Journals of Gerontology Series B-Psychological Sciences and Social Sciences最新文献

Objectives: Despite higher physical vulnerability to coronavirus disease 2019 (COVID-19), older adults reported less psychological stress than younger and midlife adults during the pandemic. However, little is known about age differences in stress within later life, and most COVID-19 studies have been cross-sectional. We examined weekly hassles exposure and severity trajectories and whether these trajectories differed by age, resilience factors (higher trait resilience and education), and vulnerability factors (identifying as a woman, being a person of color, and having chronic health conditions).

Methods: Community-dwelling adults aged 50+ in Oregon (Mage = 71.1, standard deviation = 7.3; 74% women, 89% non-Hispanic White) completed weekly online surveys across 8 weeks (April 28-June 22, 2020) during the COVID-19 stay-at-home mandate. A 2-part model estimated how age, resilience, and vulnerability factors predicted weekly odds of any hassle exposure and level of severity.

Results: Across time, hassles exposure decreased and the rate of severity declined, but these patterns differed by age and other demographics. The old-old (estimated at age 78) remained stable in odds of any exposure, whereas the young-old (estimated at age 64) evidenced a J-shaped curve; age did not moderate the severity slopes. Furthermore, both resilience factors were associated with exposure trajectories, whereas vulnerability factors (race/ethnicity and chronic illness) were associated with levels of hassles severity.

Discussion: There were age differences in patterns of hassles during the COVID-19 pandemic. Furthermore, resilience and vulnerability factors also showed complex patterns, underscoring the need for future studies to focus on age differences in well-being in later life.

Objective: Using nationally representative datasets, this study examined differences in healthcare expenditures between US-born and foreign-born individuals aged 65 and above by the presence of Alzheimer's disease and related dementias (ADRD) and cognitive limitations (CL). This study further examined whether healthcare expenditures among foreign-born individuals vary by their duration of residence in the US.

Methods: The study used the 2007-2020 Medical Expenditure Panel Survey (MEPS) and employed generalized linear regression models to estimate differences in healthcare expenditures between US-born and foreign-born older adults with ADRD, CL, and without ADRD or CL. Survey weights were applied to all estimates.

Results: Our study identified significant differences in healthcare expenditures among older adults by the presence of ADRD/CL and immigrant status. Having ADRD/CL had a more pronounced impact on high healthcare expenditures among foreign-born older adults than US-born adults with ADRD/CL, thereby diminishing the difference in healthcare expenditures by US nativity status for the older adults with ADRD or CL. In the analysis further distinguishing immigrants by their duration of residence, lower healthcare expenditures were primarily observed among foreign-born individuals with ADRD or CL who had lived in the US for less than ten years.

Discussion: Our results suggest potential shifts in costs resulting from delayed access to, and diagnosis or treatment of ADRD at a younger age, leading to increased healthcare needs and expenses among US foreign-born older adults.

Objectives: The purpose of this paper is to evaluate the mechanistic process by which family caregivers' situational stress appraisals of behavioral symptoms of dementia (BSD) increase the likelihood of a caregiver engaging in abusive and neglectful behaviors toward their care recipient with dementia. We test the hypotheses that (1) the effect of daily BSD stress appraisals on elder abuse and neglect (EAN) is mediated by the caregivers' emotion dysregulation (2) and the mediation path is moderated by self-compassion.

Methods: This study employed a multitime series design in which participants (N = 453) completed traditional longitudinal surveys at enrollment followed by 21 sequential days of diary surveys (n = 9,513). The hypothesized moderated mediation path was evaluated through a multilevel structural equation model.

Results: Hypotheses were supported. At the within-person level, daily BSD stress appraisal has a significant direct effect on daily EAN. At the between-person level, the path was no longer significant implying a full mediation of emotion dysregulation. The main effect of self-compassion and the interaction term (emotion dysregulation × self-compassion) were also statistically significant indicating the path between emotion dysregulation and EAN is moderated by self-compassion.

Discussion: This study significantly advances the field by empirically showing a mechanistic pathway for a theoretical explanation of EAN. These findings represent a breakthrough for the field and identify modifiable intervention targets for future behavioral interventions to prevent EAN. Emotion (dys)regulation and self-compassion are modifiable traits and skills that can be learned, with robust evidence bases of efficacious interventions that can be adapted for context to dementia family caregiving.

Objectives: Social networks undergo changes in later life, reflecting proactive decreases as well as increases in size, but relatively little is known about the factors that motivate older adults to expand their social ties. Loneliness might be expected to motivate older adults to expand their social ties. Paradoxically, however, studies of younger age groups have linked loneliness to a self-protective reluctance to initiate social contact. The current study investigated whether loneliness fosters or inhibits older adults' efforts to expand their social ties and whether successful efforts are related to gains in emotional health.

Methods: Loneliness, motivation to expand social ties, and emotional health were assessed in a subset of older participants (N = 375) from the Later Life Study of Social Exchanges.

Results: Greater loneliness was associated with less interest, less investment of effort, and less success in making new ties and rekindling dormant ties. Nonetheless, lonelier older adults who expanded their social ties, particularly by rekindling dormant ties, exhibited some gains in emotional health over a 1-year period.

Discussion: Greater attention to the role of loneliness in older adults' motivations for making new ties or rekindling dormant ties will broaden our understanding of social network changes in later life.

Objectives: Many choices are made in the context of one's social network, but age differences in consulting others during decision-making remain underexplored. This pre-registered study examined age differences in the composition of decision-related social networks and associated social preferences and motivations. Based on prior findings regarding age differences in information-seeking and socioemotional preferences, we predicted that with advanced age people would consult fewer and more emotionally close social partners, consult them less frequently, rate consultations as more helpful, and prioritize social goals during decision-making.

Methods: An adult lifespan sample (N = 485; Mage = 51.08; SDage = 19.63, rangeage = 18-96 years) considered hypothetical choices and reported how many and what types of people they would consult and how often they would consult them. They also identified their most important decision consultants and evaluated interactions with those individuals.

Results: As predicted, age was associated with consulting fewer people less frequently and this was not explained by having a smaller range of potential consultants in one's network. Contrary to predictions, the proportion of close social partners in decision networks and the perceived helpfulness of consultants did not vary significantly by age. Moreover, older adults were less likely than younger adults to prioritize relationship quality over decision quality. Controlling for potential covariates did not diminish the observed age effects.

Discussion: These findings align with the prior literature on age-related decrements in pre-decisional information seeking but suggest that age-related preferences for close social partners and socioemotional goals do not extend to decision-related consultations.

Objectives: Advance care planning (ACP), which comprises a living will, durable power of attorney for healthcare (DPAHC), and end-of-life discussions, is an inherently relational process. However, it is unclear how marital status affects men's and women's ACP over the life course. Drawing on social control and gender-as-relational frameworks, we examine marital status differences in ACP and how these patterns differ by gender and age.

Methods: Data are from the 2020 Health and Retirement Study (HRS), a representative sample of U.S. older adults (N = 7,074). We estimate logistic regression models to evaluate whether marital status differences in ACP are moderated by age and gender, and multinomial logistic regressions to examine age and gender differences in DPAHC designations among married parents. Analyses are adjusted for sociodemographic and health covariates.

Results: Multivariable analyses revealed significant moderation effects for discussions only. Among married/cohabiting persons, women are more likely than men to have end-of-life discussions, with gender differences diminishing slightly at oldest ages. Among divorced persons in their 60s and 70s, women are much more likely than men to have had discussions, although this gap converges among the oldest-old. Conversely, young-old widowed men and women are equally likely to have discussions, although women are increasingly likely to do so with advancing age. Men are more likely than women to name their spouse as DPAHC, yet this gap diminishes with age.

Discussion: Healthcare providers can better guide end-of-life consultations if they understand how men's and women's family relationships change with advancing age.

Objectives: Multimorbidity, known as multiple chronic conditions (MCC), is the coexistence of two or more chronic health conditions (CHC). The near-retirement-age population with MCC is more likely to experience discontinued labor force participation (LFP). Our objective was to evaluate the impact of MCC on LFP among adults aged 50-64 and to explore heterogeneous effects between self-employed and non-self-employed workers.

Methods: We constructed our sample using the Health and Retirement Study (HRS) from 1996 to 2018. We adopted an individual fixed-effect (F.E.) model and propensity score matching (PSM) to measure the impact of MCC on the probability of being employed and changes in annual work hours.

Results: 50.5% of respondents have MCC. Individuals with MCC exhibit a predicted probability of being employed that is 9.3 percentage points (p < .01, 95% confidence interval [95% CI]: -0.109, -0.078) lower than those without MCC. Compared with non-CHC, MCC significantly reduced annual working hours by 6.1% (p < .01, 95% CI: -0.091, -0.036) in the F.E. model and by 4.9% (p < .01, 95% CI: -0.064, -0.033) in PSM estimation. The effect is more pronounced for the self-employed with MCC, who have 13.0% (p < .05, 95% CI: -0.233, -0.026) fewer annual work hours than non-CHC based on the FE model and 13.4% (p < .01, 95% CI: -0.197, -0.070) in PSM estimation.

Discussion: MCC significantly reduces LFP compared with non-MCC. MCC has a heterogeneous impact across occupational types. It is important to support the near-retirement-age working population with multimorbidity through effective clinical interventions and workplace wellness policies to help manage health conditions and remain active in the labor market.

Objectives: China introduced an innovative Supplementary High-Cost Illness Insurance (SHCII) program to enhance existing social health insurance by providing extra financial support for individuals facing catastrophic illnesses in 2015. The SHCII has notably increased access to healthcare and alleviated financial strain for economically disadvantaged individuals. However, there is a lack of information regarding the program's impact on the mental health of its beneficiaries. This study aims to assess the impact of SHCII on the mental well-being of middle-aged and older individuals.

Methods: Using data from the China Health and Retirement Longitudinal Study (2011, 2013, 2015, and 2018), this study examined how SHCII affects mental health among middle-aged and older individuals in China using propensity score matching with the time-varying difference-in-differences method.

Results: We found that SHCII implementation can significantly reduce the Center for Epidemiologic Studies-Depression Scale scores of middle-aged and older individuals. This reduction was more pronounced among older individuals with poor self-rated health, chronic disease, and low household wealth when compared to their counterparts.

Discussion: The implementation of SHCII has had a significant and positive impact on mental health outcomes. We recommend that governments consider expanding the program to other areas within China, focusing especially on the most economically disadvantaged segments of the population.

Objectives: In recent decades, risk of job loss in America after age 50 has been high, potentially causing significant stress during the period preceding retirement. Yet no study has quantified the burden of clinically relevant depressive symptoms attributable to job loss in this age group over this period or identified the most vulnerable populations.

Methods: Participants aged 50+ in the Health and Retirement Study (recruited 1992-2016) who were employed and scored <5 on the Center for Epidemiologic Studies-Depression 8-item scale (CESD-8) at baseline (N = 18,571) were followed for depressive symptoms until they first had CESD-8 ≥5 or died, or through the 2018 survey. Parametric g-formula analyses examined the difference in cumulative risk of having CESD-8 ≥5 if there had been no involuntary job loss compared to the observed scenario, adjusting for sex, race/ethnicity, age, and dynamic measures of recent marriage end (divorce or widowhood), having a working spouse, assets/debt, and health changes.

Results: We estimated that risk of CESD-8 ≥5 would have been 1.1% (95% confidence interval [0.55, 1.37]) lower if no involuntary job loss had occurred; job loss accounted for 11% of the total burden among those who lost a job. Stronger associations were observed for women (1.2% [0.7, 1.8] vs men 0.5% [0.2, 1.1]), White respondents (1.0% [0.6, 1.5] vs Black respondents 0.5% [-0.1, 1.4]), and those in the lowest quartile of baseline assets (1.1% [0.4, 1.9] vs wealthiest quartile 0.5% [-0.4, 0.9]).

Discussion: Involuntary job loss is associated with high depressive symptom burden in older persons, suggesting that screening and intervention soon after job loss may help mitigate depression.

Objectives: Older adults' civic participation has received considerable attention. However, this literature has understudied the experiences of civic participation among minoritized ethnoracial older adults. Particularly absent from this literature is the contextualization of civic participation as it exists within cultural and historical structures of inequality that influence how these populations understand, participate, and experience civic life.

Methods: A phenomenological design was used to explore civic participation through participants' experiences and unique perspectives. Thirty-four in-depth, semistructured interviews were conducted with Latine immigrant and Black older adults (ages 60+) living in New Jersey and New York City. A conceptual content analysis was used to identify how older Black and Latine immigrant adults define civic participation for themselves.

Results: This study presents 3 new definitions of civic participation, that are derived directly from participants' conceptualization and applied across the lived experiences. Definitions present civic participation as the responsibility of community belonging; as a religious/spiritual practice; and as a way of life. These definitions provide new perspectives by which to study civic participation and challenge current framing of helper and needy, altruism, the voluntary nature of participation, and the separation between social, political, and spiritual participation.

Discussion: Findings from this study contribute to expanding gerontology's ontological imagination of how civic participation is experienced and conceptualized among older Latine immigrants and Black adults. The expertise shared by older African Americans and Latine immigrants lends us important perspectives to develop a critical theoretical framework by which scholars can more accurately study civic participation among this diverse population.