Conceptualizing and Operationalizing Collaboration Among Multiple Caregivers of Older Adults.

OBJECTIVES: In many families, multiple caregivers support older adults living with dementia. Studying collaboration among caregivers requires consideration of conceptual and methodological issues that have not been fully explored. This study presents a framework for conceptualizing caregiver collaboration and an index that captures variation in collaboration among multiple caregivers within care networks. METHODS: We used data from the 2015 waves of the National Health and Aging Trends Study and National Study of Caregiving (NSOC) to operationalize collaboration among multiple caregivers (N = 1,298) of 552 care recipients (Mage = 83.69, SD = 7.73; 71.6% women; 47.9% possible/probable dementia; 38.9% people of color). RESULTS: The care collaboration index considered individual and overlapping contributions while controlling for the size of the care network (caregivers in network responding to NSOC survey) and total network size (number of caregivers in network) in the statistical model. Larger care networks enabled more collaboration, both in general and across most types of tasks (ßs > 0.38). Collaboration was greater among those caring for a Black or Hispanic care recipient, both in general and for household and medical/health tasks specifically (ßs > 0.11). Collaboration was also greater among those caring for recipients with probable dementia, both in general and for most tasks (ßs > 0.11) but not transportation-related tasks (p = .219). DISCUSSION: Results are examined in the context of care network dynamics and proposed mechanisms linking care collaboration to outcomes for caregivers and recipients. Strengths and limitations of our conceptualization and operationalization of collaboration are discussed.

Better Together: Social Contact and Loneliness Among U.S. Older Adults During COVID-19.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) resulted in older adults' greater reliance on technology to contact friends and families. However, less is known regarding the association between frequency of varying modes of communication and loneliness among older adults during COVID-19, and current findings are mixed. Therefore, this study aimed to advance this understanding. METHODS: Using the National Health and Aging Trends Study COVID-19 supplement data, multinomial regression analyses assessed how the frequency of four modes of contact (i.e., phone calls; electronic and social messaging such as e-mails/texts/social media messages; video calls; and in-person visits) during the COVID-19 pandemic was associated with feelings of loneliness among older adults compared to prepandemic (n = 2,564). RESULTS: Compared to never/less than once a week in-person visits, daily in-person visits were associated with lower odds of reporting more frequent loneliness during COVID-19 versus "about the same" as pre-COVID-19 while controlling for demographics, access to information and communication technologies (ICTs), digital literacy, and health covariates. Compared to those who reported never/less than once a week contact by electronic and social messaging, more frequent contact was associated with higher odds of reporting more frequent loneliness during COVID-19 versus "about the same" as pre-COVID-19 while controlling for other variables in the model. Phone calls and video calls were not significantly related to loneliness. DISCUSSION: Results suggest that ICTs may not decrease loneliness among older adults. This article discusses potential reasons and barriers, including digital exclusion, and provides recommendations to mitigate the negative effects of social isolation through technology for older adults.

With a Little Help From My Friends and Family: Transportation and Caregiving Hours.

OBJECTIVES: To better understand the associations between the driving status of the care recipient and caregiver with provided caregiving hours, more research on the relationships between contextual caregiving factors and driving-related behaviors is needed. METHOD: Using data from Round 7 of the National Health and Aging Trends Study (NHATS) and the linked National Survey of Caregiving (NSOC; n = 1054 dyads), this study explored how caregiver transportation assistance and care recipient driving frequency are associated with caregiving hours. RESULTS: Caregiving hours were highest among caregivers who provided transportation every day and among care recipients who had not driven in the last month. After controlling for covariates, negative binomial regression results indicated that greater caregiver transportation assistance was related to more caregiving hours, while greater care recipient driving frequency was related to less caregiving hours. CONCLUSION: Integrated supports and greater accessibility to transportation services may decrease time spent caregiving.

If You Ask Them, They Will Support: A National Study of Local Initiatives Developed to Provide Social Care to Older Adults in the Community.

OBJECTIVES: Some communities across the nation are utilizing alternative funding sources to better support home and community-based services for older adults. METHODS: A variety of methods identified local initiatives across the United States. An online survey was distributed to a total of 377 communities in 15 states identified as using locally raised funds to provide aging services, yielding a 55% response rate. RESULTS: Total funding from programs generated almost 400 million dollars annually with funding ranging from $8000-$47 million. Commonly provided services with local funds include home-delivered and congregate meals, transportation, and homemaker services with provision varying by the size of the levy initiative. Additionally, six in 10 initiatives reported local funds being used to provide at least one family or friend caregiver service. CONCLUSION: Locally-funded initiatives fill a gap in long-term services needs for older adults, yet policy concerns regarding potential inequities across states and communities warrant attention.

The Impact of Caregiving Intensity and Religiosity on Spousal Caregivers' Health and Mortality in the US (2004-2014).

OBJECTIVES: Despite adverse physical and mental health outcomes related to caregiving, family caregivers also experience lower mortality rates compared to noncaregivers. However, research has not yet examined the role of caregiving intensity and religiosity with health and mortality among spousal caregivers. METHODS: Data include spousal caregivers (n=5,214 person-wave observations) and noncaregivers (n=50,311 person-wave observations) from the Health and Retirement Study (2004-2014 waves). Multinomial logistic regression was used to explore how caregiving intensity and religiosity were associated with health and mortality among spousal caregivers, compared health and mortality between caregivers and noncaregiving peers, and examined gender differences in these mechanisms. RESULTS: Greater religious salience and attending religious services, although dependent on gender and caregiving intensity, are protective for caregivers' health and mortality. DISCUSSION: Religiosity may buffer adverse effects of caregiving on health and mortality for spousal caregivers. Continuation of prior religiosity may enhance positive aspects of caregiving and decrease caregiver burden.

Planning for Driving Retirement: The Effect of Driving Perceptions, Driving Events, and Assessment of Driving Alternatives.

Most older adults will eventually stop driving, but few engage in planning for driving retirement. This study assessed whether driving stress, enjoyment, confidence, concerning driving events, and assessment of driving alternatives influence planning. Demographic factors were also included. Data were collected via a mailed transportation survey, with a final sample of 551 older adults who currently drive. Linear regression analyses revealed that more driving retirement planning was associated with greater driving stress, less driving confidence, and a more positive view of driving alternatives. Driving enjoyment and recent concerning driving events were not significantly related. Among the control variables, race and income were significantly related to planning, suggesting that lower income and identifying as Black race were associated with more planning. Gender only approached significance, suggesting that females may plan more than males. Overall, these findings suggest that more driving retirement planning is warranted. Some of the groups known to be at increased risk for driving reduction and cessation plan more for that eventuality than their counterparts. Implications of the study and suggestions for future research are discussed.

Age Differences and Similarities in Associated Stressors and Outcomes Among Young, Midlife, and Older Adult Family Caregivers.

BACKGROUND AND OBJECTIVES: Few studies have simultaneously compared caregivers in all stages of the adult life course. This study examined age differences in associations among primary stressors (caregiver burden which includes hours of provided care and number of activities of daily living and instrumental activities of daily living performed), secondary stressors (financial and employment strains), and caregiver outcomes (emotional strain and physical strain). RESEARCH DESIGN: Using Pearlin's Stress Process Model (1990) and the Caregiving in the United States 2015 dataset, 1,156 caregivers were identified (including 278 young adults aged 18-39 years, 464 midlife adults aged 40-59 years, and 414 older adults aged 60-80 years). RESULTS: Post hoc analyses revealed that compared to older adults, young adults reported less caregiver burden, less physical strain, and greater financial strain. Linear regression analyses revealed associations between caregiver burden and financial strain with emotional and physical strain for all respondents. DISCUSSION AND IMPLICATIONS: Findings emphasize the need for age-specific interventions.

Local Initiatives to Fund Services for Older Americans: Community Recognition of the Importance of Social Care.

Despite the growing proportion of older adults in the United States, federal and state funding for nonmedical supportive services remains limited. To meet increasing demand, some communities across the nation are exploring alternative funding sources for aging services. Although no systematic database exists to track such local programs, through an array of data sources including a national survey, telephone contacts, and a web review, we identified 15 states that are using local funding to support aging services. Communities are using a variety of local revenue streams, such as property tax levies, payroll, and sales taxes to provide services for older adults and/or their family or friend caregivers. There are considerable differences in community approaches including the following: amount of revenue generated, service eligibility criterion, type of services covered, and management infrastructure. Critical policy questions surrounding equity issues within and across states are raised as communities create these alternative funding mechanisms.

What's eating you? Risk factors for poor health behaviors among family caregivers.

OBJECTIVES: Overeating and obesity are major public health issues in the United States. Caregivers are at greater risk of engaging in poor health behaviors, such as emotional eating, to cope with the demands of caregiving. Using Heatherton and Baumeister (1991) Escape Theory, this study examines the associations between caregiver characteristics (i.e. age, gender, and BMI) and emotional eating, including the extent to which family strain mediates these associations. METHOD: Data are from the MIDUS 3 dataset (N = 326) and include family caregivers of older adults and children with special health care needs (Mage = 62.88 years, SD = 10.28; 69.6% female). RESULTS: Female caregivers were more likely than male caregivers to engage in emotional eating. Age was significantly associated with emotional eating, where increased age was associated with less emotional eating. ANCOVA results indicated that obese caregivers were the most likely to engage in emotional eating. Results also indicated that family strain significantly mediated the association between caregiver age and emotional eating. Linear regression analyses indicated that female gender predicted emotional eating, although family strain did not mediate the association between gender and emotional eating. Similarly, after controlling for family strain as a mediator, higher BMI was still significantly associated with emotional eating, suggesting that BMI is a strong predictor of emotional eating among family caregivers regardless of present family strain. CONCLUSION: Interventions targeted at managing family strain, particularly for younger, female caregivers, could improve coping and decrease poor health behaviors.

How Accumulated Wealth Affects Driving Reduction and Cessation.

BACKGROUND AND OBJECTIVES: Older adults can expect to live between 6 and 10 years after they give up driving, but driving reduction and cessation (DRC) are not equally experienced by all groups. Individual characteristics such as poor health, impaired vision, older age, and female gender are known to affect DRC. Using cumulative disadvantage theory as a guide, this study assessed the role played by wealth in DRC among older adults. RESEARCH DESIGN AND METHODS: Data from the National Health and Aging Trends Study were analyzed using multinomial logistic regression techniques. This allowed for the effect of each predictor on the odds of engagement in a given driving status (full driving, driving reduction [DR], and driving cessation [DC]) to be compared to each of the others. RESULTS: The final sample included 6,387 participants. After controlling for the effect of covariates, less wealth was associated with higher odds of DR compared to full driving, DC compared to full driving, and DC compared to DR. Confirming previous research, several other factors were also significantly related to driving status including age, health, vision, gender, race, education, relationship status, household size, and work status. DISCUSSION AND IMPLICATIONS: The influence of wealth on driving status among older adults represents another disadvantage unequally distributed to some in older adulthood. Those with less wealth will have fewer resources to meet their mobility needs using alternatives and may already be facing additional financial constraints due to worse health and other challenges associated with lower socioeconomic status.