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1.  An Examination of Healthy Aging Across a Conceptual Continuum: Prevalence Estimates, Demographic Patterns, and Validity 
Although the notion of healthy aging has gained wide acceptance in gerontology, measuring the phenomenon is challenging. Guided by a prominent conceptualization of healthy aging, we examined how shifting from a more to less stringent definition of healthy aging influences prevalence estimates, demographic patterns, and validity.
Data are from adults aged 65 years and older who participated in the Health and Retirement Study. We examined four operational definitions of healthy aging. For each, we calculated prevalence estimates and examined the odds of healthy aging by age, education, gender, and race-ethnicity in 2006. We also examined the association between healthy aging and both self-rated health and death.
Across definitions, the prevalence of healthy aging ranged from 3.3% to 35.5%. For all definitions, those classified as experiencing healthy aging had lower odds of fair or poor self-rated health and death over an 8-year period. The odds of being classified as “healthy” were lower among those of advanced age, those with less education, and women than for their corresponding counterparts across all definitions.
Moving across the conceptual continuum—from a more to less rigid definition of healthy aging—markedly increases the measured prevalence of healthy aging. Importantly, results suggest that all examined definitions identified a subgroup of older adults who had substantially lower odds of reporting fair or poor health and dying over an 8-year period, providing evidence of the validity of our definitions. Conceptualizations that emphasize symptomatic disease and functional health may be particularly useful for public health purposes.
PMCID: PMC3536546  PMID: 22367432
Healthy aging; Measurement; Successful aging
2.  Successful Aging in the United States: Prevalence Estimates From a National Sample of Older Adults 
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.
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.
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.
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.
PMCID: PMC2981444  PMID: 20008481
Health disparities; Healthy aging; Prevalence; Successful aging
3.  Overestimation of physical activity in a nationally-representative sample of underactive adults with diabetes 
Medical care  2012;50(5):441-445.
Using data from the national Health and Retirement Study, we sought to: a) estimate the proportion of U.S. adults with diabetes over age 50 who do not meet physical activity guidelines but believe they are sufficiently active, and b) examine demographic and health-related correlates of such ‘overestimation.’
Research design
Respondents who were classified as underactive according to a detailed activity inventory, but reported exercising at least the ‘right amount’, were designated as overestimating their physical activity. Multiple logistic regression was used to examine the association of demographic and health-related correlates with the odds of overestimation.
Fifty-four percent of the survey sample did not meet physical activity guidelines, and one-quarter of this underactive group overestimated their physical activity. The adjusted odds of overestimation were higher among respondents who held the perception that they were the right weight or underweight (OR=2.42; 95% C.I. = 1.49–3.94), who had good or better self-assessed diabetes control (1.84; 95% C.I. = 1.12–3.04), and who were Black or Hispanic (OR=1.89; 95% C.I. 1.13–3.16). Experiencing shortness of breath reduced the odds of overestimation (OR=0.34; 95% C.I. = 0.19–0.61).
Overestimation of physical activity is common among adults with diabetes, and is associated with the perceptions that one is the right weight and that one has good control of diabetes, and with being Black or Hispanic. Clinicians should be aware that these factors may affect their patients' beliefs about how much physical activity is adequate.
PMCID: PMC4161147  PMID: 22193415
4.  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.
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.
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.
PMCID: PMC3297017  PMID: 21856746
Self-efficacy; Caregiving; Frail elders; Long-term care; Disability trajectory; Multilevel analysis

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