Explicating Ageism in the Productive Aging Framework.

This essay argues for a fuller integration of ageism and age discrimination into the productive aging framework. We briefly review the productive aging scholarship and the extent to which ageism has been considered in regards to working, volunteering, education, and caregiving. We suggest that ageism has not been adequately considered, and we identify how it permeates productive engagement in later life. We introduce modifications to the productive aging framework to more directly capture the roles of ageism and age discrimination in activity engagement and the outcomes achieved. We argue for the integration of key concepts from minority stress theory and critical race theory that may yield important insights for an increasingly diverse older population. We conclude with research directions that will guide intervention development to reduce ageism at the societal, organizational and individual level.

Work Demands and Cognitive Health Inequities by Race and Ethnicity: A Scoping Review.

BACKGROUND AND OBJECTIVES: This scoping review aimed to chart the scientific literature on the association between workplace demands with cognitive health, and whether race and ethnicity have a direct or indirect relationship between occupational complexity and cognitive health. RESEARCH DESIGN AND METHODS: PRISMA scoping review guided this study. Peer-reviewed articles were drawn from 5 databases. Inclusion criteria were populations aged 18 and older, U.S.-based studies, a comprehensive conceptualization of workplace demands, and cognitive health outcomes. All articles were screened by title and abstract; qualifying articles proceeded to full-text review. RESULTS: The majority of studies drew from theories that did not interrogate heterogeneity and minority aging experiences. Consequently, the majority of studies did not include race and ethnicity in their analyses. A small and growing body of research drew from critical perspectives and interrogated cognitive health inequities by race and ethnicity within the context of workplace demands. The association between workplace demands and cognitive health is not linear when race and ethnicity are examined. Emerging evidence suggests interventions to improve substantive complexity among racial and ethnic minorities, and individuals with low education are a promising avenue for intervention research. DISCUSSION AND IMPLICATIONS: We discuss integrating emerging theories, such as minority stress and revised social determinants of health frameworks, to sharpen the focus and broaden our understanding on racial and ethnic cognitive health inequities in an emerging area of prevention research. This research can advance our basic understanding of preventable health inequities as well as provide important information for interventions.

Neighborhood Social Cohesion and the Health of Native Hawaiian and Other Pacific Islander Older Adults.

Native Hawaiian and other Pacific Islander (NHPI) older adults experience various social and health challenges. There is a growing literature linking neighborhood conditions with health, yet few have focused on NHPI older adults. This study examines associations between neighborhood social cohesion and health outcomes (i.e., self-rated health, psychological distress, and memory) in this population. Data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (n=1,045 with respondents aged 50+) were analyzed with logistic regression models. The level of neighborhood social cohesion was determined by responses to items on perceptions of mutual help, dependability, trust, and close relationships within the neighborhood. Higher perceived neighborhood social cohesion was associated with lower odds of having serious psychological distress or memory problems. There was no statistical association of social cohesion with self-rated health. Socially cohesive neighborhoods are important to the health of NHPI. We discuss methods to improve neighborhood social cohesion as a way to promote health equity for NHPI older adults in the United States (U.S.).

Multifaceted Demands of Work and Cognitive Functioning: Findings From the Health and Retirement Study.

OBJECTIVES: The present study examines the associations between mental, social, and physical demands of work and cognitive functioning among older adults in the United States. METHOD: Data from 3,176 respondents in the Health and Retirement Study were analyzed using growth curve modeling (2004-2014). The study investigated differences by gender, race, ethnicity, and education. RESULTS: Higher mental and social demands of work were associated with higher levels of initial cognitive functioning, but were not significantly associated with slower cognitive decline over time. Physical demands of work were negatively associated with initial cognitive functioning and were also marginally associated with a slower rate of decline in cognitive functioning going into older adulthood. In stratified analyses, results varied by sociodemographic characteristics. DISCUSSION: The results partially support the environmental complexity hypothesis and the productive aging framework in that higher mental and social demands and lower physical demands relate to better cognitive functioning at baseline, with the differences appearing stable throughout older adulthood. The stratified results shed light on addressing disparities in cognitive aging and work environments.

Acknowledging Systemic Discrimination in the Context of a Pandemic: Advancing an Anti-Racist and Anti-Ageist Movement.

This commentary draws together the confluence of current events - COVID-19 pandemic and racial injustice. Vulnerability to COVID-19 cannot be understood by age alone but within the context of inequity. We first review how COVID-19 has disproportionately affected Black and Latinx populations across the life span with the latest data from New York City Department of Health. We then discuss critical race theory and analyze longstanding inequities in health, economic, and social conditions that heighten the risk for vulnerability. We conclude with a discussion for the social work profession on the issues of defunding the police to undoing stereotypes.

Exploring the Consequences of Major Lifetime Discrimination, Neighborhood Conditions, Chronic Work, and Everyday Discrimination on Health and Retirement.

This study examines the associations of multiple forms of perceived discrimination and negative neighborhood conditions with mental health and retirement age. Respondents aged above 51 years from the Health and Retirement Study were selected in 2006 and surveyed through 2014. Ordinary least squares regression evaluated associations. Bias-corrected bootstrap resampling method tested whether mental health mediated the relationships between disadvantages and retirement age. Major lifetime and work discrimination, as well as neighborhood conditions, were directly associated with earlier retirement. Individuals who did not experience disadvantages retired at age 65, whereas respondents with the highest levels of disadvantage retired earlier (at age 62). Mental health partially mediated relationships between major lifetime discrimination, neighborhood conditions, and work discrimination with retirement age, whereas mental health fully mediated the relationship between everyday discrimination and retirement age. Efforts to promote civil rights, reduce discrimination, and enhance individual resilience may promote mental health and capacity to work longer.

Interactive Effects of Chronic Health Conditions and Financial Hardship on Episodic Memory among Older Blacks: Findings from the Health and Retirement Study.

Previous research links chronic health conditions and financial hardship to cognitive outcomes among older Blacks. However, few studies have explored the moderating effect of financial hardship on chronic disease burden and specific cognitive domains. This study examined whether financial hardship (as measured by difficulty paying monthly bills) modifies the impact of self-reported chronic health conditions (e.g., diabetes, stroke) on episodic memory among 871 older Blacks (50+ years) in the Health and Retirement Study (2006). Financial hardship modified the association between chronic disease burden and episodic memory performance such that individuals who reported very little difficulty paying their monthly bills had significantly lower memory scores at high levels of disease burden compared to those reporting high financial difficulty after controlling for age, gender and education (F 2, 49 = 5.03, p= 0.010). This cross-sectional study suggests that both financial and physical wellbeing may have joint effects on cognitive health in older Blacks.

Institutional and Individual Factors Affecting Health and Employment for Low-Income Women With Chronic Health Conditions.

OBJECTIVES: This qualitative study explored risk and protective factors affecting employment and health among low-income older women with chronic health conditions or physical disabilities. METHODS: The authors conducted a secondary data analysis of 14 intensive interviews with low-income older women with chronic health conditions who had participated in a federally funded training and employment program for workers aged 55 and older. Qualitative data were analyzed using thematic analysis. RESULTS: The physical nature of the work and discrimination were risk factors, with unaccommodating work environments, ageism, and/or ableism, and internalized ageism identified as subthemes of discrimination. Protective factors, namely institutional supports (e.g., access to retraining, time management flexibility) enhanced health and self-confidence. Occupational demands matched with the capacity of the individual resulted in continued employment and improved health. DISCUSSION: Working conditions can degrade health through exposure to mental and physical health risks, or support health through access to financial and interpersonal resources. Institutional supports such as workplace flexibility and retraining are crucial to obtaining a good fit between occupational demands and the capacity of individuals, enabling a positive relationship between employment and health. Legislation designed to prevent discrimination, enhance opportunities for lifelong learning, and encourage flexible work arrangements among low-income women with chronic health conditions may facilitate healthier working lives.

Utilization of Formal and Informal Home Care: How Do Older Canadians' Experiences Vary by Care Arrangements?

This study investigates how the receipt of formal, informal, and/or a combination of both types of care at home relates to older adults' perceived loneliness, life satisfaction, and day-to-day lives. Quantitative analyses using the Canadian Community Health Survey (n = 3,928) reveal that older adults who only received formal care reported lower levels of loneliness and higher levels of life satisfaction when compared with respondents who received informal or a blend of home care. Qualitative analyses of persons aged 65+ years receiving formal and informal home care in Ontario (n = 34) suggest that formal care bolstered care recipients' autonomy and reduced their sense of being a burden on family. In turn, receiving formal care served to improve these older adults' social connectedness and well-being. Findings underscore older adults' symbolic, functional, and emotional attachment to formal care services, as well as the limitations of a reliance on informal support.

Trajectories of Perceived Workplace Age Discrimination and Long-Term Associations With Mental, Self-Rated, and Occupational Health.

OBJECTIVE: This study addresses older employees' trajectories of perceived workplace age discrimination, and the long-term associations among perceived age discrimination and older workers' mental and self-rated health, job satisfaction, and likelihood of working past retirement age. We evaluate the strength and vulnerability integration (SAVI) model. METHOD: Three waves of data from employed participants were drawn from the Health and Retirement Study (N = 3,957). Latent growth modeling was used to assess relationships between the slopes and the intercepts of the variables, thereby assessing longitudinal and cross-sectional associations. RESULTS: Perceived workplace age discrimination tends to increase with age, although notable variance exists. The initial status of perceived age discrimination relates to the baseline statuses of depression, self-rated health, job satisfaction, and likelihood of working past retirement age in the expected directions. Over time, perceived age discrimination predicts lower job satisfaction and self-rated health, as well as elevated depressive symptoms, but not likelihood of working past retirement age. DISCUSSION: This study provides empirical support for the SAVI model and uncovers the "wear and tear" effects of perceived workplace age discrimination on older workers' mental and overall health. We deliberate on social policies that may reduce age discrimination, thereby promoting older employees' health and ability to work longer.

Intersections of Home, Health, and Social Engagement in Old Age: Formal Volunteering as a Protective Factor to Health After Relocation.

This study aims to further our understanding of formal volunteering as a protective mechanism for health in the context of housing relocation and to explore race, gender, and education as moderators. A quasi-experimental design evaluated the effects of volunteering on older adults' health (self-report health, number of instrumental activities of daily living [IADLs], and depressive symptoms) among individuals who relocated but did not volunteer at Time 1 ( N = 682) in the Health and Retirement Study (2008-2010). Propensity score weighting examined health differences at Time 2 between 166 volunteers (treated) and 516 nonvolunteers (controlled). Interaction terms tested moderation. Individuals who moved and engaged in volunteering reported higher levels of self-rated health and fewer IADL difficulties compared to the control group. Race moderated the relationship between volunteering and depressive symptoms, while gender moderated the relationship between volunteering and self-assessed health. Formal volunteering protects different dimensions of health after relocation. Volunteering was particularly beneficial for females and older Whites.

Formal volunteering as a protector of health in the context of social losses.

This study aims to examine the effect of the death of a family member or friend on psychological well-being, specifically the moderating effects of first-time volunteering and social network. With the sample of 354 volunteers from the Experience Corps® (EC) programs, Analysis of covariance (ANCOVA) estimated the differences in psychological well-being. Among volunteers who had experienced the death of a family member or friend, new volunteers showed significant improvement in positive affect compared to experienced volunteers. EC members gained additional social contacts through volunteering. Formal volunteering has a salutatory effect on older adults' health after the loss of family members.

Applying WHO's Age-Friendly Communities Framework to a National Survey in China.

The World Health Organization (WHO)'s Age-Friendly Community (AFC) initiative has gained worldwide momentum. Yet, measures have not been validated in regions with various levels of socio-economic development. This article used a nationally representative dataset in China to (a) analyze community-level measures within the framework of AFC and (b) compare the age-friendliness between rural and urban settings in China. Chi- square and t-tests examined the rural and urban differences. Results suggest that many AFC concepts did not apply well in developing areas. The Chinese survey measured important environmental aspects in developing regions that were missing in the WHO AFC framework.

Chronic Noncommunicable Diseases in 6 Low- and Middle-Income Countries: Findings From Wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (SAGE).

In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, and untreated NCDs in China, Ghana, India, Mexico, Russia, and South Africa. Nationally representative samples of older adults aged ≥50 years were analyzed from wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (2007-2010; n = 34,149). Analyses focused on 6 conditions: angina, arthritis, asthma, chronic lung disease, depression, and hypertension. Outcomes for these NCDs were: 1) self-reported disease, 2) algorithm/measured test-based disease, 3) undiagnosed disease, and 4) untreated disease. Algorithm/measured test-based prevalence of NCDs was much higher than self-reported prevalence in all 6 countries, indicating underestimation of NCD prevalence in low- and middle-income countries. Undiagnosed prevalence of NCDs was highest for hypertension, ranging from 19.7% (95% confidence interval (CI): 18.1, 21.3) in India to 49.6% (95% CI: 46.2, 53.0) in South Africa. The proportion untreated among all diseases was highest for depression, ranging from 69.5% (95% CI: 57.1, 81.9) in South Africa to 93.2% (95% CI: 90.1, 95.7) in India. Higher levels of education and wealth significantly reduced the odds of an undiagnosed condition and untreated morbidity. A high prevalence of undiagnosed NCDs and an even higher proportion of untreated NCDs highlights the inadequacies in diagnosis and management of NCDs in local health-care systems.

The Aging Semantic Differential in Mandarin Chinese: Measuring Attitudes toward Older Adults in China.

The Aging Semantic Differential (ASD) is the most widely used instrument to measure young people's attitudes towards older adults. This study translated the ASD to Mandarin and examined its psychometric properties. The Mandarin-ASD contains three latent factors (Personality and Mental Health, Societal Participation, and Physical) that have high internal reliability and reasonable discriminate validity. Social work researchers, practitioners and allied professionals may utilize the ASD-Mandarin instrument to measure young people's attitudes towards older adults in China. We issue a call for a universal-ASD that can be applied across different cultural contexts.

Back to Work? Not Everyone. Examining the Longitudinal Relationships Between Informal Caregiving and Paid Work After Formal Retirement.

OBJECTIVES: Research on unretirement (retirees who re-enter the workforce) is burgeoning. However, no longitudinal study has examined how informal care relates to unretirement. Utilizing role theory, this study aims to explore the heterogeneity of informal care responsibilities in retirement and to examine how informal care informs re-entering the workforce in later life. METHOD: Data were drawn from the Health and Retirement Study of fully retired individuals aged 62 years and older in 1998 (n = 8,334) and followed to 2008. Informal care responsibilities included helping a spouse/partner with activities of daily living (ADLs) or instrumental activities of daily living (IADLs); helping parent(s) or parent-in-law(s) with ADLs or IADLs; and single or co-occurrence of care roles. Covariates included economic and social factors. Cox proportional hazard models were utilized. RESULTS: When compared with noncaregivers, helping a spouse with ADLs or IADLs reduced the odds of returning-to-work in the subsequent wave by 78% and 55%, respectively (hazard ratio [HR]: 0.22, confidence interval [CI]: 0.06-0.87; HR: 0.45, CI: 0.21-0.97). There was no statistical difference to returning-to-work between noncaregivers and helping parents with ADLs/IADLs or multiple caregiving responsibilities. DISCUSSION: Role theory provided a useful framework to understand the relationships of informal care and unretirement. Aspects of role strain emerged, where, spousal caregivers were less likely to come out of retirement. Spousal caregivers may face challenges to working longer, and subsequently, opportunities to bolster their retirement security are diminished. Research and policy implications are discussed.

Social Capital and Unretirement: Exploring the Bonding, Bridging, and Linking Aspects of Social Relationships.

Working longer is an important area of research given extended life expectancy, shortfalls of retirement income, desires to remain socially engaged, and solvency concerns of social insurance programs. The purpose of this longitudinal population-based study of older adults is to examine how different types of social resources (social bonding, bridging, and linking) relate to returning to work after retirement. Data were drawn from the Health and Retirement Study of fully retired older adults aged 62+ in 1998 ( N = 8,334) and followed to 2008. After controlling for a comprehensive set of fixed and time-varying covariates, findings suggest that social bridging (informal volunteering) and social linking (formal volunteering, partnered with an employed spouse) were strongly and positively related to returning to work (Hazard Ratio [HR]: 1.49, p < .001; HR: 1.58, p < .0001; and HR: 1.75, p < .0001, respectively). Social bonding resources were not significantly associated with returning to work. Implications for social policy are discussed.

Race and Place: Exploring the Intersection of Inequity and Volunteerism Among Older Black and White Adults.

Although the historical impact of racial segregation and ongoing health and economic inequities between older Black and White adults is well documented, little is known about the relationships among race, individual- and neighborhood-resources, and formal volunteering in later life. This study explores this intersection. Individual-level data from 268 respondents aged 55+ were collected in the St. Louis metropolitan area through paper-based mail surveys. Objective neighborhood data were obtained at the zip code level from secondary sources and matched with respondents. Using exploratory factor analysis, we constructed a 14-item environmental scale with 3 neighborhood dimensions (economic, social, and built environment). Older Black adults had lower levels of education; had fewer financial assets; lived in neighborhoods with less economic resources and lower built environment scores; and fewer formally volunteered when compared to older White adults. Individual resources (financial assets, health) and neighborhood resources (social and built environment) were positively associated with formal volunteering among older Black adults. Only individual resources (age, marital status, financial assets, health) were associated with formal volunteering among older White adults. A coherent set of policies that bolsters individual and environmental capacities may increase the rate of volunteerism among older black adults.