Social Statuses, Quality of Social Relationships, and Self-Esteem Among Older Adults in Canada: Resource Multiplication or Substitution?

This research examines how older adults' self-esteem is shaped by core social statuses and ongoing social relationships. Based on a national survey of Canadian older adults (N = 4010), analyses show that men have greater self-esteem than women, as do people with higher quality of social relationships and a high degree of educational attainment. Neither gender nor quality of social relationships intersect with education to shape self-esteem, but quality of social relationships is more strongly associated with self-esteem for women. Consequently, strong gender differences are observed at low levels of relationship quality, but these gender differences are negated at high levels of relationship quality. This research shows that social statuses and relationships cohere to shape self-esteem in later-life, but gender differences are not evident in the context of high-quality social relationships. Conversely, educational attainment appears to be a key determinant of high self-esteem, irrespective of gender or quality of social relationships.

Mattering and Self-Esteem as Bulwarks Against the Consequences of Financial Strain for Loneliness in Later Life: Differentiating Between- and Within-Person Processes.

Financial strain likely constitutes a principal risk for loneliness in later-life, but a strong sense of mattering and self-esteem may mitigate these consequences by both offsetting and buffering the influence of financial strain. We test these arguments using data from a national longitudinal survey of older adults gathered between 2021 and 2022 (N = 2384), as nations emerged from the COVID-19 pandemic. Application of a within-between modelling strategy facilitates differentiation of inter-individual (i.e., between-person) and intra-individual (i.e., within-person) factors. Between-person financial strain is associated with greater loneliness, but within- and between-person mattering and self-esteem offset this association by forestalling loneliness. Between-person mattering buffers between-person financial strain, but between-person self-esteem buffers within-person financial strain. Consequently, within-person financial strain is associated with greater loneliness only at low levels of between-person self-esteem. In summary, accruing a strong sense of worth contributes to protecting older adults from the adverse consequences of financial strain for loneliness.

Perceptions of Increases in Cost of Living and Psychological Distress Among Older Adults.

Objectives: This article examines whether older adults' perceptions of an increase in their cost of living during a time of rapid inflation are associated with multiple aspects of psychological distress, as well as whether mastery buffers these associations. Methods: Data were derived from a two-wave longitudinal survey of older adults gathered in 2021 and 2022 (N = 4,010). Multiple regression models examined symptoms of depression, anxiety, and anger. Results: Perceptions of moderate or large increases in cost of living were associated with higher levels of distress at follow-up. Taking baseline financial strain, mastery, and psychological distress into account weakened these associations, but perceptions of a large increase in cost of living were still substantially linked with anger and anxiety. Mastery also buffered associations with anxiety and anger. Discussion: Macroeconomically derived adversities can shape anxiety and anger in later-life, but these mental health consequences fall more heavily on individuals possessing lower levels of mastery.

Assessment of Sociodemographics and Inflation-Related Stress in the US.

This survey study of US adults examines the association of stress experienced as a result of inflation with sociodemographic characteristics such as sex, race and ethnicity, education, and income levels.

A Profile of Positive and Negative Caregiving Experiences Among Canadian Older Adults: The Relevance of Demographic and Care Contexts.

This study examines the predictors of burdens and benefits of informal caregiving to caregivers by examining how demographic characteristics and care contexts simultaneously predict separate scales of positive and negative caregiving experiences. The Caregiving, Aging, and Financial Experiences study is a national survey which examines a representative sample of 4010 Canadians between the ages of 65 and 85, including 1641 informal caregivers that are the focus of the current analysis. Seemingly unrelated regression analyses show that there are similarities as well as differences in predictors between the two caregiving experiences. More frequent involvement in caregiving is associated with greater negative caregiving experiences but those are not significant predictors for less positive caregiving experiences. This study demonstrates that there are some overlaps of determinants of the two caregiving experiences, and a few of them are distinct. Further studies should warrant to identify additional, unobserved factors explaining variance in positive caregiving experience.

Functional Limitations and Psychological Well-Being Among Older Adults in China: The Critical Role of Hukou as a Stratifying Factor.

Based on a stress process perspective, this study examines how the hukou system and gender intersect to shape the relationship between functional limitations and psychological well-being in older adults. Using the China Health and Retirement Longitudinal Study (N = 17,708 at baseline), analyses are carried out with random- and fixed-effects models. Analyses show that an urban hukou benefits the psychological well-being of Chinese older adults by weakening the relationship between functional limitations and depression, and these differences do not vary significantly between men and women. The relationship between functional limitations and life satisfaction does not differ by hukou region. This study shows that China's household registration system provides an important context for the associations between functional limitations and psychological well-being in later life. The hukou system is an important stratifying agent and should be taken into account in the study of stress and aging in a Chinese context.

Mental Health Benefits and Detriments of Caregiving Demands: A Nonlinear Association in the Canadian Longitudinal Study on Aging.

OBJECTIVES: This study examines whether the association between caregiving demands and mental health is non-linear and also, whether this non-linear association is contingent on the marital status of the caregiver. METHODS: We analyze the data from the Canadian Longitudinal Study on Aging, applying OLS regression and quadratic interaction terms. RESULTS: A lower level of demands is salubriously associated with symptoms of depression and life satisfaction, but this association becomes deleterious at higher levels of demands. Moreover, a connection to a marital partner extends the benefits of caregiving demands and stems the adverse consequences. DISCUSSION: This research shows that acts of caregiving may not themselves be detrimental. Instead, the degree and way in which caregiving relates to mental health may vary by both the extent of the demands of the caregiving role and familial relationships in which caregivers are embedded.

Socioeconomic stratification and trajectories of social trust during COVID-19.

Extant theory suggests that crises such as the COVID-19 pandemic may change people's trust in others. A crisis-to-solidarity model suggests that people become more trusting, while a crisis-to-negative experience theory suggests that people lose trust, and a stability perspective predicts that social trust will largely remain unchanged. We argue that, when a crisis occurs, trust is likely to fall into distinct trajectories of change that will conform to these different perspectives, and placement into contrasting trajectories of change will be predicated on socioeconomic position. To test our argument, we use data from multiple waves of Canadian national surveys conducted from September 2019 to February 2021 and examine how two major forms of social trust-generalized trust and neighborhood trust-changed during the COVID-19 pandemic. A longitudinal latent class analysis (LLCA) shows increasing, decreasing, and stable trajectories of trust, which conform to each of the proposed patterns. We further show that individuals' baseline socioeconomic position is a strong indicator of the placement in these trajectories. Both forms of trust increased among individuals with higher socioeconomic positions while decreased among individuals with lower socioeconomic positions. This research contributes to the literature on the social context of trust by reconciling contrasting views of the consequences of crises for trust, and also in showing that the segmentation of changes in trust are proscribed by structures of social stratification.

Accumulation of economic hardship and health during the COVID-19 pandemic: Social causation or selection?

This study examines whether economic hardship during the COVID-19 pandemic is deleteriously associated with psychological distress and self-rated health. A social causation perspective suggests that exposure to economic hardship will harm well-being, but a social selection perspective suggests that the appearance of health effects of hardship during the pandemic are attributable to the increased risk of exposure to hardship associated with poor well-being at the start of the pandemic. We also propose a third perspective, economic selection, which suggests that economic hardship prior to the pandemic negatively affects health and increases risk of exposure to hardship during the pandemic; consequently, an association between health and economic hardship during the pandemic may be spurious, and entirely due to pre-existing levels of hardship. To test these competing perspectives, we use a longitudinal study based in Canada that began in late March of 2020 and followed respondents monthly in April, May, and June. Baseline psychological distress and self-rated health, as well as economic hardship prior to the pandemic, independently predict the accumulation of monthly periods of hardship from April to June. The accumulation of periods of hardship from April to June is deleteriously associated with psychological distress and self-rated health in June. Controls for prior economic hardship and baseline health weaken the association between accumulation of periods of hardship and psychological distress, while also eliminating the association between accumulation of hardship and self-rated health. These findings favor a social causation perspective for psychological distress and a social selection perspective for self-rated health, with less evidence found in support of economic selection. This study took place during the first months of the COVID-19 pandemic, though, and associations with self-rated health may have become more evident as hardship further wore on individual well-being over a longer period of time.

Why Have Sleep Problems in Later-Midlife Grown Following the Great Recession? A Comparative Cohort Analysis.

OBJECTIVES: This research compares three cohorts of individuals in their fifth decade of life and examines whether sleep problems are greater in cohorts following the Great Recession. We argue that these differences will occur because postrecession cohorts are exposed to more economic burdens that harm sleep. We also suggest that postrecession exposure to economic burdens will be amplified among women, leading to greater cross-cohort differences in sleep problems. METHOD: Data were derived from the Health and Retirement Study, focusing on cohort surveys starting in 2004, 2010, and 2016 (N = 12,129). Structural equation models compared cohorts in latent levels of sleep problems and also examined whether economic burdens mediated cohort differences. Interactions tested whether cohort differences varied between men and women. RESULTS: The 2010 and 2016 cohorts had higher mean levels of sleep problems than the 2004 cohort. Greater postrecession exposure to economic burdens largely explained inter-cohort change in sleep problems, with this pattern stronger among women. DISCUSSION: Americans are approaching their senior years increasingly burdened by economic stressors that incur sleep problems. Practitioners and aging researchers should be prepared to address deleterious health consequences created by heightened sleep impairments.

Social Estrangement and Psychological Distress before and during the COVID-19 Pandemic: Patterns of Change in Canadian Workers.

This article argues that the COVID-19 pandemic and associated social distancing measures intended to slow the rate of transmission of the virus resulted in greater subjective isolation and community distrust, in turn adversely impacting psychological distress. To support this argument, we examine data from the Canadian Quality of Work and Economic Life Study, two national surveys of Canadian workers-one from late September 2019 (N = 2,477) and the second from mid-March 2020 (N = 2,446). Analyses show that subjective isolation and community distrust increased between the two surveys, which led to a substantial rise in psychological distress. Increases in subjective isolation were stronger in older respondents, resulting in a greater escalation in psychological distress. These findings support a Durkheimian perspective on the harm to social integration and mental health caused by periods of rapid social change but also illustrate how a life course context can differentiate individual vulnerability to disintegrative social forces.

Psychological Well-Being Among Informal Caregivers in the Canadian Longitudinal Study on Aging: Why the Location of Care Matters.

OBJECTIVES: A caregiving stress perspective suggests that caregiving harms psychological well-being in informal caregivers, whereas a caregiving rewards perspective suggests that provision of care benefits psychological well-being. This research examines whether both perspectives apply to caregiving experiences, but differently by the primary location of caregiving (i.e., in-home, other residence, and institution), as well as by gender. METHODS: We analyzed depression and life satisfaction in the nationally representative Canadian Longitudinal Study on Aging (N = 48,648), first comparing noncaregivers (N = 27,699) to a combined caregiver group (N = 20,949) and then stratifying caregivers by the primary location of care. RESULTS: When considered as a single group, caregivers suffered relative to noncaregivers in terms of life satisfaction and depression. When stratified by the location of care, only in-home caregivers reported both greater depression and lower life satisfaction. Nonresidential caregivers did not differ significantly in levels of depression from noncaregivers and reported higher life satisfaction. Institutional caregivers reported greater depression than noncaregivers, but did not differ significantly in life satisfaction. These patterns were stronger among women than men. DISCUSSION: Both the caregiving stress and caregiving rewards perspectives are applicable to the caregiving experience, with the stress perspective more applicable to in-home caregivers and the rewards perspective more relevant to nonresidential caregivers. Recommendations include targeted practice focused on the location of care as well as the gender of the caregiver. Given that nonresidential caregivers actually benefit from providing care, interventions need to focus on identifying and bolstering positive aspects of the caregiving experience.

Utilizing a Physician Scribe in a Pediatric Plastic Surgical Practice: A Time-driven Activity-based Costing Study.

BACKGROUND: To use time-driven activity-based costing methodology to compare the costs of routine pediatric plastic surgical patient visits with and without a physician scribe. METHODS: Pediatric plastic surgical clinic visits at a tertiary care facility with the following diagnoses were studied: skin lacerations, skin lesions, and plagiocephaly. Two plastic surgeons saw patients individually either with or without a scribe over a 10-month period. The time that the scribe and physician spent on the patient was recorded, including the duration of the clinic visit and time spent creating, dictating, reviewing, and signing the note. An average appointment activity time for each measurement component was produced, and a capacity cost rate was introduced to derive the cost per minute for a scribe and physician. Sensitivity analysis and paired t-test were conducted to analyze the results. RESULTS: A total of 45 cases with a physician scribe were observed with an average appointment activity time of 12.83 minutes (4.97 min for the scribe, 0.92 min for the physician, and 6.95 min combined). A total of 72 cases without a physician scribe were observed with an average appointment activity time of 12.01 minutes. The total attributable cost saving per appointment was $13.82 when a physician scribe was utilized. CONCLUSION: Time-driven activity-based costing methodology showed that the use of a physician scribe reduced cost per office visit by substituting physician time for a less expensive resource.

Financial circumstances, mastery, and mental health: Taking unobserved time-stable influences into account.

This paper examines whether low income and subjective financial strain are associated with mental health, as well as whether mastery weakens this association. We analyze three waves of a large sample of Canadians and utilize random and fixed effects regression strategies to assess bias introduced by unobserved time-stable confounders. In random effects models, both low income and subjective financial strain are associated with distress and anger. In fixed effects models that control for all time-stable confounders, the effect of low income is reduced to non-significance for both outcomes. The effect of subjective strain is also reduced in fixed effects models, but remained statistically significant. Sobel tests indicated that the effect of subjective strain on mental health is transmitted through mastery, but this indirect path is modest in magnitude. When interactions are tested, mastery weakens the association between subjective strain and distress, and this effect is robust to the influence of time-stable controls, but mastery does not buffer the subjective strain-anger relationship in either random or fixed-effects models. Finally, moving below the low income threshold increases anger for low mastery individuals, but seems to reduce anger when moving below the low income threshold is coupled with increases in mastery. Collectively, our findings demonstrate the importance of assessing the influence of unobserved time-stable confounders in stress research. Further, discrepancies in the moderating role of mastery reinforce calls for the assessment of multiple outcomes in mental health research.

Chronic Discrimination and Sleep Problems in Late Life: Religious Involvement as Buffer.

The association between chronic discrimination and sleep problems is important to examine in older adults because sleep is highly reactive to stress and impaired sleep has diverse adverse health effects. The association between chronic discrimination and sleep problems may, however, be confounded by a number of time-stable influences, and this association may also vary by religious involvement. In three waves (2006, 2010, and 2014) of the Health and Retirement Study ( N = 7,130), the overall association between chronic discrimination and sleep problems is negated in econometric models that control for all time-stable sources of confounding. Religious involvement does not modify this association for men, but a significant association is found among women who do not attend religious services. These analyses suggest that the association between chronic discrimination and sleep quality in late life is substantially inflated due to unobserved time-stable confounders, although women who do not attend religious services may be at risk.

Neighborhood Disorder and Sleep Problems in Older Adults: Subjective Social Power as Mediator and Moderator.

BACKGROUND AND OBJECTIVES: Contextual contributors to sleep problems are important to examine among older adults because sleep problems are associated with a number of adverse outcomes in late life. We examine whether disordered neighborhoods are a key contextual determinant of sleep problems in late life, as well as how subjective social power-a sense of personal control and subjective social status-mediates and moderates this association. Central to this contribution is the use of econometric techniques that holistically control for time-stable factors that may bias estimated associations. RESEARCH DESIGN AND METHODS: Three waves (2006, 2010, 2014) of the psychosocial subsample of the Health and Retirement Study (N = 7,130) are analyzed with random-effects models that adjust for repeated observations, as well as fixed-effects models that additionally control for all time-stable confounders. RESULTS: Neighborhood disorder is associated with greater sleep problems in random-effects models, but this association is substantially weakened in a fixed-effects model. Personal control mediates this association, but does not moderate it. Subjective social status does not mediate the association, but does moderate it. DISCUSSION AND IMPLICATIONS: Although neighborhood disorder is associated with sleep problems in older adults, this association is likely to be overestimated in analyses that do not compressively control for time-stable confounders. Rather than acting as dual mediators and moderators, perceived control and subjective social status play distinct roles in this association, with seniors at lower levels of subjective social status especially at risk for sleep problems due to neighborhood disorder.

Chronic Pain and Psychological Distress Among Older Adults: A National Longitudinal Study.

This research examines whether unobserved time-stable influences confound the association between chronic pain and psychological distress in older adults as well as how race and ethnicity combine with subjective social status (SSS) to modify the association. In a nationally representative longitudinal survey, holistically controlling for unobserved time-stable influences using fixed-effects models substantially reduces the pain-depression relationship and eliminates the overall pain-anxiety relationship. The association with depression is stronger for Black and Hispanic elders, illustrating a process of double-jeopardy. Black elders with severe pain experience lower anxiety, as do Black elders with moderate pain and low SSS, which we suggest may be due to the enervating effects of undermanaged pain. Black elders at high SSS experience greater anxiety with moderate pain. This research suggests that undermanagement of chronic pain among racial and ethnic minorities differentiates the association between pain and distress in late life and especially creates stronger associations with depression.

A Longitudinal Assessment of Perceived Discrimination and Maladaptive Expressions of Anger Among Older Adults: Does Subjective Social Power Buffer the Association?

Objectives: We examine whether perceived discrimination in older adults is associated with external conflict (anger-out) and internally directed anger (anger-in), as well as how subjective social power-as indicated by a sense of personal control and subjective social status-modifies these associations while holistically controlling for time-stable confounds and the five major dimensions of personality. Method: The 2006 and 2008 psychosocial subsamples of the Health and Retirement Study were combined to create baseline observations, and the 2010 and 2012 waves were combined to create follow-up observations. Responses were analyzed with random-effects models that adjust for repeated observations and fixed-effects models that additionally control for all time-stable confounds. Results: Discrimination was significantly associated with anger-in and anger-out. Fixed-effects models and controls for personality reduced these associations by more than 60%, although they remained significant. Measures of subjective social power weaken associations with anger-out but not anger-in. Discussion: The mental health consequences of perceived discrimination for older adults may be over-estimated if time-stable confounds and personality are not taken into account. Subjective social power can protect victims of discrimination from reactions that may escalate conflict, but not from internalized anger that is likely to be wearing and cause further health problems.

Work Dissatisfaction and Sleep Problems among Canadians in the Latter Half of Life.

This study examined the relationship between work dissatisfaction and sleep problems among Canadian adults in the latter half of life, as well as how gender and social contact moderate this relationship. Data were obtained from the Canadian General Social Survey, Cycle 21 (2007), which sampled adults aged 45 and older in 2007. Analyses focused on individuals with employment as their main activity. Analyses show that work dissatisfaction positively predicts trouble sleeping. There are no significant gender differences in this relationship. Social contact with friends buffers this relationship, but social contact with family does not, and buffering does not vary significantly between men and women. This research contributes to knowledge on sleep problems by showing that work dissatisfaction is adversely associated with sleep problems among Canadians in the latter half of life, but social contact with friends can weaken this deleterious relationship.