Family caregivers' circumstances generally improved during the 16-year period. Results diverge from prevailing concerns regarding the state of family caregiving and demonstrate the importance of longitudinally monitoring trends in late-life family caregiving.

IMPORTANCE Family and unpaid caregivers often play an active role in managing the care of older adults with activity limitations. OBJECTIVE To examine caregivers' experiences with older adults' health care workers. DESIGN, SETTING, AND PARTICIPANTS This survey study constitutes a secondary analysis of a sample of 1916 family and unpaid caregivers to 1203 community-living older adults with activity limitations who participated in the 2017 National Health and Aging Trends Study. Data analysis was performed January to August 2019. EXPOSURES Caregiver sociodemographic characteristics, caregiving intensity, and frequency speaking with or emailing older adults' health care workers. MAIN OUTCOMES AND MEASURES Caregiver-reported experiences when interacting with older adults' health care workers in the prior year, including being listened to, being asked about understanding of treatments, and being asked about help needed in managing older adults' care. RESULTS Caregivers (mean [SE] age, 59.4 [0.5] years; 63.7% women) assisting community-living older adults with activity limitations reported that they never (56.3%), sometimes or rarely (33.0%), or often (10.7%) spoke with or emailed older adults' health care workers in the prior year. Most caregivers who interacted with older adults' health care workers reported being always (70.6%) or usually (18.2%) listened to and always (54.4%) or usually (17.7%) being asked about their understanding of older adults' treatments. Fewer caregivers reported being always (21.3%) or usually (6.9%) asked whether they needed help managing older adults' care, and nearly one-half (45.0%) were never asked. Caregivers who interacted with older adults' health care workers often (vs sometimes or rarely) were more likely to report being always or usually listened to (94.8% vs 86.9%; P = .004), being asked about understanding treatments (80.1% vs 69.5%; P = .02), and being asked about needing help (40.8% vs 24.1%; P < .001). No other exposures were consistently associated with caregiver experiences. Measures of caregiving intensity, including caring for an older adult with dementia, were not associated with being listened to or asked about understanding, but were associated with being asked about needed help. Although caregivers of persons with dementia were more likely than caregivers of persons without dementia to report always being asked about needed help (26.9% vs 19.0%), a high percentage in both groups were never asked (41.2% vs 46.5%)

We developed a prognostic model and simple scoring system that may be used to stratify risk of long-term NH entry of community-living older adults. Our model may be useful for population health and policy applications.

Background: Identifying factors that affect variation in health care spending among older adults with disabilities may reveal opportunities to better address their care needs while offsetting excess spending. Objective: To quantify differences in total Medicare spending among older adults with disability by whether they experience negative consequences due to inadequate support with household, mobility, or self-care activities. Design: Observational study of in-person interviews and linked Medicare claims. Setting: United States, 2015. Participants: 3716 community-living older adults who participated in the 2015 National Health and Aging Trends Study and survived 12 months. Measurements: Total Medicare spending by spending quartile in multivariable regression models that adjust for individual characteristics. Results: Negative consequences were experienced by 18.3% of older adults with household disability, 25.6% with mobility disability, and 20.0% with self-care disability. Median Medicare spending was higher for those who experienced negative consequences with household ($4,866 vs. $4,095), mobility ($7,266 vs. $4,115) and self-care disability ($10,935 vs. $4,436) versus those who did not. In regression-adjusted analyses, differences in median spending did not vary appreciably for older adults who experienced negative consequences in household activities ($338: 95% CI: $−768-$1,444) but was greater for those with mobility ($2,309: 95% CI: $208-$4,409) and self-care disability ($3,187: 95% CI: $432-$5,942). At the bottom spending quartile, differences were observed for self-care only ($1,460: 95% CI: $358-$2,561). No differences were observed at the top spending quartile. Limitations: This observational study cannot establish causality. Conclusion: Inadequate support with mobility and self-care activities is associated with higher Medicare spending, especially at the middle and lower end of spending, which creates the possibility that better supporting the care needs of older adults could offset some Medicare spending.

Objectives: To examine social and physical environmental fall-risk factors in a nationally representative sample of community-living older adults overall and by racial group. Methods: We used data from the 2015 and 2016 rounds of the National Health and Aging Trends Study ( n = 5581) linked to census tract measures from the American Community Survey. Recurrent falls are defined as 2+ self-reported falls over 12 months. Results: Older adults with recurrent falls were more likely to have lower education, lower income, financial hardship, live in homes with disorder and disrepair and in neighborhoods without sidewalks, with high social deprivation, and in nonmetropolitan counties. Home disrepair, lack of sidewalks, and residence in a nonmetropolitan county were important fall-risk factors among White older adults only. Financial hardship was an important risk factor among Black older adults. Discussion: Environmental factors are associated with recurrent falls among older Americans and should be incorporated into fall-risk profiles and prevention efforts.