When do older adults become "disabled"? Social and health antecedents of perceived disability in a panel study of the oldest old

Disability carries negative social meaning, and little is known about when (or if), in the process of health decline, persons identify themselves as "disabled." We examine the social and health criteria that older adults use to subjectively rate their own disability status. Using a panel study of older adults (ages 72+), we estimate ordered probit and growth curve models of perceived disability over time. Total prevalent morbidity, functional limitations, and cognitive impairment are predictors of perceived disability. Cessation of driving and receipt of home health care also influence older adults 'perceptions of their own disability. A dense social network slowed the rate of labeling oneself disabled, while health anxiety accelerated the process over time, independent of health status. When considering perceived disability, the oldest old use multidimensional criteria capturing function, recent changes in health status and social networks, and anxiety about their health.     

Relationships Among Active Engagement in Life Activities and Quality of Life for Assisted-Living Residents

This cross-sectional research explored the relationships between active engagement in life activities (leisure, social, and instrumental activities of daily living) and quality of life for seniors aged 65 and older residing in assisted living facilities. It is increasingly recognized that active participation in diverse physical, cognitive, and social activities can promote older adults’ quality of life, including physical and mental health, but there is limited information about this in the population of residents in assisted living facilities. It is estimated that there are one million older adults residing in assisted living facilities, making assisted living facilities a rapidly growing segment of senior housing. Older adults who relocate to assisted living facilities commonly experience lifestyle changes, often related to their altered physical and social environment, reduced demands regarding household chores and meal preparation, and new opportunities for recreation and socialization. In this study, interviews were conducted with 131 ambulatory residents from assisted living facilities in the New York City metropolitan area using the 55-Item Activity Checklist, SF-36v2, Life Satisfaction Index-Z, and demographic questions. Results found significant low to moderate correlations between retained engagement in life activities (leisure, social, and instrumental activities of daily living) and life satisfaction, and several quality of life domains, including physical functioning, mental health, general health, and vitality. Older adults continued to engage in a greater percentage of everyday life activities they identified as important. This data supports exploration of client-centered activity programs to promote participation of residents in assisted living facilities in diverse activities to both maintain resident functional abilities and manage functional decline.     

Bildung und Gesundheitsungleichheit im Alter: Divergenz, Konvergenz oder Kontinuit?t?

It is well established that health at an old age is influenced by education acquired earlier in life. Empirical evidence on the extent of health decline across educational levels, however, is heterogeneous. It remains unclear whether the health gap between individuals with high and low levels of education increases in old age (divergence), decreases (convergence), or whether it remains constant (continuity). In the present study, we investigate the effects of education on health changes with data from two waves (2004, 2007) of the Survey of Health, Ageing and Retirement in Europe (SHARE) for respondents aged 50?C80. We estimate OLS regression models drawing on 12 indicators of physical, mental and cognitive health. Our aim is to obtain more generalizable results about the age trajectories of health inequality. We find that divergence is the main pattern of health decline across educational levels: The health gap between individuals with high and low educational levels increases for the indicators of grip strength, limitations of general and of instrumental activities of daily living, mobility limitations, depressive symptoms, numerical ability, and time orientation. For single indicators, however, we also observe continuous (chronic diseases, subjective health assessment, memory) and convergent (fluency of speaking) patterns.     

The Role of Environmental Features in Social Engagement Among Residents Living in Assisted Living Facilities

The objective of this study was to describe how physical and social environmental features of assisted living facilities influence social engagement behaviors of older residents. A secondary objective was to identify the environmental features that were important to residents’ social engagement based on their perspectives. Using a qualitative approach, the authors depicted the environmental features and the social engagement patterns of older residents in two assisted living facilities in urban Saint Louis, Missouri. A stratified sample of 10 participants participated in in-depth interviews and 16 participant observations were conducted. Five physical and social features were identified as factors that influenced residents’ social engagement patterns. Environmental features that supported social engagement appeared to differ according to participant activity level. Findings from this study have the potential to inform design guidelines that will enhance social engagement in future assisted living facilities.     

Histories of poverty and self-rated health trajectories

This paper investigates the dynamic relationship between poverty histories and self-rated health trajectories. We are interested in patterns of change in individuals' health over time and the ways in which such patterns are structured by continuity and change in poverty experiences. Data, collected for adults aged 25 and older in 1984 (N = 7,258), are from the 1968-1996 annual waves of Panel Study of Income Dynamics (PSID). Individual growth curves allow us to investigate health trajectories as continuous processes, as well as individual and group heterogeneity in these trajectories. We find that, on average, health deteriorates slowly over time, but there is significant variation in health in 1984 and the rate at which health declines. Histories of poverty partly accounted for the sources of individual differences in self-rated health in 1984, but they were not related to health change over time. Although increasing incomes were better for self-rated health than falling incomes, current economic circumstances did not erase the health effects of earlier poverty experiences.     

Masters or pawns? Examining injury and chronic disease in male Masters Athletes and chess players compared to population norms from the Canadian Community Health Survey

Background

Identifying the optimal type and amount of activity for the maintenance of function in older adults has proved challenging. On the one hand, Masters Athletes have been proposed as the ideal model of successful aging but most of this research has focused on physical functioning. On the other hand, the importance of cognitive engagement has been emphasized, which may be more strongly related to activities such as playing chess. The current study aimed to compare physical health outcomes (i.e., prevalence of physical injury and chronic disease) among older athletes and chess players. Masters Athletes and chess players were recruited from track and field and chess competitions within the province of Ontario. In addition to these primary groups, moderately active and inactive older adults from Canadian Community Health Survey were also included for comparison.

Results

Masters Athletes had significantly higher rates of injury with the lowest rates of chronic disease, compared to all other activity groups. In contrast, chess players reported lower rates of injury compared to Masters Athletes as well as lower prevalence of chronic diseases compared to the moderately active and inactive groups. The normative groups reported the lowest rate of injury, but increased prevalence of chronic diseases compared to Masters Athletes and chess players.

Conclusions

Findings from this study indicate that both athletic and cognitive engagement may be positively related to the physical health of older adults, since Masters Athletes and chess players reported a lower prevalence of chronic disease. Importantly, the results expand our current understanding of health by providing evidence for physical health outcomes associated with an activity that is primarily associated with cognitive health.

     

Social Support and Health Among Senior Internet Users: Results of an Online Survey

ABSTRACT

There is some disagreement as to whether the Internet has a positive or negative impact on social connection and well-being for older adults. Using an online survey, we assessed self-reported social support, health, and Internet use patterns among users over fifty years of age. In a comparison of highly social Internet users versus low-social users, we found that high-social users spent more time on-line and reported more physical and mental health problems. However, the groups did not differ in amount of or satisfaction with social support they received. Implications of these results are discussed.     

Cognitive,social, and neural determinants of diminished decision-making and financial exploitation risk in aging and dementia: A review and new model

ABSTRACT

In this article we will briefly review how changes in brain and in cognitive and social functioning, across the spectrum from normal to pathological aging, can lead to decision-making impairments that increase abuse risk in many life domains (e.g., health care, social engagement, financial management). The review will specifically focus on emerging research identifying neural, cognitive, and social markers of declining financial decision-making capacity in older adults. We will highlight how these findings are opening avenues for early detection and new interventions to reduce exploitation risk.     

“I'm still raring to go”: Successful aging among lesbian,gay, bisexual,and transgender older adults

While we know that minority status differentiates the experience of aging, little research has been done to examine the ways in which patterns of successful aging may differ in diverse subgroups of older adults. In this exploratory study, we investigated and described experiences of successful aging in a sample of lesbian, gay, bisexual and transgender (LGBT) older adults. Directed by a community-based participatory research process, we conducted semi-structured in-depth interviews with 22 LGBT adults, age 60 and older. We took an inductive, grounded theory approach to analyze the taped and transcribed interviews. We coded respondent experiences in four domains: physical health, mental health, emotional state and social engagement. Four gradations of successful aging emerged. Very few in our sample met the bar for “traditional success” characterized by the absence of problems in all four domains of health. Most of the sample was coping to a degree with problems and was categorized in one of two gradations on a continuum of successful aging: “surviving and thriving” and “working at it.” A small number was “ailing”: not coping well with problems. Some of the experiences that respondents described were related to LGBT status; others were related to more general processes of aging. The research suggests that a successful aging framework that is modified to include coping can better describe the experiences of LGBT older adults. The modified conceptual model outlined here may be useful in future research on this population, as well as more broadly for diverse populations of adults, and may be adapted for use in practice to assess and improve health and well-being.     

Best practices for physical activity programs and behavior counseling in older adult populations

Physical activity offers one of the greatest opportunities for people to extend years of active independent life and reduce functional limitations. The article identifies key practices for promoting physical activity in older adults, with a focus on those with chronic disease or low fitness and those with low levels of physical activity. Key practices identified: (a) A multidimensional activity program that includes endurance, strength, balance, and flexibility training is optimal for health and functional benefits; (b) principles of behavior change including social support, self-efficacy, active choices, health contracts, assurances of safety, and positive reinforcement enhance adherence; (c) manage risk by beginning at low intensity but gradually increasing to moderate physical activity, which has a better risk:benefit ratio and should be the goal for older adults; (d) an emergency procedure plan is prudent for community-based programs; and (e) monitoring aerobic intensity is important for progression and motivation. Selected content review of physical activity programming from major organizations and institutions is provided.     

Physical activity and cognitive-health content in top-circulating magazines, 2006-2008

Physical activity may promote cognitive health in older adults. Popular media play an important role in preventive health communication. This study examined articles discussing associations between physical activity and cognitive health in top-circulating magazines targeting older adults. 42,753 pages of magazines published from 2006 to 2008 were reviewed; 26 articles met inclusion criteria. Explanations regarding the link between physical activity and cognitive health were provided in 57.7% of articles. These explanations were generally consistent with empirical evidence; however, few articles included empirical evidence. Physical activity recommendations were presented in 80.8% of articles; a wide range was recommended (90-300 min of physical activity per wk). Socioeconomic status and education level were not mentioned in the text. Results suggest an opportunity for greater coverage regarding the role of physical activity in promoting cognitive health in popular media. Magazine content would benefit from including more empirical evidence, culturally sensitive content, and physical activity recommendations that are consistent with U.S. guidelines.     

Best practices for physical activity programs and behavior counseling in older adult populations

Physical activity offers one of the greatest opportunities for people to extend years of active independent life and reduce functional limitations. The purpose of this paper is to identify key practices for promoting physical activity in older adults, with a focus on older adults with chronic disease or low fitness and those with low levels of physical activity. Key practices identified in promotion activity in older adults include: (1) a multidimensional activity program that includes endurance, strength, balance, and flexibility training is optimal for health and functional benefits; (2) principles of behavior change, including social support, self-efficacy, active choices, health contracts, assurances of safety, and positive reinforcement, enhance adherence; (3) management of risk by beginning at low intensity but gradually increasing to moderate physical activity which has a better risk/benefit ratio should be the goal for older adults; (4) an emergency procedure plan is prudent for community-based programs; and (5) monitoring aerobic intensity is important for progression and for motivation. Selected content reviews of physical activity programming from major organizations and institutions are provided. Regular participation in physical activity is one of the most effective ways for older adults, including those with disabilities, to help prevent chronic disease, promote independence, and increase quality of life in old age.Publication Note All National Blueprint Publications are in the public domain and can be freely reproduced without copyright. This article has been previously published in Medicine Science and Sports and Exercise and the Journal of Aging and Physical Activity. Individuals or organizations who wish to publish National Blueprint articles should contact the National Blueprint Office for permission.     

"You feel like people are looking at you and laughing": Older adults' perceptions of aquatic physical activity

Older adults' participation in Physical Activity (PA) in the United Kingdom remains low. Moreover, although the subjective and narrative elements of aging are increasingly studied, promotion of healthy behaviours such as aquatic PA still frequently reduces older adults to passive recipients who rely on health professionals for their wellbeing. Using a figurational perspective, the relationship between participants' perceptions of the aging body and participation in aquatic activity was investigated. Interviews were completed with 22 adults aged over 50years (7 men, 15 women). Participants highlighted a number of perceptual barriers that were contoured by wider social representations of older adults. Perceptions focussed upon the perceived limitations of the aging body. The need for regular participation in PA was recognised. However the potential for angst when wearing a bathing costume in the presence of 'others' was expressed, particularly amongst those considering themselves overweight. Participants objectified their bodies and compared them with those of other participants. The difficulties of managing physical (e.g. injury and illness) and environmental risk were described. At the same time, participants experienced the development of new webs of interdependence. These webs were both enabling and constraining. Some participants felt empowered. However, the exclusivity of many aquatic activity sessions re-emphasised the status of older adults as outsiders in the wider figuration of physical activity.     

Predictors of falling in older Maryland drivers: a structural-equation model

Falls can impair health and reduce quality of life among older adults. Although many factors are related to falling, few analyses examine causal models of this behavior. In this study, factors associated with falling were explored simultaneously using structural-equation modeling. A variety of cognitive, physical-performance, and health measures were administered to 694 older adult drivers from the state of Maryland. The observed and latent variables of age, cognitive ability, physical functioning, health, and falling behavior were used to create a causal model. The model revealed that being older was associated with declines in cognition, and such cognitive declines predicted increased falling. Similarly, poorer health was related to poorer physical functioning, which, in turn, also predicted increased falling. This model indicates that in addition to existing fall-prevention interventions aimed at improving physical functioning, interventions to improve cognition and health might also be effective. It is speculated that fear of falling, which often results in reduced mobility among older adults, might account for the lack of a direct relationship between age and falling. This hypothesis should be examined in further research.     

Productive Engagement Among Older Americans: Prevalence,Patterns, and Implications for Public Policy

This study estimates the prevalence of productive engagement among adults aged 60 and over residing in the United States over a nine-year period. We analyze three waves of data from the Americans' Changing Lives Study, which allows the findings to describe the non-institutionalized older American population. Focusing upon five activities—formal paid employment, irregular paid work, unpaid volunteerism, caregiving, and informal assistance to others—we identify changes in the engagement rates, examine the extent to which engagement occurs through single or multiple concurrent activities, and document intra-individual patterns of engagement within and across forms of productive activity, including the continuity, initiation, and cessation of involvement. The findings reveal that late-life productive engagement is widespread, with the majority of older individuals involved in multiple forms of activity concurrently. Non–market-based activities such as caregiving, informal assistance, and volunteering are most prevalent. Initiation and cessation of activities are common and yield more complex patterns and lower rates of non-participation than are revealed in cross-sectional analyses. Time spent in productive engagement is highly variable and exhibits an overall decline across time. We conclude by highlighting policy strategies to increase the availability and quality of opportunities for productive engagement and promote planning for engagement in late life.     

Productive engagement among older Americans: prevalence, patterns, and implications for public policy

This study estimates the prevalence of productive engagement among adults aged 60 and over residing in the United States over a nine-year period. We analyze three waves of data from the Americans' Changing Lives Study, which allows the findings to describe the non-institutionalized older American population. Focusing upon five activities--formal paid employment, irregular paid work, unpaid volunteerism, caregiving, and informal assistance to others--we identify changes in the engagement rates, examine the extent to which engagement occurs through single or multiple concurrent activities, and document intra-individual patterns of engagement within and across forms of productive activity, including the continuity, initiation, and cessation of involvement. The findings reveal that late-life productive engagement is widespread, with the majority of older individuals involved in multiple forms of activity concurrently. Non-market-based activities such as caregiving, informal assistance, and volunteering are most prevalent. Initiation and cessation of activities are common and yield more complex patterns and lower rates of non-participation than are revealed in cross-sectional analyses. Time spent in productive engagement is highly variable and exhibits an overall decline across time. We conclude by highlighting policy strategies to increase the availability and quality of opportunities for productive engagement and promote planning for engagement in late life.     

Neighborhood conditions and social network turnover among older adults

Increasing research highlights heterogeneity in patterns of social network change, with growing evidence that these patterns are shaped in part by social structure. The role of social and structural neighborhood conditions in the addition and loss of kin and non-kin network members, however, has not been fully considered. In this paper, we argue that the residential neighborhood context can either facilitate or prevent the turnover of core network relationships in later life – a period of the life course characterized by heightened reliance on network ties and vulnerability to neighborhood conditions. Using longitudinal data from the National Social Life, Health, and Aging Project linked with data from the American Community Survey, we find that higher levels of neighborhood concentrated disadvantage are associated with the loss of older adults’ kin and non-kin network members over time. Higher levels of perceived neighborhood social interaction, however, are associated with higher rates of adding non-kin network members and lower rates of adding kin network members over time. We suggest that neighborhood conditions, including older adults’ perceptions of neighborhood social life, represent an underexplored influence on kin and non-kin social network dynamics, which could have implications for access to social resources later in the life course.     

Motives for and barriers to physical activity among older adults with mobility limitations

The purpose of this study was to investigate what older adults with severe, moderate, or no mobility limitation consider motives for and barriers to engaging in physical exercise. Community-dwelling adults (N=645) age 75-81 years completed a questionnaire about their motives for and barriers to physical exercise and answered interview questions on mobility limitation. Those with severely limited mobility more often reported poor health, fear and negative experiences, lack of company, and an unsuitable environment as barriers to exercise than did those with no mobility limitation. They also accentuated disease management as a motive for exercise, whereas those with no or moderate mobility limitation emphasized health promotion and positive experiences related to exercise. Information about differences in motives for and barriers to exercise among people with and without mobility limitation helps tailor support systems that support engagement in physical activity among older adults.     

Successful aging: how does physical activity influence engagement with life?

With the increasing number of individuals over the age of 65?years worldwide, it is critical for society to recognize the importance of helping seniors maintain their health, physical, and cognitive functioning as well as their engagement with life. These three dimensions provide the foundation for successful aging (SA). The positive role of engagement with life has been understated to date in the literature. This review highlights the components of SA with particular emphasis on engagement and how physical activity positively impacts engagement which in turn positively influences health and physical function.