Kinship and Care: Racial Disparities in Potential Dementia Caregiving in the United States From 2000 to 2060Feng, Kai; Song, Xi; Caswell, Hal
2024 Journals of Gerontology - Series A: Biological Sciences and Medical Sciences
doi: 10.1093/gerona/glae106pmid: 38642100
BackgroundAlthough the family plays a pivotal role in older adults’ care, there is limited research on how evolving demographic trends affect older adults’ support networks and how the trends vary by race. To fill this gap, we examine the influence of shifting family demographics on future care needs for older adults with dementia, emphasizing the unequal health and potential caregiving burdens by race in the United States.MethodsUsing demographic models of kinship, we estimate the availability of potential caregivers, and dementia prevalence among one’s kin by race, kin type, and the age of a focal person from 2000 to 2060. We introduce an index called the Dementia Dependency Ratio to assess dementia caregiving demands at the population level, taking into account the age and kinship structure of the population.ResultsOur findings suggest that Black individuals tend to have more children, grandchildren, and nieces/nephews as they age. However, Black individuals also tend to have more kin with dementia compared to their White counterparts. This elevated prevalence of dementia among Black kinship networks counterbalances the advantage of having more kin as potential caregivers. A further projection analysis suggests that the racial gap in caregiving demand within the kinship network will widen in the next 4 decades if the racial gap in dementia prevalence remains unchanged.ConclusionsThese findings emphasize the urgency of reducing racial inequality in dementia prevalence rates and increasing public support for families with extended members affected by dementia. With the shrinkage of nuclear families and population aging in the next few decades, extended family members may undertake more caregiving responsibilities for dementia. We call for a kinship perspective in understanding dementia care in future research.
Care Need, Caregiver Availability, and Care Receipt: Variations Across Countries and Over Time in Three Middle-Income CountriesPark, Hae Yeun; Phillips, Drystan; Wilkens, Jenny; Lin, Zhiyong; Angrisani, Marco; Lee, Jinkook
2024 Journals of Gerontology - Series A: Biological Sciences and Medical Sciences
doi: 10.1093/gerona/glae141pmid: 38894603
BackgroundDementia is expected to increase more rapidly in low- and middle-income countries (LMIC) than in high-income countries (HIC) in the coming decades. Nevertheless, research on dementia care remains limited for LMIC. This study aims to fill this gap by investigating care needs and care receipt in 3 LMIC: China, Mexico, and India.MethodsUsing harmonized data from the Gateway to Global Aging Data in China, Mexico, and India and focusing on individuals aged 65 and older with cognitive impairment (N = 15 118), we estimated the proportions of care needs related to difficulties with activities of daily living and instrumental activities of daily living, and care receipt. We then used logistic regressions to examine the association between caregiver availability and informal care receipt.ResultsWe observed relatively similar patterns in care need measures across countries and over time. In contrast, the association between caregiver availability and informal care receipt showed some cross-country variations. Generally, living with family members was associated with a higher probability of receiving informal care in China and India. However, for Mexico, this association was only evident for men. Additionally, we found that the magnitude of the association between caregiver availability and informal care receipt varied with the care recipient’s gender.ConclusionsAlthough living with family members was generally associated with a higher likelihood of receiving informal care in China, Mexico, and India, there are differences in the association between caregiver availability and informal care receipt across countries and over time.
Dementia Prevalence, Incidence, and Mortality Trends Among U.S. Adults Ages 72 and Older, 2011–2021Freedman, Vicki A; Cornman, Jennifer C
2024 Journals of Gerontology - Series A: Biological Sciences and Medical Sciences
doi: 10.1093/gerona/glae105pmid: 38642407
BackgroundU.S.-focused studies have reported decreasing dementia prevalence in recent decades, but have not yet focused on the implications of the coronavirus disease 2019 (COVID-19) pandemic for trends.MethodsWe use the 2011–2021 National Health and Aging Trends Study (N = 48 065) to examine dementia prevalence, incidence, and mortality trends among adults ages 72 and older, and the contribution to prevalence trends of changes in the distribution of characteristics of the older population (“compositional shifts”) during the full and prepandemic periods. To minimize classification error, individuals must meet dementia criteria for 2 consecutive rounds.ResultsThe prevalence of probable dementia declined from 11.9% in 2011 to 9.2% in 2019 and 8.2% in 2021 (3.1% average annual decline). Pre-pandemic declines continued for women and non-Hispanic White individuals and emerged over the 2011–2021 period for men and those ages 80–89. Declines in dementia incidence were stronger for the 2011–2021 period than for the prepandemic period, while mortality among those with dementia rose sharply with the onset of the COVID-19 pandemic. Shifts in the composition of the older population accounted for a smaller fraction of the decline over the full period (27%) than over the prepandemic period (45%).ConclusionsDeclines in dementia prevalence continued into years marked by onset of the COVID-19 pandemic, along with declines in incidence and sharp increases in mortality among those with dementia. However, declines are no longer largely attributable to compositional changes in the older population. Continued tracking of dementia prevalence, incidence, and mortality among those with and without dementia is needed to understand long-run consequences of the pandemic.
Projecting Long-Term Care Costs Among Older Adults With ADL Disabilities and Cognitive Impairment in ChinaJin, Haiyu; Wu, Chenkai
2024 Journals of Gerontology - Series A: Biological Sciences and Medical Sciences
doi: 10.1093/gerona/glae140pmid: 38801341
BackgroundMounting evidence suggests that cognitive impairment is strongly associated with disability in activities of daily living (ADL disability) and long-term care (LTC) costs. However, studies forecasting future LTC costs often overlook these relationships. Consequently, this study aims to more accurately project future LTC costs in China over the next 20 years by considering the intertwined association between disability and cognitive impairment on future LTC costs.MethodsData were from 10 959 adults ≥65 years from the 2005–2018 waves of the Chinese Longitudinal Healthy Longevity Surveys. We used the Markov model to project the population of China and track the transition of older adults in the next 20 years between 4 disability–cognition states. We employed a 2-part model to estimate LTC costs (direct and indirect LTC costs) per capita.ResultsThe proportion of disabled older adults with cognitive impairment was projected to increase from 1.4% in 2021 to 3.4% in 2040, while that of those without cognitive impairment was projected to decrease from 4.7% in 2021 to 4.5% in 2040. The direct and indirect LTC costs were projected to increase from 0.3% and 0.2% of gross domestic product (GDP) in 2021 to 1.4% and 0.7% in 2040 for disabled persons without cognitive impairment and from 0.1% and 0.1% of GDP in 2021 to 1.3% and 1.3% in 2040 for those with cognitive impairment, respectively.ConclusionsPolicy-makers could include the assessment of cognition in the LTC needs assessment and allocate more compensation to LTC insurance participants with cognitive impairment.
Trends in Memory Function and Memory Impairment Among Older Adults in the United States and Europe, 1996–2018Myrskylä, Mikko; Hale, Jo Mhairi; Schneider, Daniel C; Mehta, Neil K
2024 Journals of Gerontology - Series A: Biological Sciences and Medical Sciences
doi: 10.1093/gerona/glae154pmid: 38953519
BackgroundSingle-country studies document varying time trends in memory function and impairment. Comparative analyses are limited.MethodsWe used self-respondent data on adults aged 50+ years in 13 countries from 3 surveys (United States: Health and Retirement Study, 1998–2018; England: English Longitudinal Study of Ageing, 2002–2018; 11 European countries: Survey of Health, Ageing and Retirement in Europe, 2004–2019). Memory is measured with tests of immediate and delayed word recall. Unweighted age- and gender-adjusted mixed effects regression models as well as models with adjustments for additional sociodemographic characteristics and health behaviors were examined. Heterogeneity in trends by gender, age group, and educational attainment was measured.ResultsThe age-adjusted 10-year improvement in average test score is 0.04 standard deviations (SDs) (95% confidence interval [CI]: 0.03, 0.05) in the United States, 0.17 SDs (95% CI: 0.15, 0.19) in England, and 0.24 SDs (95% CI: 0.23, 0.25) in SHARE countries. Trends are largely similar across gender, age groups, and educational attainment. Regional differences in trends remain after adjustment for potential mechanisms. The difference between the United States and other countries is particularly large under 75 years of age compared to 75 years and older.ConclusionsPace of improvement in memory function varies strongly across countries. On average, the 11 European countries studied had the fastest improvement, followed by England. The trend in the United States indicates improvement, but at a much slower pace compared to that in England and other European countries. Uncovering the causes for the cross-country heterogeneity in time trends, and in particular the reasons for the comparatively poor performance of the United States, should be both a research and public health priority.
Trend in Respite Use by Race Among Caregivers for People Living With DementiaKim, Yeunkyung; Kim, Jihye; Kim, Hyunjee; Park, Sungchul; Li, Yue
2024 Journals of Gerontology - Series A: Biological Sciences and Medical Sciences
doi: 10.1093/gerona/glae036pmid: 38306603
BackgroundRespite care provides short-term relief for caregivers. Despite efforts to promote respite use among Black caregivers, little is known if disparities in respite use between Black and White dementia caregivers have decreased over time. We examined a trend nationally to see if more recent efforts may have helped reduce disparities in respite use.MethodsWe used a repeated cross-sectional design, with the data from 2015, 2017, and 2021 of the National Health and Aging Trends Study and National Study of Caregiving. Our study sample included 764 (in 2015), 839 (in 2017), and 521 (in 2021) non-Hispanic White and Black caregivers who provided care to older adults living with dementia, representing weighted 5 157 569 (2015), 5 877 997 (2017), and 4 712 144 (2021) dementia caregivers nationally. We conducted logistic regression models to assess the differences in respite use between White and Black caregivers over time.ResultsIn 2015, Black dementia caregivers had a respite care use rate 11.6 percentage points (95% CI: −16.9 to −6.4) lower than that of White dementia caregivers. However, both in 2017 and 2021, the difference in the use of respite was not statistically significant, leading to a reduced or no gap in respite use between White and Black dementia caregivers. However, respite use remained low in both groups.ConclusionsAlthough the gap in respite use between Black and White dementia caregivers had been gradually narrowed over time, more efforts are needed to encourage more respite use among both groups through targeted efforts to address factors that hinder respite use.