Kristi Rahrig Jenkins

Activity and Health-Related Quality of Life in Continuing Care Retirement Communities

This study examines the relationships between health-related quality of life and activity engagement among residents in two continuing care retirement communities (CCRCs). Prior research indicates that involvement in activity is an important correlate of healthy aging among other community-dwelling elders, and this finding is expected to hold in CCRCs. Time spent engaged in discretionary activities, specifically active, passive, and outside retirement community activities are expected to be associated with better health-related quality of life across multiple dimensions. Data were collected from 167 independent living and assisted living residents in two CCRCs in a large Midwestern metropolitan area. Activity engagement was measured via a self-report questionnaire. Health-related quality of life was measured using the Medical Outcomes Study Short-Form Health Survey (SF-36), which generates eight health subscales (e.g., physical functioning, social functioning, pain). Based on ordinary least squares regression models, the results indicate that discretionary activities, in particular more active types of activity, are positively associated with higher healthrelated quality of life. These findings have implications for health and activity promotion in CCRCs.

Does urinary incontinence affect middle-aged and older women's time use and activity patterns?

OBJECTIVE: To investigate the relationship between urinary incontinence and womens levels and hours of participation in 31 activities. METHODS: A subset of panel members from the Health and Retirement Study completed the self-administered Consumption and Activities Mail Survey questionnaire in 2001. These data were linked with Health and Retirement Study 2000 data. Analyses were limited to 2,190 female Consumption and Activities Mail Survey self-respondents born in 1947 or earlier. Logistic regression was used to predict activity participation. Linear regression was used to predict the number of hours of participation. RESULTS: The hypothesis that urinary incontinence affects womens time use and activity patterns was supported. Compared with the continent women, the incontinent women were less likely to have house cleaned, shopped, physically shown affection, or attended religious services in the recent past; and were more likely to have watched television or made music by singing or playing an instrument. Compared with continent activity participants, incontinent participants reported significantly fewer hours spent walking, communicating with friends and family by telephone or e-mail, working for pay, using a computer, and engaging in personal grooming and hygiene. CONCLUSION: These findings substantiate prior work on the relationship between urinary incontinence and quality of life, and suggest a useful route for educating patients about the impact of urinary incontinence. Clinicians must be alert to opportunities for encouraging incontinent women to be active. It is also important to consider the implications for time use and activity patterns when advising patients about treatment and management options. LEVEL OF EVIDENCE: II-2

Body-Weight Change and Physical Functioning Among Young Old Adults:

Objectives: The main purpose of this study is to examine if body weight change is a potential risk factor for the onset of functional impairment across time among various functional domains. Methods: Using longitudinal data from the Health and Retirement Study, logistic regression models on the onset of functional impairment over three time points are estimated for young old adults. Results: Results indicate that weight gain is associated with greater risk of lower body mobility impairment. An increase in body mass index of greater than 5% increases the likelihood of the onset of lower body mobility functional impairment. Discussion: Study findings support the promotion of healthy weight management. Future studies in this area may want to investigate effective interventions that contribute to healthy weight maintenance among this cohort.

Relationship of Body Mass and Net Worth for Retirement-Aged Men and Women:

This article examines linkages between body weight and socioeconomic status (SES) among Americans at or near retirement age. The authors hypothesize that (a) body weight relates negatively to SES, (b) this relationship is greater for women than men, and (c) the relationship attenuates when health, employment, and marital status are controlled. We use the 1992 Health and Retirement Study for this examination. SES is measured as net worth. Body weight is measured as body mass index and categorized as normal weight, overweight, and obese. Results indicate that, for women, overweight and obesity relate to lower logged networth. This relationship attenuates once covariates are considered. For men, overweight and obesity relate to higher logged net worth, even when covariates are considered. The findings suggest that greater weight has different meanings for men and women in this cohort; it might be related to success for men but a sociocultural detriment for women.

Does caring for your spouse harm one’s health? Evidence from a United States nationally-representative sample of older adults

ABSTRACT The purpose of this article is to investigate the relationship between spousal care-giving and declines in functioning and self-rated health among older care-givers. The authors used data from the 2000 and 2002 waves of the United States Health and Retirement Study, a biennial longitudinal survey of a nationally representative cohort of adults aged 50 or more years. Two outcomes were examined, declines in functioning and declines in self-rated health. Care-givers were classified into three groups: no care-giving, less than 14 hours of care-giving per week, and 14 or more hours care-giving per week. To assess declines in functioning, two summary scores were created of limitations in basic and instrumental Activities of Daily Living. To assess declines in self-rated health, we compared responses from 2000 and 2002. In the fully adjusted models, care-giving hours did not have an independent effect on declines in functioning or self-rated health. The relationship between care-giving hours and declines in functioning and self-rated health is probably attributable to socio-demographic characteristics, mainly age. The findings suggest that spousal care-giving does not of itself harm functional health or perceived health among older adult care-givers. Understanding the differential effects of these socio-economic characteristics with care-giving hours on health will be useful in promoting the health of older adult care-givers and treating their disorders.

Patterns of body weight in middle-aged and older Americans, by gender and race, 1993–2000

SummaryObjectives: Despite evidence of poor health outcomes associated with excessive weight gain or loss, longitudinal patterns of body weight over the adult life course have not been fully described. This article seeks to address this by examining body weight patterns for middle-aged and older adults. Methods: Panel data from the Health and Retirement Study (HRS) original cohort and the original cohort of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study are used to compare, by social group, characteristics of respondents and non-respondents, baseline weight (1993 and 1994) to year 2000 weight, and explore various weight change trajectories over time. Results: Overall, a greater proportion of middle-aged adults are heavier over time than at baseline and a greater proportion of older adults lose weight over time compared to baseline. Examining the transitions across weight trajectories for all of the social groups suggests considerable variability. Conclusions: These findings suggest that differing physiologic and social or environmental experiences may have implications for body weight patterns. Understanding these patterns by race/ethnicity and gender could provide insight into health disparities among different social groups.

The Association Between Socioeconomic Status and Cardiovascular Risk Factors Among Middle-Aged and Older Men and Women

Studies of gender differences in the association between socioeconomic status (SES) and cardiovascular risk factors have produced mixed findings. The purpose of this research was to examine whether the association between SES and cardiovascular risk factors differed between older men and women. Using data on physical measures and biomarkers from the 2006 Health and Retirement Study (N = 2,502 men; N = 3,474 women), linear regression models were used to estimate the association between SES and seven cardiovascular risk factors. Interactions between gender and SES were tested. For all seven risks assessed, we observed significant associations of selected SES factors to cardiovascular risk for men and/or women. In all of these cases, lower SES was associated with higher cardiovascular risk. However, for six of the factors, we also observed gender differences in the association between SES and cardiovascular risk, such that lower SES was associated with higher cardiovascular risk for women but not for men. These findings suggest that the association between SES and cardiovascular risk is more pronounced for women than for men. Implementing interventions to reduce cardiovascular risk factors, particularly among older women with lower SES, might, over time, reduce cardiovascular disease in women and improve quality of life.

Factors Associated With Participation in a University Worksite Wellness Program

INTRODUCTION Healthcare reform legislation encourages employers to implement worksite wellness activities as a way to reduce rising employer healthcare costs. Strategies for increasing program participation is of interest to employers, though few studies characterizing participation exist in the literature. The University of Michigan conducted a 5-year evaluation of its worksite wellness program, MHealthy, in 2014. MHealthy elements include Health Risk Assessment, biometric screening, a physical activity tracking program (ActiveU), wellness activities, and participation incentives. METHODS Individual-level data were obtained for a cohort of 20,237 employees who were continuously employed by the university all 5 years. Multivariate logistic regression was used to assess the independent predictive power of characteristics associated with participation in the Health Risk Assessment, ActiveU, and incentive receipt, including employee and job characteristics, as well as baseline (2008) healthcare spending and health diagnoses obtained from claims data. Data were collected from 2008 to 2013; analyses were conducted in 2014. RESULTS Approximately half of eligible employees were MHealthy participants. A consistent profile emerged for Health Risk Assessment and ActiveU participation and incentive receipt with female, white, non-union staff and employees who seek preventive care among the most likely to participate in MHealthy. CONCLUSIONS This study helps characterize employees who choose to engage in worksite wellness programs. Such information could be used to better target outreach and program content and reduce structural barriers to participation. Future studies could consider additional job characteristics, such as job type and employee attitudinal variables regarding health status and wellness program effectiveness.

Perceptions of a Culture of Health Implications for Communications and Programming

Purpose. This study aims to illustrate the potential utility of open-ended survey data, regarding faculty and staff perceptions of a culture of health (CoH), for targeting communications and programming. Overall, these types of data show how they may be used to assist in implementing, improving, and sustaining a CoH in an organization. Design/method/approach. An anonymous online questionnaire was sent to 10,000 employees. The analysis of open-ended responses was performed using the grounded theory approach. Emerging themes were organized into two major categories: favorable perceptions and unfavorable perceptions regarding the university’s CoH. Findings. These findings suggest that employees have specific favorable and unfavorable perceptions regarding their university’s CoH. Two main favorable perceptions that both faculty and staff commented on were (1) leaders/supervisors showing interest in health and well-being and (2) colleagues participating in healthful behaviors and setting good examples. Examples of unfavorable perceptions include stress not adequately addressed and healthy food options not readily available. Research limitations. The generalizability of the findings may be somewhat challenging given that the analyses are limited to individuals from a large Midwestern university. Also, given that this survey was voluntary, participants in the survey may possess unique characteristics that may have played a role in their likelihood to participate. Originality/value. There are few studies that address assessing a CoH in a university setting. This study provides examples of (1) topics to consider when evaluating an organization’s CoH and (2) actionable intervention and communication strategies that account for the employee’s perceptions. Others might use such examples when evaluating or preparing to assess their own organization’s CoH.

Characterizing Employees’ Preferences for Incentives for Healthy Behaviors: Examples to Improve Interest in Wellness Programs

Background. Many employers now incentivize employees to engage in wellness programs, yet few studies have examined differences in preferences for incentivizing participation in healthy behaviors and wellness programs. Method. We surveyed 2,436 employees of a large university about their preferences for incentivizing participation in different types of healthy behaviors and then used multivariable logistic regression to estimate associations between employees’ socioeconomic and demographic characteristics and their preferences for incentives for engaging in healthy behaviors. Results. Compared with nonunion members, union members had higher odds of wanting an incentive for eating healthily (adjusted odds ratio [AOR] = 1.60, 95% [CI; 1.21, 2.12]), managing weight (AOR = 1.53, 95% CI [1.14, 2.06]), avoiding drinking too much alcohol (AOR = 1.41, 95% CI [1.11, 1.78]), quitting tobacco (AOR = 1.37, 95% CI [1.06, 1.77]), managing stress (AOR = 1.37, 95% CI [1.08, 1.75]), and managing back pain (AOR = 1.64, 95% CI [1.28, 2.10]). Compared with staff, faculty employees reported higher odds for wanting an incentive for reducing alcohol intake (AOR = 1.34, 95% CI [1.00, 1.78]) and quitting tobacco (AOR = 1.43, 95% CI [1.04, 1.96]). Women had lower odds than men (AOR = 0.80, 95% CI [0.64, 0.99]) of wanting an incentive for managing back pain. Conclusions. Preferences for incentives to engage in different types of healthy behaviors differed by employees’ socioeconomic and demographic characteristics. Organizations may consider using survey data on employee preferences for incentives to more effectively engage higher risk populations in wellness programs.