Elizabeth Dugan

Social Isolation, Loneliness and Health Among Older Adults

Objective: To examine the relationship of social isolation, loneliness and health outcomes among older adults. Methods: Using data from the Leave Behind Questionnaire of the Health and Retirement Study (2006 and 2008), (n = 11,825) several indicators of social isolation were scaled and the Hughes 3-Item Loneliness Scale was used. Two measures of health (self-rated health and mental health conditions) were examined using logistic regression. Results: Loneliness and social isolation were not highly correlated with one another (r = 0.201, p = 0.000). Loneliness was associated with higher odds of having a mental health problem (OR: 1.17; CI: [1.13, 1.21], p = 0.000); and isolation was associated with higher odds of reporting one’s health as being fair/poor (OR:1.39; CI: [1.21, 1.59], p = 0.000). Discussion: The results suggest that global measures of isolation, that fail to distinguish between social isolation and feelings of loneliness, may not detect the impact on physical and mental health in older adults.

The effects of implementation of the agency for health care policy and research urinary incontinence guidelines in primary care practices

OBJECTIVES: To determine whether a multifaceted intervention based on the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guidelines for Urinary Incontinence would increase primary care physician screening for and management of urinary incontinence (UI).

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.

U.S. 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.

Employer Perceptions of Elder Care Assistance Programs

SUMMARY Little research has been conducted to evaluate employer-sponsored elder care service programs. This study assesses the perspectives of senior human resource and employee benefit managers at large U.S. corporations about nine types of elder care services. Survey responses were obtained from 115 employer officials. The majority of employers reported that elder care services help decrease absenteeism, manage employee stress, and boost productivity. Flexible work scheduling and leave programs were considered to have the greatest benefit for employee recruitment and retention. Utilization of elder care services remains low, impeded by lack of employee awareness about the services, inability to measure their impacts, and employer concerns about program costs.

The Protective Effects of Religiosity on Depression: A 2-Year Prospective Study

PURPOSE OF THE STUDY Approximately 20% of older adults are diagnosed with depression in the United States. Extant research suggests that engagement in religious activity, or religiosity, may serve as a protective factor against depression. This prospective study examines whether religiosity protects against depression and/or aids in recovery. DESIGN AND METHODS Study data are drawn from the 2006 and 2008 waves of the Health and Retirement Study. The sample consists of 1,992 depressed and 5,740 nondepressed older adults (mean age = 68.12 years), at baseline (2006), for an overall sample size of 7,732. Logistic regressions analyzed the relationship between organizational (service attendance), nonorganizational (private prayer), and intrinsic measures of religiosity and depression onset (in the baseline nondepressed group) and depression recovery (in the baseline depressed group) at follow-up (2008), controlling for other baseline factors. RESULTS Religiosity was found to both protect against and help individuals recover from depression. Individuals not depressed at baseline remained nondepressed 2 years later if they frequently attended religious services, whereas those depressed at baseline were less likely to be depressed at follow-up if they more frequently engaged in private prayer. IMPLICATIONS Findings suggest that both organizational and nonorganizational forms of religiosity affect depression outcomes in different circumstances (i.e., onset and recovery, respectively). Important strategies to prevent and relieve depression among older adults may include improving access and transportation to places of worship among those interested in attending services and facilitating discussions about religious activities and beliefs with clinicians.

Stigma and Psychological Well-being Among Older Adults With HIV: The Impact of Spirituality and Integrative Health Approaches

Purpose of the Study The National Institutes of Health calls for research that explores what it means to age optimally with HIV/AIDS as half of the U.S. people with HIV are aged 50 or older. This study applied the stress process model to examine the association between HIV stigma and psychological well-being and mediating resources (i.e., spirituality and complementary and integrative health [CIH]) approaches) in older adults with HIV. Design and Methods Using data from the Research on Older Adults with HIV (ROAH) study, structural equation modeling was used to estimate these relationships within a latent variable model. Namely, a direct negative association between HIV stigma and psychological well-being was hypothesized that would be mediated by spirituality and/or CIH use. Results The analyses showed that the model fits the data well [χ2 (137, N = 914) = 561.44, p = .000; comparative fit index = .964; root mean square error of approximation = .058, 95% confidence interval = .053 to .063]. All observed variables significantly loaded on their latent factor, and all paths were significant. Results indicated that spirituality and CIH use significantly mediated the negative association between HIV stigma and psychological well-being. Implications Findings highlight the importance of spiritual and CIH interventions for older adults with HIV/AIDS. Practice recommendations are provided at the micro- and mesolevel.

Research brief: A literature review of frontotemporal dementia and driving

There is a growing body of research on Alzheimer’s disease and driving, but much less is known about less common dementias, such as frontotemporal dementia (FTD). The purpose of this study was to review the empirical literature about FTD and driving. A study was included if it met the following criteria: published from 1992 to 2013 in English, research involving humans, and included both FTD and driving data. We searched the following electronic databases: EBSCOhost, PubMed, Google Scholar, Proquest, Web of Knowledge, and Publishing Connect. A total of 367 abstracts were reviewed; however, only 4 articles satisfied the inclusion criteria. Results showed that drivers with FTD had more problems than control groups. Specific driving issues were related to antisocial behaviors common among people with FTD (eg, hit and run crashes, failure to stop at red lights, speeding infractions, and failure to recognize pedestrians at intersections). More research on FTD and driving is needed.

Driving with Mild Cognitive Impairment or Dementia: Cognitive Test Performance and Proxy Report of Daily Life Function in Older Women.

To investigate associations between proxy report of cognitive and functional limitations and cognitive performance and current or former driving status in older women with mild cognitive impairment (MCI) and all‐cause dementia.

The big five personality factors as predictors of driving status in older adults.

Objective: Although factors including cognitive and health status have been associated with driving cessation in older adults, the role of psychosocial variables is not well studied. Previous research on young adult drivers has suggested that personality may be related to driving behavior, but this study is among the first to explore the relationship between driving status and the Big Five Model of personality for older adults. Method: Data are from the Health and Retirement Study (2008 wave, n = 4,028). Descriptive, bivariate, and multiple logistic regression analyses were conducted. Results: Neuroticism (β = −0.4511, p < .001) and agreeableness (β = −0.5058, p < .001) were associated with decreased likelihood of driving; extraversion (β = 0.4588, p < .001), openness (β = 0.5903, p < .001), and conscientiousness (β = 0.4077, p < .001) were associated with increased likelihood of driving, although results were partially mediated by including known risk factors. People who limited their driving to nearby locations were the most different from those who no longer drove. Discussion: Personality adds a unique contribution to the prediction of late-life driving status.