TY - JOUR T1 - Profiles of Caregiving Arrangements of Community-dwelling People Living with Probable Dementia. JF - Journal of Aging & Social Policy Y1 - Forthcoming A1 - Jutkowitz, Eric A1 - Lauren L Mitchell A1 - Barbara H. Bardenheier A1 - Joseph E Gaugler KW - Caregiving KW - Dementia KW - Long-term Care AB -

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.

ER - TY - JOUR T1 - Patterns of Limitation in Physical Function in Late Midlife Associated with Late-Onset Alzheimer's Disease and Related Dementias: A Cluster Analysis. JF - Journal Of Alzheimers Disease Y1 - 2022 A1 - Bardenheier, Barbara Helen A1 - Resnik, Linda J A1 - Jutkowitz, Eric A1 - Gravenstein, Stefan KW - Alzheimer disease KW - Cluster Analysis KW - Dementia KW - Risk Factors AB -

BACKGROUND: To reduce the increasing societal and financial burden of Alzheimer's disease and related dementias (ADRD), prevention is critical. Even small improvements of the modifiable dementia risk factors on the individual level have the potential to lead to a substantial reduction of dementia cases at the population level.

OBJECTIVE: To determine if pattern(s) of functional decline in midlife associate with late-onset ADRD years later.

METHODS: Using a longitudinal study of adults aged 51-59 years in 1998 without symptoms of ADRD by 2002 and followed them from 2002 to 2016 (n = 5404). The outcome was incident ADRD identified by the Lange-Weir algorithm, death, or alive with no ADRD. We used cluster analysis to identify patterns of functional impairment at baseline and multinomial regression to assess their association with future ADRD.

RESULTS: Three groups of adults with differing patterns of functional impairment were at greater risk of future ADRD. Difficulty with climbing one flight of stairs was observed in all adults in two of these groups. In the third group, 100% had difficulty with lifting 10 pounds and pushing or pulling a large object, but only one-fourth had difficulty in climbing stairs.

CONCLUSION: Results imply that improved large muscle strength could decrease future risk of ADRD. If confirmed in other studies, screening for four self-reported measures of function among adults in midlife may be used for targeted interventions.

VL - 89 IS - 4 ER - TY - JOUR T1 - Self-reported measures of limitation in physical function in late midlife are associated with incident Alzheimer's disease and related dementias. JF - Aging Clinical and Experimental Research Y1 - 2022 A1 - Bardenheier, Barbara H A1 - Resnik, Linda A1 - Jutkowitz, Eric A1 - Gravenstein, Stefan KW - ADRD KW - Late midlife KW - Physical function limitation AB -

BACKGROUND: Even small improvements in modifiable Alzheimer's disease and related dementias (ADRD) risk factors could lead to a substantial reduction of dementia cases.

AIMS: To determine if self-reported functional limitation associates with ADRD symptoms 4-18 years later.

METHODS: We conducted a prospective longitudinal study using the Health and Retirement Study of adults aged 51-59 years in 1998 without symptoms of ADRD by 2002 and followed them to 2016. Main exposure variables were difficulty with activities of daily living, mobility, large muscle strength, gross motor and upper limb activities. The outcome was incident ADRD identified by the Lange-Weir algorithm, death, or alive without ADRD. We fit two GEE multinomial models for each measure: (1) baseline measure of function and (2) change in function over time.

RESULTS: In the model with baseline only and outcome, only difficulty with mobility associated with future ADRD across levels of difficulty with near dose-response effect (risk ratios (RR) difficulty with 1-5 functions respectively, compared with no difficulty: 1.82; 2.70; 1.73 2.81; 4.03). Mobility also significantly associated with ADRD when allowing for change over time among those with 3, 4 or 5 versus no mobility limitations (RR 1.76; 2.36; 2.37).

DISCUSSION: The results infer that an adult in midlife reporting difficulty with mobility as well as those with no mobility limitations in midlife but who later report severe limitations may be at increased risk of incident ADRD.

CONCLUSIONS: Self-reported measures of mobility limitation may be early indicators of ADRD and may be useful for public health planning.

VL - 34 IS - 8 ER - TY - JOUR T1 - Do Big Five Personality Traits Moderate the Effects of Stressful Life Events on Health Trajectories? Evidence From the Health and Retirement Study. JF - The Journals of Gerontology, Series B Y1 - 2021 A1 - Lauren L Mitchell A1 - Zmora, Rachel A1 - Finlay, Jessica M A1 - Jutkowitz, Eric A1 - Joseph E Gaugler KW - Mental Health KW - Personality KW - Physical Health KW - Stress reactivity KW - Stressful Life Events AB -

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' 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.

VL - 76 IS - 1 ER - TY - JOUR T1 - Association of Medicaid Expansion Under the Patient Protection and Affordable Care Act With Use of Long-term Care JF - JAMA Network Open Y1 - 2020 A1 - Courtney Harold Van Houtven A1 - Brian E McGarry A1 - Jutkowitz, Eric A1 - David C Grabowski KW - Affordable Care Act KW - Long-term Care KW - Medicaid KW - Patient Protection and Affordable Care Act AB - Medicaid expansion is associated with increased access to health services, increased quality of medical care delivered, and reduced mortality, but little is known about its association with use of long-term care.To examine the association of Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) with long-term care use among newly eligible low-income adults and among older adults whose eligibility did not change.This difference-in-difference cohort study used data from the Health and Retirement Study, a nationally representative longitudinal survey of persons 50 years or older. Long-term care use from 2008 to 2012 was compared with use from 2014 to 2016 among low-income adults aged 50 to 64 years without Medicare coverage residing in states in which Medicaid coverage expanded in 2014 and those living in states without expansion. Low-income adults who were covered by Medicare and were ineligible for expanded Medicaid were also included in the analysis. Data were analyzed from January 15, 2018, to December 31, 2019.Residence in a state with Medicaid expansion in 2014.Any home health care use or any nursing home use in 2014 or 2016. All estimates are weighted to account for the Health and Retirement Study sampling design.Among the 891 individuals likely eligible for expanded Medicaid, the mean (SD) age was 55.2 (3.1) years; 534 (53.4%) were women, 482 (49.5%) were married, and 661 (45.9%) were White non-Hispanic. Before the ACA-funded Medicaid expansion, 0.4% (95% CI, −0.3% to 1.1%) in expansion states and 1.0% (95% CI, −0.1% to 2.2%) in nonexpansion states used nursing homes, and 1.9% (95% CI, 0.4%-3.4%) in expansion states and 7.1% (95% CI, 4.7%-9.5%) in nonexpansion states used any formal home care. The ACA-funded Medicaid expansion was associated with an increase of 4.4 percentage points (95% CI, 2.8-6.1 percentage points) in the probability of any long-term care use among low-income, middle-aged adults, with increases in home health use (3.8 percentage points; 95% CI, 2.0-5.6 percentage points) and in any nursing home use (2.1 percentage points; 95% CI, 0.9-3.3 percentage points).In this study, ACA-funded Medicaid expansion was associated with an increase in any long-term care use among newly eligible low-income, middle-aged adults, suggesting that the population covered by the Medicaid expansion may have had unmet long-term care needs before expansion. VL - 3 SN - 2574-3805 IS - 10 ER - TY - JOUR T1 - Characteristics of Repeated Influenza Vaccination Among Older U.S. Adults. JF - American Journal of Preventive Medicine Y1 - 2020 A1 - Barbara H. Bardenheier A1 - Zullo, Andrew R A1 - Jutkowitz, Eric A1 - Gravenstein, Stefan KW - characteristics KW - Influenza Vaccines AB -

INTRODUCTION: Annual influenza vaccination is associated with reduced mortality among older adults and lower overall public health burden of influenza. This study seeks to identify the characteristics associated with repeat influenza vaccination and determine whether age-group (51-59, 60-69, ≥70 years) differences exist.

METHODS: Using the nationally representative, longitudinal Health and Retirement Study waves 2004, 2008, 2012, and 2016, adults aged >50 years were followed from 2004 to 2016. In 2020, age-stratified, multinomial regression models were estimated to identify the factors associated with respondents receiving the vaccine repeatedly (every time point), occasionally (some years), or never, with censoring for death.

RESULTS: The overall proportion of adults repeatedly receiving influenza vaccine monotonically increased across age groups from 25.9% among adults aged 51-59 years to 62.4% among those aged ≥70 years. Black, non-Hispanics and smokers were less likely to repeatedly receive an influenza vaccine than white, non-Hispanics and nonsmokers (RR=0.40-0.61 and RR=0.60-0.75, respectively, p<0.05 for all). Those who had 1‒4 medical doctor visits in the past 2 years (RR=1.60-2.99) or cholesterol screening (RR=2.67-3.48) in the past 2 years were significantly more likely to repeatedly receive influenza vaccine than those who had none.

CONCLUSIONS: Although adults aged 60-69 years and ≥70 years are more likely to receive influenza vaccine repeatedly than adults aged 51-59 years, age-specific interventions for repeat influenza vaccination may not be as effective as interventions targeted to certain subgroups among adults aged ≥51 years.

ER - TY - JOUR T1 - The Effect of Physical and Cognitive Impairments on Caregiving JF - Medical Care Y1 - 2020 A1 - Jutkowitz, Eric A1 - Gozalo, Pedro A1 - Amal Trivedi A1 - Lauren L Mitchell A1 - Joseph E Gaugler KW - Alzheimer disease KW - cognitive impairment KW - Dementia AB - BACKGROUND: Many older adults receive caregiving; however, less is known about how a change in a care recipient'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' 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. VL - 58 SN - 0025-7079 IS - 7 ER - TY - JOUR T1 - Family caregiving in the community up to 8-years after onset of dementia JF - BMC Geriatrics Y1 - 2020 A1 - Jutkowitz, Eric A1 - Joseph E Gaugler A1 - Amal Trivedi A1 - Lauren L Mitchell A1 - Gozalo, Pedro KW - Alzheimer’s disease and related dementias KW - Community based long-term care KW - Health Services KW - Public Health AB - Background Persons with Alzheimer’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 (2002–2012) 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. VL - 20 SN - 1471-2318 IS - 1 ER - TY - JOUR T1 - Caregivers dying before care recipients with dementia. JF - Alzheimer's & Dementia Y1 - 2018 A1 - Joseph E Gaugler A1 - Jutkowitz, Eric A1 - Peterson, Christine A1 - Zmora, Rachel KW - Caregiving KW - Cognitive Ability KW - Dementia AB -

Introduction: Although a handful of studies have examined mortality among caregivers of persons with Alzheimer'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.

VL - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/30581974?dopt=Abstract ER - TY - JOUR T1 - Effects of cognition, function, and behavioral and psychological symptoms on Medicare expenditures and health care utilization for persons with dementia. JF - Journals of Gerontology Series A: Biological Sciences and Medical Sciences Y1 - 2017 A1 - Jutkowitz, Eric A1 - Robert L Kane A1 - Dowd, Bryan A1 - Joseph E Gaugler A1 - Richard F MacLehose A1 - Karen M Kuntz KW - Cognitive Ability KW - Dementia KW - Medicare expenditures KW - Restricted data AB -

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.

VL - 72 IS - 6 ER -