Objectives To determine effect size and acceptability of a multi-component behavior and home repair intervention with low-income, disabled older adults Design Prospective randomized controlled pilot trial Setting Participants’ homes Participants 40 low income older adults with difficulties in at least 1 Activity of Daily Living (ADL) or 2 Instrumental Activities of Daily Living (IADL). Intervention Coordinated occupational therapy (OT), nursing (RN), and handyman (HM) visits compared to attention-control visits. The intervention consisted of up to 6 visits with an OT, up to 4 visits with an RN and an average of $1,300 in HM repairs and modifications. Each intervention participant received all components of the intervention clinically tailored to risk profile and goals. Each attention-control participant received the same number of visits as the intervention participants, involving sedentary activities of their choice. Measurement Primary Outcome: difficulty in performing ADL and IADLs. Secondary outcomes: Health related quality of life and falls–efficacy. Results Thirty five of 40 adults (87%) completed the 6-month trial and 93% and 100% of the control and intervention group, respectively, stated the study benefited them. The intervention group improved on all outcomes. When comparing the mean change in the intervention group compared to the mean change in the control group from baseline to follow up, the CAPABLE intervention had an effect size of 0.63 for reducing difficulty in ADLs, 0.62 for reducing difficulty in IADLs, 0.89 for Quality of Life, and 0.55 for Falls-efficacy. Conclusion The multi-component CAPABLE intervention was acceptable to participants, feasible to provide, and showed promising results, suggesting that this multi-component intervention to reduce disability should be evaluated in a larger trial.

The National Health and Aging Trends Study protocol preserves the ability to examine more traditional measures of functioning while offering new insights into how activities are performed and preserving key conceptual distinctions.

The remarkable growth in life expectancy during the twentieth century inspired predictions of a future in which all people, not just a fortunate few, will live long lives ending at or near the maximum human life span. We show that increased longevity has been accompanied by less variation in ages at death, but survivors to the oldest ages have grown increasingly heterogeneous in their mortality risks. These trends are consistent across countries, and apply even to populations with record-low variability in the length of life. We argue that as a result of continuing improvements in survival, delayed mortality selection has shifted health disparities from early to later life, where they manifest in the growing inequalities in late-life mortality.

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These models raise the possibility that reductions of informal care hours may be accomplished with a combination of formal care and assistive devices, rather than from either alternative alone.

Perceived quality of informal care arrangements has a bearing on the psychological health of care recipients. Individuals in more reciprocal relationships and in relationships where they felt respected and valued were less likely to be depressed than their counterparts.

OBJECTIVES Promoting independent functioning of older adults requires attention to how older adults carry out basic activities. This paper provides the first national estimates of late-life disability that explicitly recognize behavioral adaptations to functioning. METHODS We analyzed the National Health and Aging Trends Study, a study of Medicare enrollees ages 65 and older (N=8,077). For seven mobility and self-care activities we identify five hierarchical stages—fully able, successful accommodation with devices, activity reduction, difficulty despite accommodations, and receipt of help—and explore disparities and associations with quality of life measures. RESULTS 31% of older adults are fully able to complete self-care and mobility activities. The remaining groups successfully accommodate with devices (25%); reduce their activities (6%), report difficulty despite accommodations (18%), or receive help (21%). With successive stages physical and cognitive capacity decrease and symptoms and multi-morbidity increase. Successful accommodation is associated with maintaining participation in valued activities and high wellbeing, but substantial disparities by race, ethnicity and income exist. CONCLUSION Increased public health attention to behavioral adaptations to functional change can promote independence for older adults and may also enhance quality of life.

Previous research has examined determinants of the living arrangements and the informal-care arrangements of older women; research on care arrangements has often taken living arrangements as given. Here we consider each separately, then go on to analyze the simultaneous determinants of living and care arrangements. Factors influencing these outcomes can be categorized as indicators of opportunities, resources, needs, or preferences. Of particular interest is the extent to which kin availability--specifically, the existence of living children--constrains opportunities, the role of financial resources, and the consequences of needs as revealed by levels of physical and mental disability. Our analysis consists of multinomial-logit models estimated with data from the 1982 National Long-Term Care Survey. The results indicate the importance of kin availability, with striking differences in the living and care arrangements between childless and other older women. Among those with children, there are less striking but consistent differences according to the number and sex composition of living children. Finally, variables representing needs for care are generally the strongest predictors of all the outcomes analyzed.