@article {11594, title = {A national profile of kinlessness at the end of life among older adults: Findings from the Health and Retirement Study.}, journal = {Journal of the American Geriatric Society}, volume = {69}, year = {2021}, pages = {2143-2151}, abstract = {

BACKGROUND/OBJECTIVES: The majority of end-of-life (EOL) caregiving is provided by unpaid family members. An increasing number of older adults are kinless (without close family/partnerships) and may have insufficient caregiver support to remain at home at the EOL. We therefore determined what proportion of older adults are kinless at the EOL and assessed the association of kinlessness with EOL care.

DESIGN: Retrospective analysis of Health and Retirement Study decedents, 2002-2015.

SETTING: US population-based sample.

PARTICIPANTS: Decedents age 51+ who died within 1 year of interview (n = 3844) and subset who are community-dwelling at last interview.

MEASUREMENTS: Kinlessness was defined as lacking a spouse/partner and children. Primary outcome measure was location of death. Secondary outcome measures included contextual EOL measures such as symptom burden and caregiver support.

RESULTS: A total of 7.4\% of decedents were kinless at the EOL. Kinless decedents were more likely to be female, nonwhite, enrolled in Medicaid, living alone, or living in a nursing home prior to death. Although community-dwelling kinless decedents received fewer hours of caregiving per week at the EOL (34.7 vs. 56.2, p < 0.05) and were more likely to die in nursing homes (18.1\% vs. 10.3\%, p < 0.05) than those with kin, they did not have higher EOL symptom burden or treatment intensity (e.g., intensive care unit use). In multinomial logistic analysis controlling for demographic and illness characteristics, kinless decedents living in the community before death had a twofold increased risk of dying in the nursing home (odds ratio [OR] = 2.02 [95\% confidence interval (CI) = 1.09-3.72]) and a trend toward increased risk of hospital death (OR = 1.60 [95\% CI = 0.96-2.69]) versus home setting.

CONCLUSIONS: Kinless individuals are more likely to die in nursing homes, even if they are living in the community in their last year of life. Expanded long-term care services and policies are needed to enable all older adults regardless of their family support systems to receive high-quality EOL care.

}, keywords = {Caregiving, end of life, Families, kinlessness, location of death}, issn = {1532-5415}, doi = {10.1111/jgs.17171}, author = {Natalie Plick and Claire K. Ankuda and Christine A Mair and Husain, Mohammed and Katherine A Ornstein} } @article {10002, title = {Caregiving, recovery, and death after incident ADL/IADL disability among older adults in the United States}, journal = {Journal of Applied Gerontology}, volume = {39}, year = {2020}, type = {Journal}, abstract = {This study assesses patterns of caregiving, death, and recovery after incident disability in older adults. We used the Health and Retirement Study to follow of a cohort of adults age >=65 years in the United States with incident disability in activities of daily living (ADLs) or instrumental activities of daily living (IADLs; n = 8,713). Rates of care and function state were assessed biennially: deceased, nursing home dwelling, at home with paid help, at home with both paid and unpaid help, at home with unpaid help, at home with no assistance and recovered. In the 2 years after incident disability, 22.1\% recovered and 46.8\% died. Transitions between care and function states occurred frequently, with more than 20\% of the cohort living at home with no assistance despite disability at least once. This study demonstrates the high levels of care and function state fluctuation and unmet needs after functional disability.}, keywords = {Activities of Daily Living, Caregiving, Disabilities}, issn = {0733-4648}, doi = {10.1177/0733464819826842}, url = {https://journals.sagepub.com/doi/10.1177/0733464819826842}, author = {Claire K. Ankuda and Deborah A Levine and Kenneth M. Langa and Katherine A Ornstein and Amy Kelley} } @article {11293, title = {Kinlessness at the End of Life in the United States: Implications for Place of Death, and Quality of Life Among Older Adults}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {604 }, abstract = {We used the Health and Retirement Study, a large nationally representative study of U.S. older adults from 2002-2015, to identify decedents and assess quality of EOL care by availability of kin. 7.9\% of participants were kinless at EOL (no adult children or spouses), reflecting national estimates of 1,027,600 older adults. Those who were kinless at EOL were more likely to be female (61.2\% vs 51.5\%), from the lowest wealth quartile (53.6\% vs 35.6\%), and less likely to be white and non-Hispanic (75.6\% vs 81.8\%). Among the community-dwelling population, individuals with kin received 2.4 times as much hours of help from informal caregivers per month, compared to those without kin. We did not observe differences in rates of hospital death by kin status in adjusted models. More work is needed to assess any unmet needs in the EOL period for kinless older adults, especially as healthcare moves towards increased in-home supports.}, keywords = {end of life, kinless}, isbn = {2399-5300}, doi = {https://doi.org/10.1093/geroni/igaa057.2037}, author = {Katherine A Ornstein and Natalie Plick and Claire K. Ankuda} } @article {10557, title = {Lifetime History of Traumatic Brain Injury is Associated with Increased Loneliness in Adults: A U.S. Nationally Representative Study}, journal = {International Journal of Geriatric Psychiatry}, volume = {35}, year = {2020}, pages = {553-563}, abstract = {Background/Objectives: An estimated 55 million individuals worldwide live with chronic disability associated with Traumatic Brain Injury (TBI) which may include cognitive, behavioral and social impairments. Reduced participation in social activities is common after TBI, however few studies have evaluated loneliness among survivors of TBI. The current study aimed to evaluate the association between history of TBI and loneliness, and to identify mediators of this association. Methods/Design: Retrospective cohort study. Nationally representative sample of N=724 adults over age 50 (Health and Retirement Study). Loneliness was evaluated using the 11-item Revised UCLA (R-UCLA) Loneliness Scale (range 11-33). Lifetime history of TBI evaluated retrospectively using the Ohio State University TBI Identification Method. We included the following covariates: age, sex, race, education; and mediators: depressive symptoms, number of comorbidities, chronic pain, difficulty with activities of daily living, and social network index. Results: History of TBI was associated with a 1.28 point (95\% CI: 0.46, 2.11, p<0.05; Cohen{\textquoteright}s D=0.284) increase in R-UCLA loneliness scale scores, after covariate adjustment. Individuals with more recent injuries (within 10 years) and multiple lifetime TBIs reported the highest loneliness scores. In the structural equation model, depressive symptoms and comorbidity burden partially mediated the relationship between TBI and loneliness. All models were adjusted for United States (U.S.) population sampling weights. Conclusions: History of TBI was associated with greater loneliness compared to individuals without TBI in a representative sample of U.S. adults. Managing depressive symptoms and medical consequences of TBI may be a target to ameliorate reporting of loneliness in this population. This article is protected by copyright. All rights reserved.}, keywords = {Loneliness, Older Adults, Traumatic Brain Injury}, doi = {10.1002/gps.5271}, author = {Raj G. Kumar and Katherine A Ornstein and Bollens-Lund, Evan and Watson, Eric M. and Claire K. Ankuda and Amy Kelley and Dams-O{\textquoteright}Connor, Kristen} }