Mara Rosenberg

Background: Emotional and financial mistreatment among older adults is often under‐recognized among clinicians. Exploring whether sensory impairment is linked to an elevated risk of elder financial or emotional mistreatment could help inform targeted screening strategies. Methods: We used nationally‐representative, cross‐sectional data from the National Social Life, Health, and Aging Project, including interview rounds with available assessments of recent elder mistreatment (Round 1 (R1): 2005–06 and Round 4 (R4): 2021–23). Elder mistreatment included reported emotional mistreatment (being insulted or feeling controlled) and financial mistreatment (money or belongings taken without permission) within the last 12 months. Assessments of sensory impairment differed slightly by round of data collection and included self‐reported overall vision, olfaction, and hearing, self‐reported hearing loss that interferes with communication, and objective vision (visual acuity) and olfaction (sniff test). We used multivariable logistic regressions to determine the association of self‐reported and objective individual and multi‐sensory impairments with mistreatment risk. Analyses for multisensory impairment were conducted using the full sample, while analyses for individual impairments were stratified by round of data collection. Results: The total sample included 5231 participants; R1 included 2461 participants who were on average 70 years old (SD 7) and 53% female, and R4 included 2770 participants who were on average 71 years old (SD 9) and 55% female. Multisensory impairment was linked to a higher adjusted probability of experiencing either emotional or financial mistreatment (0 impairments: 20% vs. 1 impairment: 23% vs. 2+ impairments: 28%, p < 0.01). Respondents with self‐reported vision impairment had a higher adjusted probability of financial mistreatment (8% vs. 3%, p < 0.001) whereas objective vision impairment had no association. Self‐reported hearing impairment that interfered with communication was associated with financial mistreatment (12% vs. 7%, p = 0.03). Conclusion: Integrating assessments for multisensory impairment, vision, and hearing loss may add to elder mistreatment prevention and detection efforts.

Background: Loneliness (subjective feeling of lacking connection) and social isolation (objective deficit in number of relationships or contact with others) are common at the end‐of‐life and can be detrimental to quality of life. Investigating the association between symptoms and end‐of‐life loneliness and social isolation could help inform targeted interventions. Methods: We used nationally‐representative, cross‐sectional Health and Retirement Study data, including adults > 50 years old ( N = 2385) who died while enrolled. Respondents self‐reported on validated loneliness and social isolation measures within 1 year of death; 12 physical and psychological symptoms were determined via after‐death interviews with proxies. We use multivariable logistic regression to determine the adjusted probability of end‐of‐life loneliness or social isolation by each symptom, adjusting for socio‐demographic covariates. Results: Respondents were on average 76 years old, 50% female, 82% identified as White, 10% Black, and 5% Latino. Loneliness was more common among the following symptoms ( p < 0.05): pain (30% vs. 20%), depression (35% vs. 18%), fatigue (29% vs. 22%), drowsiness (32% vs. 25%), and agitation (38% vs. 24%). Social isolation was more common in decedents who had difficulty breathing (22% vs. 14%, p = 0.03), drowsiness (30% vs. 17%, p = 0.006), and persistent cough (24% vs. 15%, p = 0.007). Conclusions: In the last year of life, multiple psychosocial symptoms were associated with experiences of loneliness whereas physical symptoms were associated more with social isolation. While these relationships are complex, addressing the social sequela of physical and psychological symptoms may be an opportunity to improve overall well‐being at the end‐of‐life.

Background: Social engagement is crucial for well‐being, yet caregivers often face restrictions due to care responsibilities. The caregiver‐specific consequences of these restrictions are underexplored. Methods: We used cross‐sectional data from the National Study of Caregiving (2021), a nationally representative study of 1619 unpaid caregivers of adults aged 65 years and older. Caregivers reported if care responsibilities kept them from participating in four social activities (visiting friends/family, attending religious services, going out for enjoyment, and attending group activities). Caregiver burden (emotional, physical, and/or financial) was self‐reported. “Any” burden was defined as reporting at least one of the three types of burden. We performed survey‐weighted, multivariable logistic regression to determine the adjusted probability of caregiver burden based on social activity participation. Results: Caregivers were on average 62.5 (SD 22) years old, 65% female, 53% children of the care recipient, and 73% White. 43% reported at least one form of caregiving burden: 35% emotional, 17% physical, and 9% financial. Caregivers had higher adjusted probabilities of “any” caregiving burden ( p < 0.001) if they were kept from going out (88% vs. 62%), visiting family/friends (86% vs. 55%), or engaging in group activities (88% vs. 61%). For missed religious activities, caregivers primarily reported higher burden if they rated the missed activities as “important” versus “unimportant” (Any burden: 85% vs. 57%; Emotional burden: 74% vs. 45%; Physical burden: 65% vs. 29%, p < 0.05). Importance was not significant for other activities. There was a step‐wise association between the number of missed activities and any reported burden (0 activities missed: 54%, 1 activity: 77%, 2+ activities: 91%, p < 0.01). Conclusions: Restriction from social activities was associated with higher caregiver burden, with the impact of missing religious activities influenced by its importance to the caregiver. These findings emphasize the need for tailored interventions to help caregivers maintain social engagement despite care responsibilities.