Debasree Das Gupta

Objectives: Neighborhood environments influence falls in later life, but the role of functional limitations in this relationship is unclear. Guided by environmental gerontology theories, we examined whether functional limitations (none/mild/severe) moderated the association between neighborhood social cohesion and physical disorder and subsequent falls. Methods: We pooled adults aged ≥65 ( n = 5,075) from the 2014–2016 Health and Retirement Study and assessed falls 2 years later (2016–2018). Survey-weighted logistic regressions estimated associations at each limitation level, adjusting for sociodemographic and health covariates. Results: Higher social cohesion and physical disorder were associated with greater odds of falls. Among those with mild limitations, both associations were attenuated, while among those with severe limitations, higher physical disorder was associated with lower odds of falls. Discussion: Findings highlight the need to address both environmental and individual factors in fall prevention and suggest that lower risk among limited adults reflects self-restriction, underscoring supervised indoor exercise and accessible transportation.

Population aging impacts the utilization of health services, especially in Emergency Departments (EDs). A rising share of older adults in the US report ED use, especially frequent ED use, defined as ≥ 4 visits annually. Prior works have examined frequent utilization of EDs among geriatric populations, but no study has focused on age‐based trends or examined type of ED care sought by different age groups. Thus, using the 2017‐2019 State Emergency Department Databases (SEDD), we examined how types of ED care influenced frequent ED utilization among geriatric patients in Maryland across the three age groups of youngest‐old (65–74), middle‐old (75–84), and oldest‐old (85 and above), after controlling for covariates. Types of ED care included emergent, primary‐care‐sensitive conditions (PCSC), injuries, and behavioral conditions which were identified using the New York University–Johns Hopkins University Emergency Department Algorithm. Over the study period, frequent geriatric users made up 13.86% and 3.68% of all ED visits and ED patients respectively. The probabilities for being a frequent user was the lowest for nonsevere injuries (2.3%–2.7%) and the highest for care related to alcohol, drug, and psychological disorders (ADP: 5.0%–8.7%). The youngest‐old and middle‐old had a higher predicted probability of visiting the ED frequently for PCSC (4.1%) compared to the oldest‐olds (3.8%). The youngest‐old had the highest predicted probability of visiting the ED frequently for ADP (8.7%), while the oldest‐old reported the highest predicted probability of visiting the ED frequently for severe injuries (3.7%). These findings are critical to healthcare stakeholders to better understand the heterogeneous medical needs of the different older adult age groups.

The use of Emergency Departments (EDs) for non-urgent medical conditions is a global public health concern. A systematic review, guided by a registered protocol (PROSPERO: CRD42023398674), was conducted to interpret the association between distance as a measure of healthcare access and the utilization of EDs for non-urgent care in high- and middle-income countries. The search was conducted on 22 August 2023 across five databases using controlled vocabulary and natural language keywords. Eligibility criteria included studies that examined non-urgent care, and featured concepts of emergency departments, non-urgent health services and distance, reported in English. Articles and abstracts where patients were transported by ambulance/paramedic services, referred/transferred from another hospital to an ED, or those that measured distance to an ED from another health facility were excluded. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework informed the quality of evidence. Fifteen articles met the inclusion criteria. All studies demonstrated satisfactory quality with regard to study design, conduct, analysis and presentation of results. Eight (53.3%) of the studies (1 paediatric, 4 all ages/adult, 3 ecological) found a moderate level of evidence of an inverse association between distance and ED visit volume or utilization for non-urgent medical conditions, while the remaining studies reported very low or low evidence. Half of the studies reported non-urgent ED use to be associated with shortest distance traveled or transportation time. This finding bears implications for healthcare policies aiming to reduce ED use for non-urgent care.

Background and Objectives: Fall incidents from unsafe home environments are frequent in older-adult homes but the literature is ambiguous whether it is the presence/absence, or the interplay of such conditions and physical functioning that is of salience. We therefore estimated whether unsafe home environment is adversely associated with subsequent falls among older adults and what proportion of this association was mediated through limitations in daily and instrumental activities of daily living (ADL/IADL). Research Design and Methods: Using a nationally representative sample of community-dwelling Medicare beneficiaries (≥65 years) in the 2018–2019 National Health and Aging Trends Study (n = 2,599), we conducted bivariate and multivariable analyses. We examined baseline conditions of home disorders, unsafe bathroom settings, unsafe house/building features, and house disrepairs in 2018 and their relation with subsequent falls in 2019, after controlling for covariates. To assess whether ADL/IADL limitations mediated this relationship, we employed the Karlson–Holm–Breen methodology. Results: In 2019, the self-reported prevalence of falls among older adults was estimated at 34.68%. Although baseline home disorders had both a direct (adjusted odds ratio [aOR]: 1.14, 95% confidence interval [CI]:1.03,1.26) and an indirect effect through limitations in ADL and IADL (aOR: 1.01; 95% CI: 1.00,1.03), the relation between unsafe bathroom settings and subsequent falls was unclear. Unsafe house/building features and house disrepairs were not statistically significantly related either directly or indirectly with subsequent falls. Discussion and Implications: Addressing home disorders through policy and housing assessments to highlight home environmental safety would be essential to address falls among older adults.

Objectives: The current study examined whether informal caregivers performed worse, better, or similar to non-caregivers on cognitive tests of executive functioning and episodic memory over 10 years. Methods: Data were from waves 2 (2003–04) and 3 (2013–14) of the Midlife in the United States (MIDUS) study ( N = 2086). Multiple linear regression models examined whether caregiving at both waves 2 and 3 predicted better cognitive functioning at wave 3, than caregiving at only one time point or no caregiving (reference) while controlling for baseline covariates (i.e., sociodemographic, health, and functional status). Results: After controlling for covariates, caregiving at both waves was independently associated with better performance in episodic memory ( b = .24, SE = .10, p = .013) but not executive function ( b = −.06, SE = .05, p = .246). Discussion: The findings partially supported both healthy caregiver and stress process models, indicating caregiving may be associated with better episodic memory but not executive functioning over time among the middle-aged and older adults.

Frequent mental distress (FMD) is prevalent among older Americans, but less is known about disparities in FMD of older adults living in multigenerational families versus living alone. We pooled cross-sectional data (unweighted, n = 126,144) from the Behavioral Risk Factor Surveillance System (BRFSS) between 2016 and 2020 and compared FMD (≥14 poor mental health days in the past 30 days = 1; 0 otherwise) of older adults (≥65 years) living in multigenerational families versus living alone in 36 states. After controlling for covariates, findings indicate 23% lower odds of FMD among older adults living in multigenerational households compared to counterparts living alone (adjusted odds ratio (AOR): 0.77; 95% confidence interval (CI): 0.60, 0.99). Findings also show that the reduction in the odds of FMD with each 5 year increase in age was larger among older adults living in multigenerational families by 18% (AOR: 0.56; 95% CI: 0.46, 0.70) compared to older adults living alone (AOR: 0.74; 95% CI: 0.71, 0.77), and this difference was significant at the 5% significance level. Multigenerational living may have a protective association with FMD among older adults. Further research is needed to identify multigenerational family and non-kin factors that translate into mental health advantages for older adults.

A recent study shows that among the three age groups of youth, adult and older adult, youth‐older adult has the highest age segregation while youth‐adult has the lowest. Similar to many previous age segregation studies, racial‐ethnic differences, an important population axis in segregation studies, were not considered. Prior studies are also limited to using two‐group measures, failing to compare multiple groups together. We explore the complexity in measuring intersectional segregation focusing on the two axes of age and race‐ethnicity and propose a conditional approach to measure age segregation by racial‐ethnic groups, and racial‐ethnic segregation by age groups. Using this approach, we empirically study the 2010 age‐race‐ethnic segregation at the county and state levels in the United States, using census tracts as the basic units. Both the two and multigroup dissimilarity indices were used. Results show that the racial‐ethnic axis had been a stronger force in segregation than the age axis. Results also show disparities of racial‐ethnic segregation across age groups with the highest levels present among older adults and in urban counties. For all three age groups, segregation levels involving Natives and Asians tend to be higher than those without them. In contrast, age segregation was the highest between youths and older adults, and the levels varied across racial‐ethnic groups with Natives at the highest levels. Although age segregation was significantly different between urban and rural counties, higher segregation in urban areas were mostly involving Whites as opposed to higher segregation in rural counties involving minority racial groups. Studying age segregation should not be colour blinded, as nonwhite older adults in rural counties were more likely to experience higher levels of age segregation than other groups.