The Interplay of Race, Ethnicity, and Language in Caregiver Health: Insights from the National Social Life, Health, and Aging Project.

Background: Recent socio-demographic shifts in the United States have underscored the growing importance of informal caregiving and raised concerns about caregivers' health and well-being. This study aims to deepen our understanding of the health dimensions of caregivers, considering their diverse backgrounds. Objective: To examine five key health dimensions (physical, cognitive, mental, social, and sexual health) of caregivers, and to identify potential disparities based on ethnoracial and linguistic differences. Methods: Using data from the National Social Life, Health, and Aging Project (NSHAP), this study explores the interconnections among the specified health dimensions of caregivers and their ethnoracial (Black, Hispanic, White, and others) and linguistic (Spanish, English) backgrounds, in addition to their social networks (N=1,309). Regression analysis was employed to discern the patterns and associations. Results: The findings indicate that White caregivers generally report better physical, cognitive, and social health compared to their Black and Hispanic counterparts, but exhibit less favorable outcomes in sexual health than Hispanic caregivers. Spanish-speaking caregivers, while having lower cognitive and self-rated mental health than English-speaking caregivers, show stronger social health and greater relationship satisfaction. Notably, these correlations persist irrespective of the size of social networks, pointing to intrinsic links with health outcomes. Conclusion: The study underscores the necessity of a comprehensive health evaluation for caregivers, acknowledging the intricate interplay between their health and various socio-demographic factors. It advocates for the development of targeted policies and interventions that address the complex health needs of caregivers, with an emphasis on their ethnoracial and linguistic contexts and social environments.

Addressing Cognitive Assessment Disparities Among Hispanic Adults: Adapting the MoCA-SA for Improved Accuracy and Accessibility Among Spanish-speakers.

OBJECTIVES: Hispanic adults display a higher likelihood of early-stage cognitive decline than their White counterparts yet receive fewer clinical diagnoses. This troubling trend highlights the significance of longitudinal surveys like the National Social Life, Health, and Aging Project (NSHAP) in monitoring cognitive changes in aging Hispanics. Using NSHAP's Rounds 2 and 3, we observed notable cognitive score differences between English and Spanish speakers, as assessed by the survey-adapted version of the Montreal Cognitive Assessment (MoCA-SA). Our study aims to discern if statistical adjustments can reduce measurement variance in global cognition scores between these language groups. METHODS: We applied modification indexes, two-parameter item response theory models, and split-sample testing to pinpoint items that exhibit resilience to language-related bias among our Hispanic sample. From this analysis, an abbreviated version of the MoCA-SA, termed MoCA-SAA, was introduced. Subsequently, we juxtaposed the performance and predictive validity of both MoCA versions against four consequential outcomes indicative of cognitive decline. RESULTS: Our refined methodologies enabled the identification of consistent items across both language cohorts. The MoCA-SAA demonstrated a performance and predictive validity in line with the original MoCA-SA concerning outcomes linked to cognitive deterioration. DISCUSSION: The translated measures ensure the inclusion of Hispanic Spanish speakers in NSHAP, who might otherwise be overlooked. The statistical adjustment outlined in this study offers a means to mitigate potential measurement disparities when assessing overall cognition. Despite these advancements, we acknowledge persistent issues related to the translation of the MoCA-SA into Spanish that warrant further attention.

Do Latino Older Adults and Service Providers Agree on Positive Aging? Using Concept Mapping to Compare Perspectives.

BACKGROUND AND OBJECTIVES: In the United States, Latino adults are a growing segment of the aging population who will need research-informed interventions to help them age successfully. Arguably, how Latino older adults and service providers understand "positive aging" serves as an important precursor for the cultivation of such interventions. This investigation explored whether Latino older adults' conceptualizations of positive aging aligned with those of service providers. RESEARCH DESIGN AND METHODS: We compared how Latino older adults (n = 93) and service providers (n = 45) rated 85 positive aging statements produced by Latino older adults. These 85 items were used to generate a concept map, which displays those items thematically by clusters and overarching regions of meaning. RESULTS: We found divergences at each level of the map-statements, clusters, and regions-which illuminate differences between how service providers and Latino older adults think about Latino positive aging. For example, whereas Latino older adults prioritized the cluster containing items related to internal well-being, service providers rated it seventh of 11 clusters. The region comprising clusters related to relationships garnered the highest agreement between groups, but also a notable departure; compared to Latino older adults, service providers rated community and social involvement as less important. DISCUSSION AND IMPLICATIONS: Understanding such differences can help providers tailor services consistent with the interests of Latino older adults. Future studies should examine the extent to which stakeholders believe various aspects of positive aging are modifiable.

Convivir (to Coexist) and Other Insights: Results From the Positive Aging for Latinos Study.

Many Latinos in the United States do not have access to culturally sensitive services to help them age well. We combined community-based participatory research with concept mapping methods to understand how a sample of community-dwelling Latino older adults view positive aging. Nine focus groups (N = 101) generated 85 non-repeating statements, which were used to produce a final map with 11 clusters, organized into four overarching regions: Convivir (To Coexist), Self-Sufficiency, Perspectives on Life, and Healthy Behaviors. Further analyses revealed three themes: (1) the importance of varied social connections, as conveyed by the region labeled Convivir; (2) a multifaceted understanding of "stability" that includes finances, relationships, and spirituality; and (3) the need for a mature mindset reflected in the thematic cluster Tomalo Suave (Take It Easy). Findings can inform the development of interventions for Latino older adults and the cultural adaptation of programs initially designed for non-Latinos.

Latinos and the Pandemic: Results from the National Social Life, Health, and Aging Project-COVID-19 Study.

Pre-pandemic disparities placed Latinos at risk for COVID-19. This report describes the associations between increased viral exposure through social contact and material hardship and the uneven distribution of COVID-19 morbidity among Latino older adults using data from the recently released supplement to the National Social Life, Heath, and Aging Project (NSHAP) (N = 2672), a population-based panel study of adults born 1920-1965. Logistic regression revealed that material hardship and reliance on outside help were significantly correlated with COVID-19 infection, which may partially explain the disproportionate burden Latinos experience during the pandemic.

Elder Mistreatment Methods and Measures in Round 3 of the National Social Life, Health, and Aging Project.

OBJECTIVES: Elder mistreatment has negative consequences for older adults' health and well-being. As such, scholars aim to understand its causes, the contexts in which it occurs, how to prevent victimization, and how to design interventions for mistreated older adults. This paper provides a detailed overview of the 2015-2016 National Social Life, Health, and Aging Project (NSHAP) Round 3 Elder Mistreatment Module (EMM) to encourage further research on the topic. METHOD: This paper reviews previous elder mistreatment scholarship, describes the EMM, provides descriptive analyses of elder mistreatment among community-dwelling older adults, and discusses promising approaches and limitations to future research with these data. RESULTS: The EMM includes 10 stem questions to measure elder mistreatment behaviors experienced since age 60 and 2 follow-up questions about perceived severity and the identity of the perpetrator. The stem questions can be analyzed individually or combined into a scale, and researchers can account for severity as a robustness check. Analysts can also group the measures into specific types of elder mistreatment. A major strength of the EMM is its ability to identify perpetrators in victims' core social networks. DISCUSSION: The NSHAP Round 3 EMM provides scholars an opportunity to study older Americans' mistreatment experiences, particularly as they relate to their physical and mental health, their social networks and personal relationships, and their broader social contexts.

Detecting Risk of Neglect in NSHAP Round 3 Using New Follow-Up Questions to Activities of Daily Living Measures.

OBJECTIVES: Elder neglect is a type of elder abuse wherein an older adult's basic needs remain unmet through negligence. The risk of neglect and its harmful consequences coincides with the need for care that arises with difficulties completing activities of daily living (ADLs) and instrumental activities of daily living (IADLs). In this paper, we describe how new questions included in Round 3 (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP-R3) can help detect the risk of elder neglect. METHODS: Based on the 2,340 respondents who indicated problems with at least one ADL or IADL, we categorized respondents as at a higher risk of neglect if they were either: (a) not getting wanted help (WANTHELP) or (b) getting help from an undependable caregiver (UNRELIABLE). We tested the external validity of these indicators by examining their association with NSHAP-R3 measures of physical and mental health, personal hygiene, home tidiness, social support, and elder mistreatment, using t tests and chi-square tests. RESULTS: Those labeled higher neglect risk based on the WANTHELP variable showed significantly worse self-rated physical health, personal hygiene, room tidiness, mental health, partner support, family support, and elder mistreatment. The same correlates were significantly associated with higher neglect risk based on the UNRELIABLE variable, except for self-rated physical health, personal hygiene, and room tidiness. DISCUSSION: Findings suggest that these new measures can be useful for identifying NSHAP respondents who are at risk of types of neglect that can be associated with having I/ADL limitations.

Stakeholders' Ideas About Positive Aging for Latinos: A Conceptual Map.

Few studies explore the differences between diverse stakeholders' understandings of what constitutes "positive aging" for Latino older adults. To address this gap, we worked with a 20-member steering committee (SC) of community stakeholders to collect concept mapping data from 38 scholars and community workers. We generated 90 statements related to positive aging from the literature and produced concept maps based on four different stakeholder groups' ratings of them. All stakeholders prioritized "Financial Security," but scholars marked "Spirituality" as least important whereas community workers rated it second highest. The design of programs for Latino older adults should reflect such differences.

The Social Relationship Context of Elder Mistreatment.

BACKGROUND AND OBJECTIVES: Elder mistreatment victims at risk of poor physical and psychological health may benefit from increased social support. This article identifies mistreatment victims among community-dwelling older Americans and maps their social networks to guide the design of social support interventions. RESEARCH DESIGN AND METHODS: Using nationally representative survey data from Wave 3 (2015-2016) of the National Social Life, Health, and Aging Project (N = 2,334) and descriptive, latent class, and regression analyses, we estimate the prevalence of mistreatment since age 60, identify the alleged perpetrators' relationships to the victims, and examine victims' social networks. RESULTS: Self-reported lifetime prevalence of elder mistreatment is as high as 21%, depending on the mistreatment behavior measured. Latent class analysis reveals two mistreatment classes: 12% of older adults experienced multiple types of mistreatment (polyvictimization), and 6% experienced primarily financial mistreatment. Although alleged perpetrators are unlikely to appear in older adults' core social networks, the most commonly reported perpetrators are children and relatives. Regression analyses show that experiencing mistreatment since age 60 is associated with having less current social support, more social strain, and fewer kin in the core social network. Older adults reporting polyvictimization also have less-dense core networks. DISCUSSION AND IMPLICATIONS: Increasing family support should be done cautiously because children and relatives are frequently named as mistreatment perpetrators. Increasing communication across polyvictimization victims' network members may support their well-being. Providing outside assistance with financial management could benefit financial mistreatment victims.

Development of short-form measures to assess four types of elder mistreatment: Findings from an evidence-based study of APS elder abuse substantiation decisions.

Improving the standardization and efficiency of adult protective services (APS) investigations is a top priority in APS practice. Using data from the Elder Abuse Decision Support System (EADSS), we developed short-form measures of four types of elder abuse: financial, emotional/psychological, physical, and neglect. The EADSS data set contains 948 elder abuse cases (age 60+) with yes/no abuse substantiation decisions for each abuse type following a 30-day investigation. Item sensitivity/specificity analyses were conducted on long-form items with the substantiation decision for each abuse type as the criterion. Validity was further tested using receiver-operator characteristic (ROC) curve analysis, correlation with long forms and internal consistency. The four resulting short-form measures, containing 36 of the 82 original items, have validity similar to the original long forms. These short forms can be used to standardize and increase efficiency of APS investigations, and may also offer researchers new options for brief elder abuse assessments.