@article {11634, title = {Profiles of Caregiving Arrangements of Community-dwelling People Living with Probable Dementia.}, journal = {Journal of Aging \& Social Policy}, year = {Forthcoming}, abstract = {

People living with dementia receive care from multiple caregivers, but little is known about the structure of their caregiving arrangements. This study used the Health and Retirement Study and latent class analyses to identify subgroups of caregiving arrangements based on caregiving hours received from spouses, children, other family/friends, and paid individuals among married (n~=~361) and unmarried (n~=~473) community-dwelling people with probable dementia. Three classes in the married sample (class 1 "low hours with shared care," class 2 "spouse-dominant care," and class 3 "children-dominant care") were identified. In class 1, spouses, children, and paid individuals provided 53\%, 22\%, and 26\% of the caregiving hours, respectively. Three classes in the unmarried sample (class 1 "low hours with shared care," class 2 "children-dominant care," and class 3 "paid-dominant care") were identified. In unmarried class 1, children, other family/friends, and paid individuals provided 35\%, 41\% and 24\% of the caregiving hours, respectively.

}, keywords = {Caregiving, Dementia, Long-term Care}, issn = {1545-0821}, doi = {10.1080/08959420.2021.1927613}, author = {Jutkowitz, Eric and Lauren L Mitchell and Barbara H. Bardenheier and Joseph E Gaugler} } @article {11377, title = {Do Big Five Personality Traits Moderate the Effects of Stressful Life Events on Health Trajectories? Evidence From the Health and Retirement Study.}, journal = {The Journals of Gerontology, Series B }, volume = {76}, year = {2021}, pages = {44-55}, abstract = {

OBJECTIVES: Theory suggests that individuals with higher neuroticism have more severe negative reactions to stress, though empirical work examining the interaction between neuroticism and stressors has yielded mixed results. The present study investigated whether neuroticism and other Big Five traits moderated the effects of recent stressful life events on older adults{\textquoteright} health outcomes.

METHOD: Data were drawn from the subset of Health and Retirement Study participants who completed a Big Five personality measure (N = 14,418). We used latent growth curve models to estimate trajectories of change in depressive symptoms, self-rated physical health, and C-reactive protein levels over the course of 10 years (up to six waves). We included Big Five traits and stressful life events as covariates to test their effects on each of these three health outcomes. We examined stressful life events within domains of family, work/finances, home, and health, as well as a total count across all event types.

RESULTS: Big Five traits and stressful life events were independently related to depressive symptoms and self-rated health. There were no significant interactions between Big Five traits and stressful life events. C-reactive protein levels were unrelated to Big Five traits and stressful life events.

DISCUSSION: Findings suggest that personality and stressful life events are important predictors of health outcomes. However, we found little evidence that personality moderates the effect of major stressful events across a 2-year time frame. Any heightened reactivity related to high neuroticism may be time-limited to the months immediately after a major stressful event.

}, keywords = {Mental Health, Personality, Physical Health, Stress reactivity, Stressful Life Events}, issn = {1758-5368}, doi = {10.1093/geronb/gbaa075}, author = {Lauren L Mitchell and Zmora, Rachel and Finlay, Jessica M and Jutkowitz, Eric and Joseph E Gaugler} } @article {10688, title = {The Effect of Physical and Cognitive Impairments on Caregiving}, journal = {Medical Care}, volume = {58}, year = {2020}, pages = {601-609}, type = {Journal}, abstract = {BACKGROUND: Many older adults receive caregiving; however, less is known about how a change in a care recipient{\textquoteright}s functional activity limitations [instrumental activities of daily living (IADL) and basic activities of daily living (ADL)] as well as their cognitive impairment influence the amount of caregiving received. METHODS: Using the Health and Retirement Study (2002-2014) we identified community-dwelling respondents with Alzheimer disease and related dementias (ADRD; n=674), cognitive impairment no dementia (CIND; n=530), and no cognitive impairment (n=6126). We estimated a series of two-part regression models to identify the association between care recipients{\textquoteright} level of cognitive impairment, change in total number of IADL/ADL limitations and amount of caregiving received. RESULTS: Persons with ADRD received 235.8 (SD=265.6) monthly hours of care compared with 26.0 (SD=92.6) and 6.0 (SD=40.7) for persons with CIND and no cognitive impairment, respectively. An increase in one IADL/ADL limitation resulted in persons with ADRD and CIND receiving 4.90 (95\% confidence interval: 3.40-6.39) and 1.43 (95\% confidence interval: 0.17-2.69) more hours of caregiving than persons with no cognitive impairment. Increases in total IADL/ADL limitations were associated with persons with ADRD, but not CIND, receiving more days of caregiving and having more caregivers than persons with no cognitive impairment. CONCLUSIONS: Compared with persons with no cognitive impairment, increases in IADL/ADL limitations disproportionally increases the caregiving received for persons with ADRD. Policies and programs must pay attention to functional impairments among those living with ADRD.}, keywords = {Alzheimer disease, cognitive impairment, Dementia}, isbn = {0025-7079}, doi = {10.1097/mlr.0000000000001323 }, author = {Jutkowitz, Eric and Gozalo, Pedro and Amal Trivedi and Lauren L Mitchell and Joseph E Gaugler} } @article {10854, title = {Family caregiving in the community up to 8-years after onset of dementia}, journal = {BMC Geriatrics}, volume = {20}, year = {2020}, abstract = {Background Persons with Alzheimer{\textquoteright}s disease and related dementias (ADRD) receive care from family/friends, but how care changes from the onset of dementia remains less understood. Methods We used the Health and Retirement Study (2002{\textendash}2012) to identify community-dwelling individuals predicted to have incident ADRD. We investigated the amount of caregiving received for activities of daily living in the 8-years after disease onset. Results At incidence (n = 1158), persons with ADRD received 151 h (SD = 231) of caregiving a month, 25 (SD = 26) caregiving days a month and had 1.3 (SD = 1.4) caregivers a month. By 8-years post incidence, 187 (16\%) individuals transitioned to a nursing home and 662 (57\%) died in the community. Community-dwelling persons with ADRD at 8-years post incidence (n = 30) received 283 h (SD = 257) of caregiving, 38 (SD = 24) caregiving days, and had 2.2 (SD = 1.3) caregivers. Conclusions Community-dwelling persons with ADRD receive a substantial amount of caregiving over the first 8-years after disease onset.}, keywords = {Alzheimer{\textquoteright}s disease and related dementias, Community based long-term care, Health Services, Public Health}, isbn = {1471-2318}, doi = {10.1186/s12877-020-01613-9}, author = {Jutkowitz, Eric and Joseph E Gaugler and Amal Trivedi and Lauren L Mitchell and Gozalo, Pedro} } @article {9764, title = {Interdependence in Health and Functioning Among Older Spousal Caregivers and Care Recipients.}, journal = {Western Journal of Nursing Research}, volume = {41}, year = {2019}, pages = {685-703}, abstract = {Older spousal caregiving relationships involve support that may be affected by the health of either the caregiver or care recipient. We conducted a longitudinal analysis using pooled data from 4,632 community-dwelling spousal care recipients and caregivers aged ⩾50 from the 2002 to 2014 waves of the Health and Retirement Study. We specified logistic and negative binomial regression models using lagged predictor variables to assess the role of partner health status on spousal caregiver and care recipient health care utilization and physical functioning outcomes. Care recipients{\textquoteright} odds of hospitalization, odds ratio (OR): 0.83, p<.001, decreased when caregivers had more ADL difficulties. When spouses were in poorer versus better health, care recipients{\textquoteright} bed days decreased (4.69 vs. 2.54) while caregivers{\textquoteright} bed days increased (0.20 vs. 0.96). Providers should consider the dual needs of caregivers caring for care recipients and their own health care needs, in adopting a family-centered approach to management of older adult long-term care needs.}, keywords = {Activities of Daily Living, Caregiving, Marriage, Physical Ability}, issn = {1552-8456}, doi = {10.1177/0193945918781057}, author = {Geoffrey J Hoffman and Sarah A. Burgard and Carolyn A Mendez-Luck and Joseph E Gaugler} } @article {9915, title = {Caregivers dying before care recipients with dementia.}, journal = {Alzheimer{\textquoteright}s \& Dementia }, volume = {4}, year = {2018}, pages = {688-693}, abstract = {

Introduction: Although a handful of studies have examined mortality among caregivers of persons with Alzheimer{\textquoteright}s disease or a related dementia (ADRD), the proportion of caregivers who die before their cognitively impaired care recipients remains unknown.

Methods: We conducted descriptive and survival analyses on up to 17~years of data from the nationally representative Health and Retirement Study to evaluate the proportion of spouse caregivers who died before their care recipients.

Results: Eighteen percent of spouse ADRD caregivers died before their care recipients, and spouse caregivers had a significantly lower risk of mortality than their husbands or wives with ADRD.

Discussion: Although a large majority of spouse ADRD caregivers will likely not die before their cognitively impaired husband or wife, those persons with ADRD who survive longer than their caregivers are worthy of future inquiry given their potential risk for negative health outcomes.

}, keywords = {Caregiving, Cognitive Ability, Dementia}, issn = {2352-8737}, doi = {10.1016/j.trci.2018.08.010}, author = {Joseph E Gaugler and Jutkowitz, Eric and Peterson, Christine and Zmora, Rachel} } @article {9061, title = {Effects of cognition, function, and behavioral and psychological symptoms on Medicare expenditures and health care utilization for persons with dementia.}, journal = {Journals of Gerontology Series A: Biological Sciences and Medical Sciences}, volume = {72}, year = {2017}, pages = {818-824}, abstract = {

Background: Clinical features of dementia (cognition, function, and behavioral/psychological symptoms [BPSD]) may differentially affect Medicare expenditures/health care utilization.

Methods: We linked cross-sectional data from the Aging, Demographics, and Memory Study to Medicare data to evaluate the association between dementia clinical features among those with dementia and Medicare expenditures/health care utilization (n = 234). Cognition was evaluated using the Mini-Mental State Examination (MMSE). Function was evaluated as the number of functional limitations (0-10). BPSD was evaluated as the number of symptoms (0-12). Expenditures were estimated with a generalized linear model (log-link and gamma distribution). Number of hospitalizations, institutional outpatient visits, and physician visits were estimated with a negative binomial regression. Medicare covered skilled nursing days were estimated with a zero-inflated negative binomial model.

Results: Cognition and BPSD were not associated with expenditures. Among individuals with less than seven functional limitations, one additional limitation was associated with $123 (95\% confidence interval: $19-$227) additional monthly Medicare spending. Better cognition and poorer function were associated with more hospitalizations among those with an MMSE less than three and less than six functional limitations, respectively. BPSD had no effect on hospitalizations. Poorer function and fewer BPSD were associated with more skilled nursing among individuals with one to seven functional limitations and more than four symptoms, respectively. Cognition had no effect on skilled nursing care. No clinical feature was associated with institutional outpatient care. Of individuals with an MMSE less than 15, poorer cognition was associated with fewer physician visits. Among those with more than six functional limitations, poorer function was associated with fewer physician visits.

Conclusions: Poorer function, not cognition or BPSD, was associated with higher Medicare expenditures.

}, keywords = {Cognitive Ability, Dementia, Medicare expenditures, Restricted data}, issn = {1758-535X}, doi = {10.1093/gerona/glx035}, author = {Jutkowitz, Eric and Robert L Kane and Dowd, Bryan and Joseph E Gaugler and Richard F MacLehose and Karen M Kuntz} } @article {7885, title = {Analysis of Cognitive, Functional, Health Service Use, and Cost Trajectories Prior to and Following Memory Loss}, journal = {The Journals of Gerontology Series B: Psychological Sciences and Social Sciences}, volume = {68}, year = {2013}, pages = {562-567}, publisher = {68}, abstract = {Objectives. This brief report examines whether significant changes in cognition, functional dependence, health service use, and out-of-pocket medical expenditures (OOPMD) occur in the years prior to a physician-identified memory problem in a nationally representative sample of older adults. Method. Longitudinal data from the RAND-Health and Retirement Survey were utilized. Those who reported a physician-identified memory problem (n = 387) were compared with a randomly selected control group of similar age, race, and gender who did not indicate a memory problem (n = 387). Multilevel linear models were used to construct trajectories for various measures of cognition, function, health service use, and OOPMD in the years prior to and following memory problem identification. Results. Several trajectories demonstrated significant rates of change in the years leading up to a physician-identified memory problem, including symptoms (mental status, fine motor skills, and instrumental activities of daily living) and utilization (OOPMD and overnight stays in hospital). Discussion. Preclinical declines in mental status and function and increases in hospital use and OOPMD are apparent prior to the formal identification of memory problems. Earlier identification of these changes might provide a basis for interventions that could alter the clinical course of dementia.}, keywords = {Health Conditions and Status, Healthcare}, doi = {10.1093/geronb/gbs078}, url = {http://psychsocgerontology.oxfordjournals.org/content/68/4/562.abstract}, author = {Joseph E Gaugler and Hovater, Martha and David L. Roth and Johnston, Joseph A. and Robert L Kane and Sarsour, Khaled} }