%0 Journal Article %J Journal of the American Geriatric Society %D 2021 %T A national profile of kinlessness at the end of life among older adults: Findings from the Health and Retirement Study. %A Natalie Plick %A Claire K. Ankuda %A Christine A Mair %A Husain, Mohammed %A Katherine A Ornstein %K Caregiving %K end of life %K Families %K kinlessness %K location of death %X

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.

%B Journal of the American Geriatric Society %V 69 %P 2143-2151 %G eng %N 8 %R 10.1111/jgs.17171 %0 Journal Article %J Innovation in Aging %D 2020 %T Perceived Everyday Age Discrimination and Depressive Symptoms:The Moderating Effect of Social Environment %A Park, Min Kyoung %A Christine A Mair %K age discrimination %K Depressive symptoms %X Approximately 30% of men and women in the United States have experienced age discrimination (Rippon, Zaninotto, & Steptoe, 2015). Experiencing age discrimination may lead to increased risk of depressive symptoms among older adults. Although positive social environments are known to buffer depressive symptoms, it is unknown to what extent a positive social environment may buffer the association between age discrimination and depressive symptoms for older adults in the US. The purpose of this study is to examine the association between perceived age discrimination and depressive symptoms among older adults, and to explore whether this association varies by two aspects of the social environment: social support and neighborhood environment. We explore this topic with data on 5,439 adults aged 50 and older in a sample drawn from the Psychosocial Module of the Health and Retirement Study (HRS, 2016 wave). Our results show a clear association between age discrimination and increased risk of depressive symptoms, net of a range of covariates. Older adults who receive more positive social support and rate their neighborhood environment more positively also report lower depressive symptoms. Finally, we find statistically significant interactions between age discrimination and both measures of the social environment, which suggest that social support and a positive neighborhood environment may buffer the negative impact of age discrimination on depressive symptoms. We discuss these findings in light of the prevalence of age discrimination in the US and cross-nationally, and consider potential mechanisms for improving the social environment of older adults, particularly in the post-COVID era. %B Innovation in Aging %V 4 %P 872 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.3224 %0 Journal Article %J J Palliat Med %D 2016 %T Spousal Characteristics and Older Adults' Hospice Use: Understanding Disparities in End-of-Life Care. %A Katherine A Ornstein %A Melissa D. Aldridge %A Christine A Mair %A Rebecca Jean Gorges %A Albert L Siu %A Amy Kelley %K Hospice Care %K Hospices %K Humans %K Medicare %K Prospective Studies %K Quality of Life %K Terminal Care %K United States %X

BACKGROUND: Hospice use has been shown to benefit quality of life for patients with terminal illness and their families, with further evidence of cost savings for Medicare and other payers. While disparities in hospice use by patient diagnosis, race, and region are well documented and attention to the role of family members in end-of-life decision-making is increasing, the influence of spousal characteristics on the decision to use hospice is unknown.

OBJECTIVES: To determine the association between spousal characteristics and hospice use.

DESIGN: We used data from the Health and Retirement Study (HRS), a prospective cohort study, linked to the Dartmouth Atlas of Health Care and Medicare claims.

SETTING: National study of 1567 decedents who were married or partnered at the time of death (2000-2011).

MEASURES: Hospice use at least 1 day in the last year of life as measured via Medicare claims data. Spousal factors (e.g., education and health status) measured via survey.

RESULTS: In multivariate models controlling for patient factors and regional variation, spouses with lower educational attainment than their deceased spouse had decreased likelihood of hospice use (odds ratio [OR] = 0.58; 95% confidence interval [CI] = 0.40-0.82). Health of the spouse was not significantly associated with likelihood of decedent hospice use in adjusted models.

IMPLICATIONS: Although the health of the surviving spouse was not associated with hospice use, their educational level was a predictor of hospice use. Spousal and family characteristics, including educational attainment, should be examined further in relation to disparities in hospice use. Efforts to increase access to high-quality end-of-life care for individuals with serious illness must also address the needs and concerns of caregivers and family.

%B J Palliat Med %I 19 %V 19 %P 509-15 %8 2016 05 %G eng %U http://dx.doi.org/10.1089/jpm.2015.0399 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/26991831?dopt=Abstract %2 PMC4860657 %4 hospice/medicare/Public Policy/end of life/caregiver burden %$ 999999 %R 10.1089/jpm.2015.0399 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2015 %T Race/Ethnic Differentials in the Health Consequences of Caring for Grandchildren for Grandparents. %A Chen, Feinian %A Christine A Mair %A Bao, Luoman %A Yang Claire Yang %K Aged %K Black People %K Female %K Frail Elderly %K Health Status %K Health Status Disparities %K Hispanic or Latino %K Humans %K Intergenerational Relations %K Longitudinal Studies %K Male %K Middle Aged %K Parenting %K Residence Characteristics %K Socioeconomic factors %K United States %X

OBJECTIVES: The phenomenon of grandparents caring for grandchildren is disproportionately observed among different racial/ethnic groups in the United States. This study examines the influence of childcare provision on older adults' health trajectories in the United States with a particular focus on racial/ethnic differentials.

METHOD: Analyzing nationally representative, longitudinal data on grandparents over the age of 50 from the Health and Retirement Study (1998-2010), we conduct growth curve analysis to examine the effect of living arrangements and caregiving intensity on older adults' health trajectories, measured by changing Frailty Index (FI) in race/ethnic subsamples. We use propensity score weighting to address the issue of potential nonrandom selection of grandparents into grandchild care.

RESULTS: We find that some amount of caring for grandchildren is associated with a reduction of frailty for older adults, whereas coresidence with grandchildren results in health deterioration. For non-Hispanic black grandparents, living in a skipped generation household appears to be particularly detrimental to health. We also find that Hispanic grandparents fare better than non-Hispanic black grandparents despite a similar level of caregiving and rate of coresidence. Finally, financial and social resources assist in buffering some of the negative effects of coresidence on health (though this effect also differs by race/ethnicity).

DISCUSSION: Our findings suggest that the health consequences of grandchild care are mixed across different racial/ethnic groups and are further shaped by individual characteristics as well as perhaps cultural context.

%B J Gerontol B Psychol Sci Soc Sci %I 70 %V 70 %P 793-803 %8 2015 Sep %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2014/12/06/geronb.gbu160.abstract %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/25481922?dopt=Abstract %2 PMC4635642 %4 Caregiving/Grandparents/Health disparities/Race/ethnic differences/family Caregivers/transfers/socioeconomic Differences %$ 999999 %R 10.1093/geronb/gbu160 %0 Journal Article %J Journal of Applied Gerontology %D 2010 %T Social Ties and Depression: An Intersectional Examination of Black and White Community-Dwelling Older Adults %A Christine A Mair %K Demographics %K Health Conditions and Status %K Other %X Aging literature often links social ties to lower depression for older adults; however, research shows inconsistent findings by race and gender. Drawing from an intersectionality framework, this article explores whether the relationship between social ties and depression is moderated by race and gender for a nationally representative sample of diverse, community-dwelling older adults (aged 60 and older). Analysis of the most recent wave of the Health and Retirement Study (HRS) indicates that White men, Black men, White women, and Black women differ in terms of the relationship between social ties and depression. Main findings include (a) the overwhelming benefit of marriage and partnership, (b) pronounced differences between Black women s and White women s friend and kin ties, and (c) the potential vulnerability of older Black men. Findings highlight the importance of catering community-based elder support toward diverse aging populations. Potential community-based care solutions are discussed. %B Journal of Applied Gerontology %I 29 %V 29 %P 667-696 %G eng %N 6 %L newpubs20110328_Mair.pdf %4 social ties/depression/intersectionality/gender %$ 24560 %R https://doi.org/10.1177/0733464809350167