Sarah L. Canham

Racial/Ethnic Differences in Insomnia Trajectories Among U.S. Older Adults

OBJECTIVES Insomnia is reported to be more prevalent in minority racial/ethnic groups. Little is known, however, about racial/ethnic differences in changes in insomnia severity over time, particularly among older adults. We examined racial/ethnic differences in trajectories of insomnia severity among middle-aged and older adults. DESIGN Data were drawn from five waves of the Health and Retirement Study (2002-2010), a nationally representative longitudinal biennial survey of adults aged > 50 years. SETTING Population-based. PARTICIPANTS 22,252 participants from non-Hispanic white, non-Hispanic black, Hispanic, and other racial/ethnic groups. MEASUREMENTS Participants reported the severity of four insomnia symptoms; summed scores ranged from 4 (no insomnia) to 12 (severe insomnia). We assessed change in insomnia across the five waves as a function of race/ethnicity. RESULTS Across all participants, insomnia severity scores increased 0.19 points (95% CI: 0.14-0.24; t = 7.52; design df = 56; p < 0.001) over time after adjustment for sex, race/ethnicity, education, and baseline age. After adjusting for the number of accumulated health conditions and body mass index, this trend decreased substantially and even changed direction (B = -0.24; 95% CI: -0.29 to -0.19; t = -9.22; design df = 56; p < 0.001). The increasing trajectory was significantly more pronounced in Hispanics compared with non-Hispanic whites, even after adjustment for number of accumulated health conditions, body mass index, and number of depressive symptoms. CONCLUSIONS Although insomnia severity increases with age-largely due to the accumulation of health conditions-this trend appears more pronounced among Hispanic older adults than in non-Hispanic whites. Further research is needed to determine the reasons for a different insomnia trajectory among Hispanics.

Substance-use coping and self-rated health among US middle-aged and older adults

The prevalence of alcohol, drug, and tobacco use among US middle-aged and older adults is increasing. A subset of this population uses substances to cope with stress, but the characteristics of these individuals, and the association between substance-use coping and health outcomes remain unclear. We identified correlates of substance-use coping and measured its association with self-rated health in a community-based sample of adults aged 54-99 in the Health and Retirement Study (HRS). In the 2008 HRS, 1351 participants reported their frequency of prescription/other drug-, alcohol-, and cigarette-use coping with stress and reported self-rated health (excellent/very good, good, or fair/poor); 1201 of these participants also reported self-rated health in 2010. One in six participants frequently used substances to cope. The oldest participants were least likely to engage in frequent alcohol-use coping. Those with elevated depressive symptoms were more likely to frequently engage in cigarette- and prescription/other drug-use coping. In multivariable-adjusted analyses, participants who frequently used cigarettes (compared to participants who infrequently used cigarettes) to cope had 2.7 times (95% CI=1.1-6.7) the odds of poor (vs. excellent) self-rated health. Relative to participants who infrequently used prescription/other drugs to cope, participants who frequently used prescription/other drugs to cope had 2.4 times (95% CI=1.1-5.1) the odds of reporting poor self-rated health. The association between prescription/other drug-use coping in 2008 and self-rated health in 2010 was statistically significant (relative OR=3.5, 95% CI=1.7-7.2). Participants engaging in substance-use coping likely have particular demographic and clinical characteristics. Interventions to reduce substance-use coping may prevent adverse health outcomes.

'Til Divorce Do Us Part: Marriage Dissolution in Later Life

Late-life divorce—commonly referred to as gray divorce—is a rising trend that parallels the growth of the older adult population. We sought to gain an in-depth understanding of the experience of marriage dissolution, the divorce process, and life following divorce in a sample of older adults who divorced after more than 20 years of marriage. Qualitative data were collected from 10 divorcees (7 women and 3 men; M age = 63.5) and analyzed to understand the gray divorce experience; that is, factors that determined or delayed the decision to divorce and divorcees’ coping during and after divorce. Participants’ stories demonstrate that marriages endure despite problems because relationships are complex, and good experiences mix with bad ones. Outcomes of late-life divorce have significant health and financial implications for both individuals and society.

Personal theories of substance use among middle-aged and older adults with bipolar disorder

ABSTRACT Objectives: Most persons with bipolar disorder (BD) misuse alcohol and/or illicit drugs at some point, yet research specific to older adults with BD is nascent. The current study sought an in-depth understanding of the experiences and meanings of substance use in a sample of adults who self-reported substance misuse. Methods: Semi-structured interviews were conducted and thematically analyzed to understand the personal theories of substance use by 12 adults (9 women and 3 men; M = 49 years old) who self-reported diagnoses of BD and regular alcohol or illicit drug use. Results: Findings provide an in-depth picture of the theories middle-aged and older adults with BD have developed to explain their substance use. Participants’ theories suggest multiple reasons for substance use, including self-medication; increased confidence with substance use; rejection of prescribed medications; easy access to alcohol; early social exposure/use as facilitator; and living in a culture of substance use. Conclusion: Findings suggest multiple theories for the comorbid link between BD and substance use, primarily that persons with BD use drugs and/or alcohol to relieve stress or manage symptoms. It is clinically relevant to incorporate personal reasons for actively and regularly using substances as part of personalized substance treatment and BD symptom management.

Ageing well in the right place: partnership working with older people

Purpose: The provision of home and community supports can enable people to successfully age-in-place by improving physical and mental health, supporting social participation and enhancing independence, autonomy and choice. One challenge concerns the integration of place-based supports available as older people transition into affordable housing. Sustainable solutions need to be developed and implemented with the full involvement of communities, service organisations and older people themselves. Partnership building is an important component of this process. This article details the intricacies of developing partnerships with low-income older people, local service providers and nonprofit housing associations in the context of a Canadian housing development. Design/methodology/approach: A community based participatory approach was used to inform the data collection and partnership building process. The partnership building process progressed through a series of democratized committee meetings based on the principles of appreciative inquiry, four collaboration cafes with nonprofit housing providers, and four community mapping workshops with low-income older people. Data collection also involved 25 interviews and 15 photovoice sessions with the housing tenants. The common aims of partnership and data collection were to: (i) understand the challenges and opportunities experienced by older people, service providers and nonprofit housing providers; (ii) identify the perspectives of service providers and nonprofit housing providers for the provision and delivery of senior-friendly services and resources; and (iii) determine actions that can be undertaken to better meet the needs of service providers and nonprofit housing providers in order to help them better serve older people. Findings: The partnership prioritised the generation of a shared vision together with shared values, interests and the goal of co-creating meaningful housing solutions for older people transitioning into affordable housing. Input from interviews and photovoice sessions with older people provided material to inform decision making in support of ageing well in the right place. Attention to issues of power dynamics and knowledge generation and feedback mechanisms enable all fields of expertise to be taken into account, including the experiential expertise of older residents. This resulted in functional, physical, psychological and social aspects of ageing in place to inform the new build housing complex. Research limitations/implications: The time and effort required to conduct democratized partnerships slowed the decision making process. Research limitations/implications: The time and effort required to conduct democratized partnerships slowed the decision making process. Originality/value: The findings confirm that the drive toward community partnerships is a necessary process in supporting older people to age well in the right place. This requires sound mechanisms to include the voice of older people themselves alongside other relevant stakeholders. Ageing well in a housing complex requires meaningful placemaking to include the functional, physical, psychological and social aspects of older people’s everyday life in respect to both home and community.

Why Do Holocaust Survivors Remember What They Remember

Purpose of the Study The ability to integrate traumatic memories into a coherent life narrative is one factor associated with the mental health and well-being of Holocaust survivors. In the present study, reminiscences reported by survivors in Israel were collected to identify themes arising in positive and negative memories and experience. Design and Methods Participants (M = 80.4 years; SD = 6.87) were asked to describe memories that typify a reminiscence function in which they frequently or very frequently engage. Open-ended responses were collected from 269 Holocaust survivors and thematic analyses were conducted in English (translated) and Hebrew. Results Thematic analyses of these data suggest three overarching themes related to bridging the past and present, rebuilding families and the Jewish state, and the duty to share. These suggest how integral endurance, survival, and resilience were to participants during the war and how these themes defined their choices and understanding of their lives. Implications The results of this study demonstrate how reminiscence serves many functions. Participants appear to have integrated memories of horror and loss as part of coherent life narratives. Resilience and memory are ongoing and intertwined processes whereby survivors juxtapose their early lives to the present.

Intercorrelation of Alcohol and Other Drug Use Disorders among a National Sample of Drivers

ABSTRACT This study examined the relationship between alcohol, marijuana, cocaine, and painkiller use disorders in a sample of drivers. We studied nighttime drivers aged 16 to 87 (n = 4,277) from the 2007 National Roadside Survey who reported substance use behaviors and provided breath tests for alcohol. Logistic regression analyses assessed the relationships between (1) substance (i.e., alcohol/marijuana/cocaine/pain killer) use disorders; (2) demographic characteristics; and (3) BAC levels. Overall, 13.2% of participants met criteria for marijuana use disorder, 7% met criteria for cocaine use disorder, and 15.4% met criteria for extra-medicinal painkiller use disorder. When self-report data were analyzed, three reciprocal associations emerged: (1) marijuana use disorders and alcohol use disorders were correlated; (2) marijuana use disorders and cocaine use disorders were correlated; and (3) cocaine use disorders and painkiller use disorders were correlated. BAC data revealed that marijuana and cocaine use disorders were both associated with positive BAC levels, but only cocaine use disorders were associated with BAC levels over the legal limit. Results suggest significant poly-substance use disorders in a sample of nighttime drivers, with variations by demographic characteristics. The individual and public health consequences of multiple substance use disorders among drivers are significant.

Co-creation Methods: Informing Technology Solutions for Older Adults

With the demographic shift towards an aging population, there is an increasing need for and interest in technologies that address challenges associated with aging. The AGE-WELL Network of Centres of Excellence is developing and building capacity in researchers and partners affiliated with the network and beyond to co-create solutions with older adults and other stakeholders. In this paper three projects using different approaches to co-creation are explored: community-based participatory research, integrated knowledge translation, and transdisciplinary working. The projects span different focus areas and disciplines: (1) a seniors’ affordable housing redevelopment evaluation; (2) a realist review of middle-aged and older adults and the digital divide; and (3) development of rehabilitation software for older adults’ cognitive health. Based on these projects, opportunities for enriching the research process through co-creation methods are highlighted. In addition, factors to consider when choosing and implementing co-creation methods, such as the type of research project, level of project development, ethical issues, and resources available will be discussed. We conclude the paper with a call for researchers using co-creation in technology development to evaluate the impact of such approaches.

Understanding the functionality of housing-related support services through mapping methods and dialogue

This article describes the experience and process of using community mapping as a tool for collecting data on the functioning of housing-related support services in Metro Vancouver. We outline our mapping methods and discuss strengths and challenges encountered during workshops aimed at understandings how the system of housing-related supports function. Strengths were that workshops provided a forum for social participation and engagement. In addition, mapping is a research tool that enables local knowledge of service functioning and service gaps to be accessed and exchanged. Challenges include ensuring diverse representation; reducing power imbalances; and having adequate space to accommodate interested participants.

Co-creating Home and Community: Building Partnerships to Support Older Adults to Age-Well-in-Place

The provision of home and community supports can enable people to successfully age-in-place by improving physical and mental health, supporting social participation, and enhancing independence, autonomy, and choice. One challenge to ageing in place concerns the integration of place-based supports available as older people transition into affordable housing. Sustainable solutions need to be developed and implemented with the full involvement of communities, service organisations, and older people themselves. Partnership building is an important component of this process. This chapter details the intricacies of developing partnerships with low-income older people, local service providers, and non-profit housing associations in the context of a Canadian housing development. The findings confirm that the drive towards community partnerships is a necessary process in supporting seniors to live independently and age well within their homes and communities.