SOCIAL COHESION, TRANSPORTATION, AND PARTICIPATION IN SOCIAL ACTIVITIES AMONG OLDER ADULTS

Objectives: The purpose of this research is to examine the role that social cohesion and access (conceptualized as mobility and transportation) plays on participation in social activities (i.e., visiting friends/family, attending religious services, participating in organizations, and going out for enjoyment). Participation in valued, social activities promotes of well-being through social interactions and the maintenance of personally meaningful relationships and lifestyles. Methods: Data from the National Health and Aging Trends (NHATS) study were used. The NHATS is representative of U.S. Medicare recipients ages 65 and older. The NHATS collects information on health and participation as well as detailed environmental measures, which makes it well suited for this research. Results: Higher ratings of social cohesion were associated with higher cumulative odds of participating in social activities among older adults, net of sociodemographic characteristics, personal network size, neighborhood disorder, and health factors. Taking public transportation services and walking places were associated with higher cumulative odds of participating in social activities. An interaction between social cohesion and walking places was significant (p=0.002). Older adults who reported high levels of social cohesion and walked to get around their community were more likely to participate in social activities compared with those reporting low social cohesion and walking as a transportation. Discussion: This research provides evidence that socially cohesive neighborhoods enable greater access to social activities through transportation services. Offering a range of transportation services is only piece of creating an age-friendly community—older adults must also feel comfortable using these options

CHRONIC KIDNEY DISEASE, MUSCLE WEAKNESS, AND MOBILITY LIMITATION

Objectives: Chronic kidney disease (CKD) is associated with increased mobility limitation. Prior research has documented that peripheral nerve abnormalities occur early in CKD and progressively worsen. Loss of balance, impaired muscle strength, and slow gait predispose older adults to falls and frailty. However, the current literature is limited by a lack of nationally representative data that includes objective measures of kidney disease and physical functioning. Thus, this research examines whether CKD is associated with muscle strength, balance, gait, and self-reported mobility limitations. Methods: Data come from the 2016 Health and Retirement Study (HRS). Estimated GFR, a measure of kidney functioning derived from creatinine levels in the blood, was used to classify CKD (i.e, eGFR<45 or Stage 3b CKD). Logistic and linear regression models were generated to examine the association of CKD with physical functioning, net of demographic characteristics (i.e., age, sex, race, and education) and comorbidities (i.e., obesity, pain, and number of diagnosed medical conditions). Results: In unadjusted models, CKD was significantly associated (p<0.05) with more mobility limitations, slower walking speeds, stronger grip strengths, and non-participation in balance tests. After adjusting for covariates, CKD (β=-1.43, p=0.01) was negatively associated with grip strength. In sex-stratified models, CKD was associated with slower walking speeds among men, whereas CKD was associated with more mobility limitations among women. Discussion: In a nationally representative sample of older adults, CKD was associated with poorer physical functioning on multiple measures. After adjusting for demographic characteristics and comorbidities, CKD was associated with increased muscle weakness

Staying Connected: Alternative Transportation Use, Neighborhoods, and Social Participation Among Older Americans

BACKGROUND AND OBJECTIVES: A wealth of empirical evidence documents improved health among older adults who participate in social activities. Alternative transportation can serve as a bridge linking older adults to social activities and improving person-environment fit. RESEARCH DESIGN AND METHODS: Using Waves 1-8 of the National Health and Aging Trends Study, this research examines whether alternative transportation use is associated with participation in diverse social activities among a sample of Medicare beneficiaries aged 65 or older. Additionally, this research explores whether the effect of transportation use varies across neighborhood environments. We analyzed individual trajectories of participation in social activities by estimating 2-level growth curve models. RESULTS: The use of public transportation, paratransit, getting a ride, or walking/using wheelchair/scooter to get places was associated with participating in more types of social activities. Respondents who used alternative transportation had less steep declines in participation. The effect of getting rides and using paratransit services was more pronounced among respondents living in disordered neighborhoods. DISCUSSION AND IMPLICATIONS: This research underscores the importance of alternative transportation use and the neighborhood context for participation among older adults. Age-friendly initiatives aimed at fostering greater community engagement should think broadly about the role of multiple forms of transportation

Linked Lives: Does Disability and Marital Quality Influence Risk of Marital Dissolution among Older Couples?

Using fourteen waves of data from the Health and Retirement Study (HRS), a longitudinal panel survey with respondents in the United States, this research explores whether marital quality—as measured by reports of enjoyment of time together—influences risk of divorce or separation when either spouse acquires basic care disability. Discrete-time event history models with multiple competing events were estimated using multinomial logistic regression. Respondents were followed until they experienced the focal event (i.e., divorce or separation) or right-hand censoring (i.e., a competing event or were still married at the end of observation). Disability among wives was predictive of divorce/separation in the main effects model. Low levels of marital quality (i.e., enjoy time together) were associated with marital dissolution. An interaction between marital quality and disability yielded a significant association among couples where at least one spouse acquired basic care disability. For couples who acquired disability, those who reported low enjoyment were more likely to divorce/separate than those with high enjoyment; however, the group with the highest predicted probability were couples with low enjoyment, but no acquired disability

Racial differences in cumulative disadvantage among women and its relation to health: Development and preliminary validation of the CSI-WE

Background: Cumulative disadvantage (CD) is a measure of accumulated social, economic, and person-related stressors due to unequal access to resources and opportunities, which increases a person's biological risk for disease. The purpose of this research was to develop an instrument tailored to women's experiences that had intervention and translational potential. In addition, we explored whether CD contributed to racial health disparities among black and white women. Methods: In-depth life course interviews were used to assess stressful experiences of 15 black and 15 white women. Using information from the interviews, we developed the Cumulative Stress Inventory of Women's Experiences (CSI-WE) as a quantitative instrument to measure stressful life experiences from childhood to adulthood. The CSI-WE was then administered to the original 30 women for validation and feedback. Results: Qualitative and quantitative assessments were highly correlated, which suggested that the CSI-WE reliably captured the experiences of the interviewed women. Black participants reported significantly higher numbers of childhood and adult stressors, more acute adulthood and lifetime stressors, and worse adult physical self-rated health. Conclusions: This study supports the preliminary validity of an instrument that once fully validated may be used in future studies to elucidate the experiences of CD among black and white women and examines how these experiences relate to perceived and objective health status

Time Use among Older Adults: Differentials and Implications for Well-Being

How do older adults spend their time, and what are the implications of daily time use for health and well-being? Drawing on daily diary data from the American Time Use Survey (ATUS) and Supplements on Disability and Use of Time to the Panel Study of Income Dynamics (PSID), these five papers document the correlates and consequences of older adults’ time use, with particular attention to the ways that health, caregiving responsibilities and family relationships shape time use. Dukhovnov, Zagheni and Ryan explore racial and ethnic differences in informal care transfers and the implications for older adults’ emotional well-being. Kalenkoski examines how the unpaid caregiving responsibilities of older adults affect their well-being, paying particular attention to gender differences. Lam and Garcia assess whether elder caregivers report time constraints, and compare whether caregivers and non-caregivers vary in the time spent in personal care, social activities and sports, housework and employment. Shandra examines how the presence of a sensory, cognitive, physical, or multiple disability is associated with the likelihood and intensity of participation in six types of leisure activities (passive, exercise, organizational, hobbies, arts, and social), with particular attention to age variation therein. Flood and Genadek investigate the relationship between marital quality and duration and couples’ shared time during later adulthood, with particular attention to active versus passive time use. The authors discuss the methodological and theoretical implications of their work, and show how daily diary data provides a unique window on older adults’ daily lives and well-being

Social isolation in chronic kidney disease and the role of mobility limitation

Background: Chronic kidney disease (CKD) is associated with multiple comorbidities, hospitalizations and mortality. In older adults, social isolation and poor mobility contribute to these outcomes. We tested the hypothesis that a glomerular filtration rate (GFR) <45 mL/min/1.73 m2 (CKD Stages 3b-5) is associated with social isolation and that mobility limitation is a key driver of social isolation in patients with CKD. Methods: Data from 9119 participants, ages 57-107 years, from the 2016 wave of the Health and Retirement Study's Venous Blood Study were used for this cross-sectional analysis. Kidney function measured by estimated GFR (eGFR) was the predictor and patients were classified as CKD Stages 3b-5 or non-CKD Stages 3b-5 (eGFR ≤45 or >45 mL/min/1.73 m2). The outcomes tested were mobility limitation assessed by self-report and social contact and participation measures assessed by the Psychosocial Life Questionnaire. The associations among kidney function, mobility and social isolation were examined with logistic and ordinary least squares regression, adjusted for covariates and testing for interaction with gender. Results: Participants with CKD Stages 3b-5 (N = 999) compared with non-CKD Stages 3b-5 were older (74.9 versus 68.2 years, P < 0.001) and fewer were female (15% versus 58%, P < 0.001). CKD Stages 3b-5 were associated with higher odds of difficulty walking several blocks [odds ratio 1.44 (95% confidence interval 1.16-1.78)]. Participants with CKD Stages 3b-5 had reduced social contact and social participation (B = -0.23, P < 0.05; B = -0.62, P < 0.05, respectively). Women with CKD Stages 3b-5 were 2.7 times more likely to report difficulty walking several blocks than men with CKD Stages 3b-5, but social isolation in CKD Stages 3b-5 did not vary by gender. In CKD Stages 3b-5 patients, mobility limitation was a risk factor for reduced social contact and participation but did not explain the poor social contact and participation. Conclusion: CKD Stages 3b-5 was associated with both mobility limitation and social isolation in a population-based study of older adults. In contrast to older adults without CKD Stages 3b-5, mobility limitation did not explain the lack of social contact and poor social participation, suggesting other factors are more important

Linking Mastery Across the Life Course to Mobility Device Use in Later Life

Objectives Mastery in older ages is shaped by earlier-life experiences. Prior research has demonstrated that mastery is associated with health-promoting behaviors; however, little research has examined whether mastery histories influence health behaviors such as mobility device use in later life. Method Using 25 years of data from the Americans’ Changing Lives Survey (N = 1,427), this research explores whether different trajectories of life course mastery influence the odds that an older adult will use a mobility device when experiencing functional impairment. We used growth mixture models with a distal outcome and examined the relationship between functional limitations and mobility device use as it varies across latent classes of life course mastery, controlling for social and health factors. Results The odds of device use in the face of functional limitations were significantly higher among those with a history of high life course mastery, relative to those with low life course mastery, all things being equal. Discussion Our findings suggest that mastery over the life course is a source of psychological human capital that is associated with health-promoting behaviors in later life among those with functional limitations