Order of Onset of Physical Frailty and Cognitive Impairment and Risk of Repeated Falls in Community-Dwelling Older Adults.

Objectives: To examine whether physical frailty onset before, after, or in concert with cognitive impairment is differentially associated with fall incidence in community-dwelling older adults.

Design: A longitudinal observational study.

Setting And Participants: Data from 1337 older adults age ≥65 years and free of physical frailty or cognitive impairment at baseline were obtained from the National Health Aging Trends Study (2011‒2017), a nationally representative cohort study of US older adult Medicare beneficiaries.

Incident Care Trajectories for Older Adults With and Without Dementia.

Objective: Despite cross-sectional evidence that persons living with dementia receive disproportionate hours of care, studies of how care intensity progresses over time and differs for those living with and without dementia have been lacking.

Method: We used the 2011-2018 National Health and Aging Trends Study to estimate growth mixture models to identify incident care hour trajectories ("classes") among older adults (N = 1,780).

Results: We identified 4 incident care hour classes: "Low, stable," "High, increasing," "24/7 then high, stable," and "Low then resolved.

Changes in Older Adults' Social Contact During the COVID-19 Pandemic.

Objectives: To understand changes during the coronavirus disease 2019 (COVID-19) pandemic in weekly contact with nonresident family and friends for U.S. adults aged 70 and older in residential care and community settings.

Collecting Objective Measures of Visual and Auditory Function in a National in-Home Survey of Older Adults.

Maintenance of visual and auditory function is important for preventing the onset of activity limitations and preserving quality of life in later life. To date, national panel studies focused on health and aging have mostly collected subjective (self-reported) measures of visual and auditory function. The National Health and Aging Trends Study (NHATS), a study of Medicare beneficiaries ages sixty-five and older, recently developed a protocol for measuring objective visual and auditory function for its annual, in-home data collection conducted by trained interviewers.

Frailty, With or Without Cognitive Impairment, Is a Strong Predictor of Recurrent Falls in a US Population-Representative Sample of Older Adults.

Background: Physical frailty and cognitive impairment have been separately associated with falls. The purpose of the study is to examine the associations of physical frailty and cognitive impairment separately and jointly with incident recurrent falls among older adults.

Methods: The analysis included 6000 older adults in community or non-nursing home residential care settings who were at least 65 years old and participated in the National Health and Aging Trends Study.

Progression of Physical Frailty and the Risk of All-Cause Mortality: Is There a Point of No Return?

Objectives: To investigate the rate and patterns of accumulation of frailty manifestations in relationship to all-cause mortality and whether there is a point in the progression of frailty beyond which the process becomes irreversible and death becomes imminent (a.k.a.

Associations of insomnia symptoms with subsequent health services use among community-dwelling U.S. older adults.

Study Objectives: Determine the association of insomnia symptoms with subsequent health services use, in a representative sample of U.S. older adults.

Do Caregiving Factors Affect Hospitalization Risk Among Disabled Older Adults?

Background/objectives: Hospitalization is common among older adults with disability, many of whom receive help from a caregiver and have dementia. Our objective was to evaluate the association between caregiver factors and risk of hospitalization and whether associations differ by dementia status.

Design: Longitudinal observational study.

U.S. National Profile of Older Adults with Cognitive Impairment Alone, Physical Frailty Alone, and Both.

Background/objectives: To obtain national and regional estimates of prevalence of frailty with or without cognitive impairment, and cognitive impairment with or without frailty among older adults in the United States, and to identify profiles of characteristics that distinguish their joint versus separate occurrence.

Design: Cross-sectional.

Setting: Community or non-nursing home residential care settings.

Race Differences in Characteristics and Experiences of Black and White Caregivers of Older Americans.

Background And Objectives: Racial disparities in health and socioeconomic characteristics of older adults have implications for the experiences of their family and unpaid caregivers, but knowledge to date has primarily drawn from convenience samples. Using a population-based sample, we examine associations between caregiver race and caregiving-related effects.

Research Design And Methods: Study participants include white (n = 992) and black (n = 556) respondents to the 2015 National Study of Caregiving who assisted community-dwelling older adults with disabilities who participated in the National Health and Aging Trends Study.

Evaluation of Hospice Enrollment and Family and Unpaid Caregivers' Experiences With Health Care Workers in the Care of Older Adults During the Last Month of Life.

This survey study assesses end-of-life caregivers’ experiences with health care workers during older adults’ last month of life.

Dissecting the Racial/Ethnic Disparity in Frailty in a Nationally Representative Cohort Study with Respect to Health, Income, and Measurement.

Background: Racial/ethnic frailty prevalence disparities have been documented. Better elucidating how these operate may inform interventions to eliminate them. We aimed to determine whether physical frailty phenotype (PFP) prevalence disparities (i) are explained by health aspects, (ii) vary by income, or (iii) differ in degree across individual PFP criteria.

Utilization of driving and other transportation rehabilitation in the National Health and Aging Trends Study.

Background: As people age, their mobility begins to decrease. In an effort to maintain mobility, this population can seek out rehabilitation services with the goal of improving their driving. However, it is unclear who has sought out rehabilitation for this purpose.

Family Caregivers' Experiences With Health Care Workers in the Care of Older Adults With Activity Limitations.

Importance: Family and unpaid caregivers often play an active role in managing the care of older adults with activity limitations.

Objective: To examine caregivers' experiences with older adults' health care workers.

Design, Setting, And Participants: This survey study constitutes a secondary analysis of a sample of 1916 family and unpaid caregivers to 1203 community-living older adults with activity limitations who participated in the 2017 National Health and Aging Trends Study.

Financial Stress and Risk for Entry into Medicaid Among Older Adults.

Background And Objectives: Spending in the Medicaid program is a significant concern to both state and federal policy makers. Medicaid spending is driven by program enrollment and services use. Older adults with high health care needs incur a disproportionate proportion of program spending.

Family Caregiver Factors Associated With Emergency Department Utilization Among Community-Living Older Adults With Disabilities.

Older adults with disability are frequent users of the emergency department (ED) and often rely on family caregiver support. We identify whether and which caregiver characteristics are associated with older adults' ED use. We use Cox proportional hazards regression to model the likelihood of all-cause ED use (defined as 1 or more visits within 12 months of survey) as a function of caregiver characteristics after adjusting for older adult sociodemographic and health characteristics.

Comparing Survey-Based Frailty Assessment to Medicare Claims in Predicting Health Outcomes and Utilization in Medicare Beneficiaries.

To assess two models for the prediction of health utilization and functions using standardized in-person assessments of frailty and administrative claims-based geriatric risk measures among Medicare fee-for-service beneficiaries aged 65 years and above. Outcomes of hospitalizations, death, and functional help were investigated for participants in the 2011 National Health and Aging Trends Study. For each outcome, multivariable logistic regression model was used to investigate claims-based geriatric risk and survey-based frailty.

Medicare Spending and the Adequacy of Support With Daily Activities in Community-Living Older Adults With Disability: An Observational Study.

Background: Identifying factors that affect variation in health care spending among older adults with disability may reveal opportunities to better address their care needs while offsetting excess spending.

Objective: To quantify differences in total Medicare spending among older adults with disability by whether they experience negative consequences due to inadequate support with household activities, mobility, or self-care.

Design: Observational study of in-person interviews and linked Medicare claims.

Hierarchical Development of Frailty and Cognitive Impairment: Clues Into Etiological Pathways.

Background: Frailty and cognitive impairment (CI) are associated and often coexist in older adults. Whether temporal patterns of occurrence reflect different etiologies remain unknown.

Methods: Participants from the National Health and Aging Trends Study were assessed annually (2011-2016) for frailty (Fried's criteria) and CI (bottom quintile of clock drawing test or immediate and delayed recall; proxy-report of dementia diagnosis or AD8 ≥ 2).

Change Over Time in Caregiving Networks for Older Adults With and Without Dementia.

Objectives: We provide national estimates of caregiving networks for older adults with and without dementia and examine how these networks develop over time. Most prior research has focused on primary caregivers and rarely on change over time.

Method: We identify a cohort of older adults continuously followed in the National Health and Aging Trends Study between 2011 and 2015 and receiving help from family members or unpaid caregivers in 2015 (n = 1,288).

Care Arrangements of Older Adults: What They Prefer, What They Have, and Implications for Quality of Life.

Background And Objectives: Meeting individual preferences for long-term services and supports (LTSS) is a policy priority that has implications for quality of care. Evidence regarding preferences is sparse. In addition, little is known regarding whether preferences and care arrangements match for those receiving care, and implications for quality of life.

Long-Term Nursing Home Entry: A Prognostic Model for Older Adults with a Family or Unpaid Caregiver.

Objectives: To comprehensively examine factors associated with long-term nursing home (NH) entry from 6 domains of older adult and family caregiver risk from nationally representative surveys and develop a prognostic model and a simple scoring system for use in risk stratification.

Design: Retrospective observational study.

Setting: National Long-Term Care Surveys 1999 and 2004 and National Health and Aging Trends Study 2011 and linked caregiver surveys.

Late Transitions and Bereaved Family Member Perceptions of Quality of End-of-Life Care.

Objectives: To examine associations between healthcare transitions at the end of life (EOL; late transitions) and bereaved family members' and friends' assessment of EOL quality of care (QOC).

Design: National Health and Aging Trends Study (NHATS), a prospective cohort of Medicare enrollees aged 65 and older.

Setting: United States, all sites of death.