Time Use and Well-Being in Family and Other Unpaid Caregivers of Older Adults.

Objectives: Caregivers report limited freedom to engage with others, participate in physical activities, pursue leisure activities, and sleep. Few studies have focused on caregivers' time use across different activities, particularly how different patterns of time use are associated with well-being. This study aimed to (a) identify time-use profiles of family caregivers of older adults and (b) examine associations between identified time-use profiles and caregiver well-being.

Frailty as a predictor of mortality: a comparative cohort study of older adults in Costa Rica and the United States.

Background: Frailty is a common condition among older adults that results from aging-related declines in multiple systems. Frailty increases older adults' vulnerability to negative health outcomes, including loss of mobility, falls, hospitalizations, and mortality. The aim of this study is to examine the association between frailty and mortality in older adults from Costa Rica and the United States.

Residential Segregation, Social Cohesion, and Aging in Place: Health and Mental Health Inequities.

Background And Objectives: Research shows that living in segregated neighborhoods may have deleterious health outcomes via social, physical, and socioeconomic contexts that deepen existing inequities. However, there has been limited scholarship examining the effects of segregation on older adults, despite an increasing focus on aging in place. Guided by the Ecological Model of Aging, we examined the effects of segregation on older adults' self-rated health and mental health, accounting for both individual characteristics and neighborhood opportunities and risks (e.

Neighborhood Age Composition and Self-Rated Health: Findings from a Nationally Representative Study.

Neighborhood age composition is an understudied area. Furthermore, existing empirical and conceptual work is conflicting, with some scholarship-indicating neighborhoods with older adults are beneficial and other scholarship suggesting it can be detrimental. Combining data from 7,197 older adults from the first wave (2011) of the National Health & Aging Trends Study and census tract data from the National Neighborhood Change Database, the purposes of our study were to: 1) identify the characteristics of neighborhoods experiencing different types of changes in age composition, and 2) examine the association between neighborhood age composition and self-rated health.

The Role of County Characteristics in Mental Health Service Use by Older African Americans.

Objective: Older African Americans may underutilize mental health services, although they experience mental health problems at rates comparable with those of whites. Untreated mental disorders contribute to increased risk of morbidity and mortality and decreased quality of life, and therefore, understanding the factors that influence racial disparities in service use is critical. This study examined whether county characteristics were associated with mental health service use by older African Americans after the analyses adjusted for individual characteristics.

Aging in Place in Gentrifying Neighborhoods: Implications for Physical and Mental Health.

Background And Objectives: In the United States, the older adult population and the proportion of neighborhoods experiencing gentrification are both growing. However, there is limited scholarship on the effects of gentrification on older adults, with most work focusing on those who leave rather than stay. This study examines the effects of remaining in a gentrifying neighborhood on older adults' self-rated health and mental health, with particular attention to outcomes for those who are economically vulnerable.

Organizational Characteristics Associated With the Predicted Sustainability of Villages.

Guided by resource dependence theory, this mixed-methods study examined organizational characteristics contributing to the perceived sustainability of Villages, a rapidly proliferating grassroots approach for promoting social participation and service access for community-dwelling older adults. Surveys conducted with leaders of 86% of Villages in the United States in 2012 found that higher predicted confidence in their Village's 10-year survival was associated with greater financial reserves, human resources, number of Village members, formal policies and procedures, and formal collaboration agreements. Respondents' explanations of their confidence ratings revealed additional themes of organizational leadership and perceived community need.

Caregiver stressors and depressive symptoms among older husbands and wives in the United States.

Framed by Pearlin's Stress Process Model, this study prospectively examines the effects of primary stress factors reflecting the duration, amount, and type of care on the depressive symptoms of spousal caregivers over a2-year period, and whether the effects of stressors differ between husbands and wives. Data are from the 2004 and 2006 waves of the Health and Retirement Study and we included community-dwelling respondents providing activities of daily life (ADL) and/or instrumental activities of daily life (IADL) help to their spouses/partners (N = 774). Results from multivariate regression models indicate that none of the primary stressors were associated with depressive symptoms.

Aging in Place vs. Relocation for Older Adults with Neurocognitive Disorder: Applications of Wiseman's Behavioral Model.

Some older adults are more vulnerable to housing concerns due to physical and cognitive challenges, including those with a neurocognitive disorder who need extensive support. Environmental gerontology frameworks, including Wiseman's 1980 Behavioral Model of Elderly Migration, have informed scholarship on aging in place and relocation. Understanding Wiseman's model, including considerations for working with families confronting a neurocognitive disorder, can help practitioners ensure that older clients live in settings that best meet their wants and needs.

Variations on the Village Model.

Villages, which are community-based initiatives designed to help older adults age in place through a combination of services, participant engagement, and peer support, have expanded rapidly since their initial development in the early 2000s. Using a sample of Villages in the United States, we examined variations from characteristics of the Village model as portrayed by media and organizational leaders. Results indicate there is no uniform Village model that can be implemented and evaluated by policy makers, funders, service providers, and researchers.

Assessing the factor structure of well-being in older adults: findings from the National Health and Aging Trends Study.

Objectives: Well-being has been conceptualized as a two-dimensional construct that includes both hedonic and eudaimonic components. To date, existing measures of well-being may not adequately capture both of these components for older adults, and limited literature has explored whether the two constructs can be integrated into one factor to measure well-being in this population.

Method: This study examined the factor structure of the 11 well-being items from the National Health and Aging Trends Study (NHATS), a nationally representative panel study of Medicare recipients in the US.

Age-friendly environments and self-rated health: an exploration of Detroit elders.

While a number of organizations and government entities have encouraged the development of more "age-friendly" environments, to date there has been limited research linking these environment features to elder outcomes. Using a representative sample of older adults living in Detroit, this study examined the association between age-friendly environment factors and self-rated health. Results indicated that access to health care, social support, and community engagement were each associated with better self-rated health, while neighborhood problems were associated with poorer self-rated health.

Does becoming an ADL spousal caregiver increase the caregiver's depressive symptoms?

This study investigated whether transitioning into the role of activities of daily living (ADL) spousal caregiver is associated with increased depressive symptoms for older husbands and wives among a sample of coresiding community-dwelling older couples. Using data from the Health and Retirement Study, we estimated a two-level linear model to examine the association between change in caregiver status and respondents' depressive symptoms at follow-up, controlling for other factors identified in Pearlin's stress process model (PSPM). Results indicate that both husbands and wives who become ADL caregivers have more follow-up depressive symptoms than noncaregivers.

Do age-friendly characteristics influence the expectation to age in place? A comparison of low-income and higher income Detroit elders.

Currently there is limited evidence linking age-friendly characteristics to outcomes in elders. Using a representative sample of 1,376 adults aged 60 and older living in Detroit, this study examined the association between age-friendly social and physical environmental characteristics and the expectation to age in place, and the potential differences between low- and higher-income elders. Based on U.

Local and regional governments and age-friendly communities: a case study of the San Francisco Bay Area.

The purpose of this study was to assess the extent to which cities, county departments of adult and aging services, county transportation authorities, and public transit agencies in the San Francisco Bay Area have in place age-friendly policies, programs, and infrastructure in the areas of community design, housing, transportation, health care and supportive services, and opportunities for community engagement. The most common age-friendly features include those that target alternative forms of mobility (for example, incentives for mixed-use neighborhoods and changes to improve the accessibility of public transit), while the least common policies and programs are those that aim to help older adults continue driving, such as driver education programs, driver assessment programs, and slow-moving vehicle ordinances. The article concludes with policy and research implications of these findings.

Does the Village model help to foster age-friendly communities?

This article explores the potential role of the Village model, a social initiative that emphasizes member involvement and service access, in helping communities to become more age-friendly. A survey of 86.3% of operational Villages examined activities designed to help members access a variety of supports and services consistent with the World Health Organization's (WHO) Global Network of Age-Friendly Cities and Communities program model, as well as other potential contributions to community age friendliness.

A tale of two community initiatives for promoting aging in place: similarities and differences in the national implementation of NORC programs and villages.

Purpose: Villages and Naturally Occurring Retirement Community (NORC) Supportive Service Programs (NORC programs) are among the most prominent community-based models for promoting aging in place. To advance systematic understanding of their development, this study examined how these models have been implemented nationally and the models' similarities and differences.

Design And Methods: A survey of program leaders representing 69 Villages and 62 NORC programs was conducted from January to June of 2012.

Facilitators of home and community-based service use by urban African American elders.

Objective: To examine the factors associated with urban African American elders' utilization of home and community-based services and explore whether these factors differ by category of service.

Methods: Data came from a representative sample of 1,099 African American older adults living in Detroit. Logistic regression models were used to explore the predisposing, enabling, and need factors associated with any service use and five categories of service use: in-home care, household services, functional care, out-of-home services, and financial/legal services.

Conceptualizing age-friendly community characteristics in a sample of urban elders: an exploratory factor analysis.

Accurate conceptualization and measurement of age-friendly community characteristics would help to reduce barriers to documenting the effects on elders of interventions to create such communities. This article contributes to the measurement of age-friendly communities through an exploratory factor analysis of items reflecting an existing US Environmental Protection Agency policy framework. From a sample of urban elders (n = 1,376), we identified 6 factors associated with demographic and health characteristics: access to business and leisure, social interaction, access to health care, neighborhood problems, social support, and community engagement.

City governments and aging in place: community design, transportation and housing innovation adoption.

Purpose Of The Study: To examine the characteristics associated with city government adoption of community design, housing, and transportation innovations that could benefit older adults.

Design And Methods: A mixed-methods study with quantitative data collected via online surveys from 62 city planners combined with qualitative data collected via telephone interviews with a subsample of 18 survey respondents.

Results: Results indicate that advocacy is an effective strategy to encourage city government adoption of these innovations.

On Lok: a pioneering long-term care organization for the elderly (1971-2008).

On Lok is a pioneering nonprofit organization that has delivered services to the frail and elderly since its founding in 1971. The agency began as a grassroots effort focused on improving the health care available to older adults living independently in the community. Over its 40-year history, On Lok has evolved into a $70 million nonprofit human service organization with a national reputation for innovation as a leading provider of care to frail elderly.

Long-term care in the United States: policy themes and promising practices.

This analysis provides an overview of the major policy themes and promising practices emerging in recent years as policymakers and researchers struggle to design a long-term care system that meets the needs of an aging population. Themes that have dominated the long-term care policy debates include: recruiting and retaining a qualified long-term care workforce; devising financing mechanisms for those requiring long-term care; and moving away from an institutional-based long-term care system towards more home- and community-based services. Three promising practices that have emerged in the past few decades include: the culture change movement; service integration that combines medical and social care; and various forms of community residential care that bring together housing and services in a more home-like environment.

Assessing elder mistreatment: instrument development and implications for adult protective services.

Assessment of elder mistreatment is hindered by a myriad of factors, including inconsistent definitions, divergent and untested theories of causation, and limited research attention to the problem. In addition to these difficulties, professionals encounter complex situations requiring considerable clinical assessment skills and decision-making capacity. Adult Protective Services (APS) workers, as well as mandated reporters such as healthcare providers and social workers, need an assessment tool that can reliably and accurately assess for elder mistreatment.

Palliative care in nursing homes: a comparison of high- and low-level providers.

The purpose of this study was to explore staff perceptions and concerns about the use of palliative care services in the nursing home setting. Six administrators from nursing homes were purposively selected for key informant interviews. Four common themes emerged, including issues related to the culture of care, the model of care, the relationships with hospice partners, and the role of staff.