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1.  Caregiver Confidence: Does It Predict Changes in Disability Among Elderly Home Care Recipients? 
The Gerontologist  2011;52(1):79-88.
Purpose of the study:
The primary aim of this investigation was to determine whether caregiver confidence in their care recipients’ functional capabilities predicts changes in the performance of activities of daily living (ADL) among elderly home care recipients. A secondary aim was to explore how caregiver confidence and care recipient functional self-efficacy jointly influence changes in ADL performance over time.
Design and Methods:
The sample included 5,138 elderly recipients of home and community-based long-term care in Michigan. ADL performance was assessed multiple times over a 2-year period. Caregiver confidence was measured at baseline with a single item. Multilevel modeling was used to estimate the effect of caregiver confidence on changes in ADL performance over time, controlling for baseline self-efficacy, ADL performance, and other factors that might confound the relationship. Based on caregiver confidence and elder self-efficacy, we created 4 groups of elder caregiver dyads to explore the combined effect of caregiver and elder confidence on change in ADL performance.
Results:
Elders whose caregivers were confident in their capacity for greater functional independence experienced greater improvement in ADL performance than those whose caregivers were not confident. Elders in dyads in which both members expressed confidence experienced more improvement in ADL performance than those in dyads in which either one or both members lacked confidence.
Implications:
Interventions to strengthen caregivers’ confidence in their care recipients’ functional capabilities may slow functional losses among home care elders. Additional research is needed to confirm these findings and identify the factors that influence caregiver confidence.
doi:10.1093/geront/gnr073
PMCID: PMC3297017  PMID: 21856746
Self-efficacy; Caregiving; Frail elders; Long-term care; Disability trajectory; Multilevel analysis
2.  Effects of Changes in Depressive Symptoms and Cognitive Functioning on Physical Disability in Home Care Elders 
Background
This study sought to investigate the effect of changes in depression status on physical disability in older persons receiving home care, examine whether the effect is due to concomitant changes in cognitive status, and test whether affective state and cognitive ability interact to influence physical disability.
Methods
Multilevel analyses were conducted using longitudinal data collected about every 3 months from older participants in Michigan's community-based long-term care programs (N = 13,129). The data set provided an average of nine repeated measures of depressive symptoms, cognitive functioning, and physical disability. We estimated the lag effects of within-person changes in depression and cognitive status, and their interaction, on physical disability measured by activities of daily living (ADL) and instrumental activities of daily living (IADL), controlling for health-related events that occurred in the interim.
Results
Changes between not having and having depressive symptoms, including subsyndromal symptoms, are critical to physical disability for home care elders. The effects are independent of concomitant changes in cognitive status, which also have significant adverse effects on physical disability. There is some evidence that improvement of depression buffers the adverse effect of cognitive decline on IADL disability.
Conclusions
Providers should monitor changes in depression and cognitive status in home care elders. Early detection and treatment of subthreshold depression, as well as efforts to prevent worsening of cognitive status in home care elders, may have a meaningful impact on their ability to live at home.
doi:10.1093/gerona/gln023
PMCID: PMC2655022  PMID: 19196904
Frail elderly; Depression; Cognitive impairment; Disability; Aging in place; Multilevel analysis
3.  Social Exchanges and Subjective Well-Being among Older Chinese: Does Age Make a Difference? 
Psychology and aging  2007;22(2):386-391.
We examined the effects of social support and negative interactions on life satisfaction and depressed affect among older Chinese, and age differences in these associations. The sample consisted of 2,943 Chinese elders aged 60 to 94 years old. Structural equation modeling (SEM) results suggest that both social support and negative interactions have significant contributions to life satisfaction and depressed affect. Social support has stronger effects than negative interactions on life satisfaction; their effects on depressed affect are comparable. Further, depressed affect of old-old (70+) Chinese reacts more strongly to both social support and negative interactions than the young-old (60-69).
doi:10.1037/0882-7974.22.2.386
PMCID: PMC3495234  PMID: 17563194
Chinese elderly; social support; negative interactions; mental health; heterogeneity in old age
4.  Pain and Self-Injury Ideation in Elderly Men and Women Receiving Home Care 
OBJECTIVES
To investigate the associations of self-injury ideation with pain severity, pain control, and their combination in home care elders, and to examine gender differences in the associations.
DESIGN
Secondary data analysis, mixed models repeated-measures design.
SETTING AND PARTICIPANTS
N=16,700 elderly participants in two publicly-funded home care programs in Michigan.
MEASUREMENTS
All participants received in-home assessments at baseline and every three months thereafter using a standardized instrument which included questions about self-injury ideation and pain experience. Assessment data collected over one year following baseline were used.
RESULTS
Participants averaged 77.5 years old. The majority was female (72.2%) and White (81.4%). At baseline 1.4% of the sample—2.1% of men and 1.2% of women—had self-injury ideation. Compared to those without pain, the risk of self-injury ideation in men increased with pain severity (some pain: adjusted OR=1.88, 95% CI=1.12-3.13; severe pain: adjusted OR=2.36, 95% CI=1.29-4.30) and pain control (controlled by medication: adjusted OR=1.81, 95% CI=1.08-3.04; uncontrolled by medication: adjusted OR=3.39, 95% CI=1.45-7.95). Men with severe and uncontrolled pain were at especially high risk (adjusted OR=4.10, 95% CI=1.37-12.28). No measures of pain were significantly associated with self-injury ideation in women. Gender differences in the association of pain severity and self-injury ideation were significant (p<.05).
CONCLUSION
Pain in home care elders should be taken seriously and treated as one means to reduce risk of suicide. Pain assessment should include severity and control of pain. In men, complaints about pain should prompt questioning for self-injury ideation.
doi:10.1111/j.1532-5415.2010.03151.x
PMCID: PMC3058671  PMID: 21054298
suicidal behavior; deliberate self-harm; mental health; long-term care; frail elderly
5.  Successful Aging in the United States: Prevalence Estimates From a National Sample of Older Adults 
Objectives.
To estimate the prevalence of successful aging in the United States, with the broad aim of contributing to the dialogue on Rowe and Kahn’s concept of successful aging.
Methods.
Using data from the Health and Retirement Study, the prevalence of successful aging was calculated for adults aged 65 years and older at four time points: 1998, 2000, 2002, and 2004. Successful aging was operationalized in accordance with Rowe and Kahn’s definition, which encompasses disease and disability, cognitive and physical functioning, social connections, and productive activities.
Results.
No greater than 11.9% of older adults were aging “successfully” in any year. The adjusted odds of successful aging were generally lower for those of advanced age, male gender, and lower socioeconomic status. Between 1998 and 2004, the odds of successful aging declined by 25%, after accounting for demographic changes in the older population.
Discussion.
Few older adults meet the criteria put forth in Rowe and Kahn’s definition of successful aging, suggesting the need for modification if the concept is to be used for broad public health purposes. Disparities in successful aging were evident for socially defined subgroups, highlighting the importance of structural factors in enabling successful aging.
doi:10.1093/geronb/gbp101
PMCID: PMC2981444  PMID: 20008481
Health disparities; Healthy aging; Prevalence; Successful aging
6.  Mental Health Status of Home Care Elderly in Michigan 
The Gerontologist  2007;47(4):528-534.
This study describes the mental health status of community-living frail elders in Michigan and identifies subgroups who are vulnerable to mental health problems. We analyzed the baseline assessment data collected from older adults admitted to two community-based long-term care programs in Michigan (N = 18,939). Results show that 40.5% of the sample have recognized mental disorders, 39.6% use psychotropic medications, 24.5% have probable depression, and 1.4% have self-injury thoughts or attempts. Frail elders who are white, younger, and female--as well as those who experience more pain, disease burden, cognitive impairment and IADL limitations--are more prone to psychological distress. Mental health care is greatly needed by community-living frail elders.
PMCID: PMC2855310  PMID: 17766673
depression; psychological distress; community-based long-term care; frail elders; MDS-HC

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