Healthy Aging Data Reports: Measures of Community Health to Identify Disparities and Spur Age-Friendly Progress.

BACKGROUND AND OBJECTIVES: This translational research had 2 aims: first, to analyze and translate data from multiple original data sources to provide accurate, unbiased local community and statewide information about healthy aging; second, to work with stakeholders to use the tools to identify disparities in healthy aging and to support their efforts to advance healthy aging. RESEARCH DESIGN AND METHODS: Data sources from the Centers for Medicare and Medicaid Services, Behavioral Risk Factor Surveillance System, U.S. Census American Community Survey, and other sources were analyzed using small area estimation techniques to determine age/gender-adjusted local community rates in Connecticut (CT), Massachusetts (MA), New Hampshire (NH), and Rhode Island (RI). RESULTS: State-level analyses revealed gender and racial/ethnic disparities in healthy aging. A factor analysis identified 4 dimensions of community population healthy aging/morbidity: serious complex chronic disease, indolent conditions, physical disability, and psychological disability. DISCUSSION AND IMPLICATIONS: Healthy Aging Data Reports now exist for MA (2014, 2015, and 2018), NH (2019), RI (2016 and 2020), and CT (2021) and demonstrate differences in health by place. Each report includes community profiles for every city, town, and some urban neighborhoods with more than 170-197 indicators. The reports include maps of the statewide distribution of rates, an infographic, highlights report with state-specific multivariate analyses, and 18 interactive web maps, 18 regional interactive web maps, and technical documentation about data sources and methods. Overall, the research has identified variations in healthy aging and provided tools to track change over time to support age-friendly efforts in the region.

A New Measure of Community Health: Findings From the Healthy Aging Data Reports.

BACKGROUND AND OBJECTIVES: The purpose of this study was to develop a multidimensional measure of community healthy aging that is more nuanced than existing measures. The social-ecological framework guided this analysis of the latent structure of community prevalence rates of chronic diseases and functional impairments. RESEARCH DESIGN AND METHODS: The sample was 471 communities in Massachusetts (n = 319) and New Hampshire (n = 152). Data were drawn from publicly available healthy aging data reports for both states. Community prevalence rates for 45 chronic conditions, rates of mortality, and Medicare service utilization were estimated with the 2014-2015 Centers for Medicare & Medicaid Services (CMS) Medicare Beneficiary Summary Files and used in factor analyses to explore the latent structure of community healthy aging. RESULTS: Results revealed a multidimensional structure composed of 4 latent population health components: serious complex chronic disease, indolent chronic disease, physical disability, and psychological disability. We found that while lower community socioeconomic status is a major determinant of all 4 components of population health, it is predictably associated with higher levels of serious complex chronic disease and physical disability and yet surprisingly with lower levels of indolent chronic disease and psychological disability. DISCUSSION AND IMPLICATIONS: The 4-dimensional model provides a more nuanced measure of community healthy aging than mortality rate, and it identifies community health disparities that otherwise may go undetected. Understanding the multiple levels that influence community healthy aging may reveal new interventions or programs to improve it and allow policymakers or other stakeholders to more accurately tailor interventions to match the conditions of need.

Risk factors related to cognitive functioning: a cross-national comparison of U.S. and Korean older adults.

The purpose of this study was to conduct a cross-national comparison of factors related to cognitive functioning in later life in a U.S. and Korean sample. The study sample was comprised of subjects from the HRS (N = 10,175) and the KLoSA (N = 3,550). Separate multivariate regression models were employed to examine the impact of socio-demographic, health, and health behaviors on cognitive functioning among older adults. Regression results showed that age, gender, education, wealth, self-rated health, ADL, IADL, stroke, and poor eyesight were significantly associated with cognitive functioning in both countries. However, depression, high blood pressure, diabetes, and drinking were significantly associated with cognition only among Americans, while marital status and poor hearing were significantly associated with cognition only among Koreans. In addition, gender-specific models suggested several socio-economic and health factors had significantly different effects by gender in both countries. Cross-national comparative research identified similar risk factors, suggesting robust associations. Unique factors related to cognitive functioning in U.S. and Korean older adults highlight the important role of societal influences on cognitive outcomes.

Risk factors related to cognitive functioning: a cross-national comparison of U.S. and Korean older adults.

The purpose of this study was to conduct a cross-national comparison of factors related to cognitive functioning in later life in a U.S. and Korean sample. The study sample was comprised of subjects from the HRS (N = 10,175) and the KLoSA (N = 3,550). Separate multivariate regression models were employed to examine the impact of socio-demographic, health, and health behaviors on cognitive functioning among older adults. Regression results showed that age, gender, education, wealth, self-rated health, ADL, IADL, stroke, and poor eyesight were significantly associated with cognitive functioning in both countries. However, depression, high blood pressure, diabetes, and drinking were significantly associated with cognition only among Americans, while marital status and poor hearing were significantly associated with cognition only among Koreans. In addition, gender-specific models suggested several socio-economic and health factors had significantly different effects by gender in both countries. Cross-national comparative research identified similar risk factors, suggesting robust associations. Unique factors related to cognitive functioning in U.S. and Korean older adults highlight the important role of societal influences on cognitive outcomes.

Intergenerational financial exchange and the psychological well-being of older adults in the Republic of Korea.

OBJECTIVES: This study examined whether the exchange of instrumental support (i.e., financial resources) among older adults and their children was related to the psychological well-being of older Koreans. METHODS: Data from the Korean Longitudinal Study of Ageing were employed. Older adults who were aged 65 and older and who had at least one living child who did not live in the respondent's household were included (N = 3791). Well-being was measured with depressive symptoms (CES-D-10) and life satisfaction. For the direction model of exchange, giving and receiving support was assessed with financial aid (cash and non-cash). For the reciprocity model of exchange, four patterns of financial exchanges were identified: both giving and receiving, receiving only, giving only, and no exchange. RESULTS: The results from the direction model showed that older adults who give financial support were less likely to be depressed and reported higher levels of life satisfaction. The effect of receiving support was not significant for depression but was related to higher levels of life satisfaction. The results from the reciprocity model showed that those who gave and received support had better psychological health compared to those who only received support. CONCLUSIONS: Both giving and receiving were positively related to the psychological well-being of older adults. Our results provide support for identity theory and equity theory as frameworks for understanding intergenerational exchange and well-being of older Koreans.

Biopsychosocial risk factors for driving cessation: findings from the Health and Retirement Study.

OBJECTIVE: This study aims to identify social, psychological, and biomedical risk factors for current and future driving cessation in older adults. METHOD: Data from six waves (1998-2008) of the Health and Retirement Study (HRS) were pooled. Participants aged 65 and above were included in the study (N = 17,349). RESULTS: Multivariate logistic regression models to identify risk factors for current and future driving cessation were consistent (age, gender, education, race, marital status, income, cognitive function, limits in activities of daily living and instrumental activities of daily living, vision, health, diabetes, stroke, arthritis, and hip fracture). Only one variable, falls, was associated with future driving cessation (odds ratio [OR] = 0.92; confidence interval [CI] = [0.85, 1.0]), but not current driving cessation. DISCUSSION: Older age, female gender, and minority race were risk factors for current and future cessation. Adults with arthritis were more likely to keep driving compared with those without arthritis.

US policies to enhance older driver safety: a systematic review of the literature.

The purpose of this study was to conduct a systematic review of the literature related to state policies concerning older drivers and to draw policy conclusions about which policies appear to work to reduce older driver crashes and to identify areas needed for further research. Specific policies examined in this paper concern medical reporting and medical review, license renewal processes, and driver testing. A study was included in the systematic review if it met the following criteria: published in English between 1991and January 2013; included data on human subjects aged 65 and older residing in the United States; included information on at least one policy related to older drivers; and had a transportation-related outcome variable (e.g., crash, fatality, renewal). A total of 29 studies met inclusion criteria. Twenty-two studies investigated license renewal and seven articles examined medical reporting. In-person license renewal requirements were associated with reduced risk for fatal crashes. Restricted licenses were associated with reduced number of miles driven per week. More intensive renewal requirements and being the subject of a medical report to the licensing authority was associated with delicensure. Given the importance of driving to mobility, quality of life, and public safety, more research is needed.