%0 Journal Article %J Journal of Aging & Social Policy %D Forthcoming %T Profiles of Caregiving Arrangements of Community-dwelling People Living with Probable Dementia. %A Jutkowitz, Eric %A Lauren L Mitchell %A Barbara H. Bardenheier %A Joseph E Gaugler %K Caregiving %K Dementia %K Long-term Care %X

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.

%B Journal of Aging & Social Policy %G eng %R 10.1080/08959420.2021.1927613 %0 Journal Article %J The Journals of Gerontology, Series B %D 2021 %T Do Big Five Personality Traits Moderate the Effects of Stressful Life Events on Health Trajectories? Evidence From the Health and Retirement Study. %A Lauren L Mitchell %A Zmora, Rachel %A Finlay, Jessica M %A Jutkowitz, Eric %A Joseph E Gaugler %K Mental Health %K Personality %K Physical Health %K Stress reactivity %K Stressful Life Events %X

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.

%B The Journals of Gerontology, Series B %V 76 %P 44-55 %G eng %N 1 %R 10.1093/geronb/gbaa075 %0 Journal Article %J JAMA Network Open %D 2020 %T Association of Medicaid Expansion Under the Patient Protection and Affordable Care Act With Use of Long-term Care %A Courtney Harold Van Houtven %A Brian E McGarry %A Jutkowitz, Eric %A David C Grabowski %K Affordable Care Act %K Long-term Care %K Medicaid %K Patient Protection and Affordable Care Act %X 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. %B JAMA Network Open %V 3 %@ 2574-3805 %G eng %N 10 %R https://doi.org/10.1001/jamanetworkopen.2020.18728 %0 Journal Article %J Medical Care %D 2020 %T The Effect of Physical and Cognitive Impairments on Caregiving %A Jutkowitz, Eric %A Gozalo, Pedro %A Amal Trivedi %A Lauren L Mitchell %A Joseph E Gaugler %K Alzheimer disease %K cognitive impairment %K Dementia %X 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. %B Medical Care %V 58 %P 601-609 %@ 0025-7079 %G eng %N 7 %9 Journal %R 10.1097/mlr.0000000000001323 %0 Journal Article %J BMC Geriatrics %D 2020 %T Family caregiving in the community up to 8-years after onset of dementia %A Jutkowitz, Eric %A Joseph E Gaugler %A Amal Trivedi %A Lauren L Mitchell %A Gozalo, Pedro %K Alzheimer’s disease and related dementias %K Community based long-term care %K Health Services %K Public Health %X 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. %B BMC Geriatrics %V 20 %@ 1471-2318 %G eng %N 1 %R 10.1186/s12877-020-01613-9 %0 Journal Article %J Journals of Gerontology Series A: Biological Sciences and Medical Sciences %D 2017 %T Effects of cognition, function, and behavioral and psychological symptoms on Medicare expenditures and health care utilization for persons with dementia. %A Jutkowitz, Eric %A Robert L Kane %A Dowd, Bryan %A Joseph E Gaugler %A Richard F MacLehose %A Karen M Kuntz %K Cognitive Ability %K Dementia %K Medicare expenditures %K Restricted data %X

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.

%B Journals of Gerontology Series A: Biological Sciences and Medical Sciences %V 72 %P 818-824 %G eng %N 6 %R 10.1093/gerona/glx035