and increased engagement in Passive Social Spiritual. Fourth Age adults (age 80+) reported greater reductions in AI than Third Age adults (age 64-79). Reduced AS investment had the strongest association with depression and mediated the relationship between poor health or functioning and depression. These categories of activity may guide occupational therapy practitioners and other health providers in selecting the focus of intervention for older clients according to their identified life stage. The study provides evidence of distinct differences in interests within the parameters of normal aging and a baseline from which to assess the impact of illness and disability on the activity choices for clients in different life stages.

Specific effects of caring for a spouse with dementia: differences in depressive symptoms between caregiver and non-caregiver spouses.

BACKGROUND: Caring for spouses with dementia is a risk factor for increased levels of depression. Less is known about specific symptom differences between groups of caregivers and non-caregivers. This study characterizes differences on the CES-D depression screening scale between caregiving and non-caregiving spouses. METHODS: Data were obtained from 391 spouse caregivers of persons with dementia and 226 control subjects. Significant between-group differences on demographic variables determined covariates used in two multivariate ANCOVA analyses, on the set of four CES-D subscales and on the set of the 20 CES-D individual items. Significant multivariate analyses were followed by univariate tests between the two groups. RESULTS: Dementia caregiving spouses had significantly more depressive symptoms than non-caregiving married adults, after controlling for group differences. Proportion of variance in the set of CES-D subscales explained by caregiver group status was 13.4%. The greatest between-groups difference in univariate analysis was found in the Positive Affect subscale, and significant differences were found in 11 of the 20 CES-D items. Caregiver spouses experienced less hope for the future and less happiness and enjoyment in life than the non-caregiving spouses. They also reported greater degrees of sadness, being bothered, and loneliness than the non-caregivers. CONCLUSIONS: The differences, particularly caregivers' lack of positive affect, suggest the need for appropriate intervention approaches to assist spouse caregivers.

The transition to caregiving: the experience of family members embarking on the dementia caregiving career.

Although there is an extensive literature on dementia caregiving, research on family members' adjustment to the onset of dementia and on the early stage of caregiving is limited. This article describes a phenomenological study based on twenty semi-structured interviews with spouses and adult daughters of someone with early/mild dementia or mild cognitive impairment (MCI). Participants were asked to describe the earliest changes in the parent or spouse and the changes to their everyday lives and in their relationships brought by cognitive impairment. These family members reported taking on many new responsibilities in a highly interactive caregiving process consisting primarily of decision-making and supervision. Many participants reported experiencing frustration, resentment, grief, and relational deprivation, along with increased protectiveness and tenderness towards the person with dementia. Most of the participants were ambivalent about seeking or accepting help from others and seemed to want to maintain the status quo as long as possible. Social workers meeting with families in the context of disclosure of a dementia diagnosis or the early adjustment period may help by identifying their losses, normalizing negative feelings, and helping families envision ways they could use outside help.

Use of live theater to increase minority participation in Alzheimer disease research.

Recruitment and retention of African Americans into Alzheimer disease (AD) research studies poses challenges owing to long-standing socio-economic and cultural differences, pragmatic difficulties in reaching the African American population, and a legacy of distrust of medical research. In this study, we report on our efforts to use live theater to educate African Americans about AD research and to increase minority participation in it. We describe our experiences at the University Memory and Aging Center (Cleveland, OH) in commissioning, writing, and producing several theater productions focused on themes related to African Americans and their experiences dealing with family members with AD. Analysis of recruitment data, gathered before and after one of our productions, indicated that minority enrollment into our Center's Research Registry increased after the play. Survey data, gathered before and after production of a different play, indicated that viewing this piece increased knowledge about: (1) the symptoms of AD; (2) the fact that memory loss is not a part of normal aging; and (3) the greater prevalence of AD among African Americans. Also, after viewing this production, more audience members: (1) reported knowing how to become involved in research; (2) felt comfortable involving family members in research; and (3) would recommend research to others. We conclude that live theater that dramatizes the experiences of a family living with a person with AD can increase knowledge about AD, improve attitudes about taking part in research, and lead to greater participation in AD research studies. An explanatory model is offered to account for our findings.

Grief reactions and depression in caregivers of individuals with Alzheimer's disease: results from a pilot study in an urban setting.

The relationship between grief and depression in caregivers of individuals with Alzheimer's disease has not been clearly defined through empirical research. This pilot study examined the relationship between these two variables and determined the strength of their relationship. A racially diverse sample of caregivers was drawn from an urban setting on the east coast of the United States. Results indicated not only that a significant proportion of caregivers experience high levels of grief that may place them at risk of other difficulties, but also that grief is a significant predictor of increased depressive symptoms. Clinical social work implications are examined.