CUMULATIVE DIS/ADVANTAGE IN HEALTH AS AN INTERGENERATIONAL PROCESS

Abstract Empirical applications of cumulative dis/advantage primarily focus on accumulative processes within an individual life course as a mechanism generating growing intracohort inequality with age. However, adult health reflects the accumulation of exposures to advantages and disadvantages across the individual life course as well as the transmission of resources and practices across generations within one’s family of origin, which forms the foundation from which children are launched and inequality is reproduced. In analyses using two panel studies (PSID and Add Health), we integrate literature on the early-life origins of health with the concept of linked lives and the intergenerational transmission of resources to examine the relationship between parents’ health and the health of their children in adulthood. Results indicate an intergenerational persistence in health and demonstrate the importance of looking beyond the individual life course to better understand cumulative dis/advantage in health as a process operating across generations within families.


LATENCY/PATHWAYS, FUNCTIONALISM/ MORPHOGENESIS: CONTRASTING PARADIGMS OF LIFE-COURSE INEQUALITY AND CHANGE
Dale Dannefer 1 , 1. Department of Sociology, Case Western Reserve University, Cleveland, Ohio, United States Attention to dis/advantage during childhood has become a major interest of life-course studies. It has been a force in advancing attention to inequality over the undifferentiated "normal aging" versions of life-course and gerontological research, making clear the irreducible importance of the presence/ absence of key resources in accounting for life-course outcomes, from early onward. Explanatory strategies set forth within this work often contrast "latency/early origins" models (with explanation anchored in the early years) with "pathways" models (which examine the independent effects of adult life-course circumstances). This paper argues that these two types of models actually are aligned with distinct conceptual paradigms that imply fundamentally different understandings of aging in society ("functionalist/organismic" and "systemic/morphogenetic"). The differential implications of these two models for the relation of cumulative dis/advantage and social change is explored.

CUMULATIVE DIS/ADVANTAGE, COHORTS, AND ECONOMIC SHOCKS BEFORE AND AFTER: LIFE COURSE INEQUALITY AND THE RECESSION
Stephen Crystal, 1 and Naomi Zewde 2 , 1. Rutgers University,New Brunswick,New Jersey,United States,2. School of Social Work,Columbia University,New York,New York,United States We examined age/cohort profiles of income inequality in the Survey of Consumer Finances for 2007, 2010, and 2016. Overall, the Gini coefficient decreased somewhat following the 2008 onset of the Recession, but rebounded by 2016 to a higher level than the 2007 baseline. Within-cohort inequality trends from 2007-2016 differed considerably across cohorts. For late baby boomers and millennials, inequality increased sharply -from .56 to .67 for the 1963-1972 birth cohort and from .49 to .60 for the 1973-1982 birth cohort. Inequality was higher at baseline for early baby boomers than later cohorts but did not increase as they moved into midlife and early late life. The Great Recession, with its large drops in asset values, initially led to slight reductions in inequality, but this effect was temporary. Late boomers and millennials experienced sharp increases in inequality following the Recession, presaging a very high-inequality late-life experience for these cohorts.

UNDERSTANDING THE ROLE OF STRESS PROCESSES IN CUMULATIVE DIS/ADVANTAGE PROCESSES Deborah Carr 1 , 1. Boston University, Boston, Massachusetts, United States
In my book Golden Years (2019), I argue that the psychosocial consequences of normal biological processes of aging are intensified for those who have had lives of disadvantage, just as the harmful consequences of life-course disadvantages are particularly acute for those experiencing age-related physical health declines. In this paper, I discuss the role of stress processes, including stress proliferation and amplification, as possible mechanisms contributing to cumulative dis/advantage. I evaluate these ideas empirically by focusing on the linkages between functional limitations (an indicator of normal biological aging) and psychological well-being in later life, and explore the extent to which these linkages are amplified diverse indicators of life course disadvantage including low education; poor-quality employment; avoidant coping strategies; and family-related strains including intensive caregiving. Analyses are based on data from the Midlife in the United States (MIDUS) study. I discuss the implications of incorporating stress process models in cumulative dis/advantage research.

CUMULATIVE DIS/ADVANTAGE IN HEALTH AS AN INTERGENERATIONAL PROCESS
Kim Shuey 1 , 1. Department of Sociology, :University of Western Ontario, London, Ontario, Canada Empirical applications of cumulative dis/advantage primarily focus on accumulative processes within an individual life course as a mechanism generating growing intracohort inequality with age. However, adult health reflects the accumulation of exposures to advantages and disadvantages across the individual life course as well as the transmission of resources and practices across generations within one's family of origin, which forms the foundation from which children are launched and inequality is reproduced. In analyses using two panel studies (PSID and Add Health), we integrate literature on the early-life origins of health with the concept of linked lives and the intergenerational transmission of resources to examine the relationship between parents' health and the health of their children in adulthood. Results indicate an intergenerational persistence in health and demonstrate the importance of looking beyond the individual life course to better understand cumulative dis/advantage in health as a process operating across generations within families.

CURRENT EFFORTS TO UNDERSTAND AND IMPROVE OLDER ADULTS' FUNCTIONAL RECOVERY AFTER HIP FRACTURE Chair: Richard H. Fortinsky, University of Connecticut School of Medicine, Farmington, Connecticut, United States Discussant: Nancy Latham, Brigham and Women's Hospital, Boston, Massachusetts, United States
The annual number of hip fractures in the US is projected to increase from 258,000 in 2010 to 458,000 by 2050. Globally, annual hip fractures are projected to reach 4.5 million by 2050. Yet the majority of older adults experience long-term mobility disability following hip fracture and do not return to pre-fracture functional capacity. Published reviews have concluded there is insufficient evidence regarding effectiveness of interventions designed to reduce residual disability and enhance mobility post-hip fracture. This Symposium features current efforts to understand and improve functional recovery post-hip fracture. Dr. Magaziner will present results from the recently-completed Community Ambulation Project (CAP), a multi-site randomized trial in which two in-home physical therapy interventions were compared: PUSH, which included aerobic conditioning, strengthening, balance and functional training; and PULSE, which included transcutaneous electrical nerve stimulation, flexibility and active range of motion exercises. Dr. Fortinsky will present CAP data examining the role of psychological resilience, optimism, depression, and balance confidence on mobility measures. Dr. Gruber-Baldini will present CAP data examining differences between PUSH and PULSE on study participants' cognition and the impact of cognition on community ambulation. Dr. Binder will present the study design and early results from the STEP-HI study, a multi-site randomized trial evaluating whether structured exercise and topical testosterone therapy can improve function post-hip fracture among older women. Discussant Dr. Latham will comment on design, results, and implications of these two studies for research, policy, and practice intended to improve older adults' recovery after hip fracture.

A MULTI-COMPONENT HOME-BASED PHYSICAL THERAPY INTERVENTION FOR IMPROVING COMMUNITY AMBULATION AFTER HIP FRACTURE Jay S. Magaziner 1 , 1. University of Maryland Baltimore School of Medicine, Baltimore, Maryland, United States
Presented is a two-group RCT evaluating a multicomponent exercise program for hip fracture patients to determine if it is effective in improving the ability to walk independently in the community. Hip fracture patients age ≥60 years (N=210) were assessed and randomized within 26 weeks of hospitalization, and reassessed 16 and 40 weeks later. The primary outcome was ability to walk 300m in six minutes. PUSH (active treatment) included aerobic conditioning, strengthening, balance and functional training. PULSE (attention control) included transcutaneous electrical nerve stimulation, flexibility and active range of motion exercises. Both groups received 2-3 visits per week for 16 weeks in their residences from a physical therapist. 22/96 in PUSH (22.9%) and 18/101 in PULSE (17.8%) (difference 5.1%; 95% CI: -6.1%, 16.3%; P=.37) became community ambulators. We conclude that advancing substantial proportions of hip fracture patients to community ambulation will require more than the intervention evaluated in this study.

PSYCHOLOGICAL FACTORS ASSOCIATED WITH AMBULATION PERFORMANCE AFTER HIP FRACTURE AMONG HOME-DWELLING OLDER ADULTS Richard H. Fortinsky 1 , 1. University of Connecticut School of Medicine, Farmington, Connecticut, United States
Many older adults fail to resume optimal community living after hip fracture due to sustained limitations in ambulation capacity, yet reasons remain poorly understood. Roles of psychological factors in affecting ambulation performance post-hip fracture remain particularly understudied; depression has been associated with poorer self-reported functional status, and little is known about self-perceived balance confidence, resilience, and optimism. This presentation reports associations between each psychological factor, measured at CAP baseline, and gait speed and walking endurance, measured at baseline and 16 weeks later. In the CAP cohort (N=210), baseline mean/sd 4-meter gait speed (gs), 50-foot walk gs, and 6-minute walk distance were: 0.60/0.19 meters per second (mps); 0.67/0.20 mps; and 186.9/55.4 meters, respectively. In multivariate models, balance confidence was positively associated with all baseline ambulation measures (p<0.001 in all models), and resilience was positively associated with all 16-week follow-up ambulation measures (p>0.05 in all models). Implications of results will be discussed.

IMPACT OF THE MULTI-COMPONENT HOME-BASED PHYSICAL THERAPY INTERVENTION ON COGNITIVE OUTCOMES IN THE CAP TRIAL
Ann Gruber-Baldini 1 , 1. University of Maryland Baltimore School of Medicine, Baltimore, Maryland, United States Cognitive impairment after hip fracture influences recovery and some RCTs suggest aerobic and resistance exercise may improve cognition. This presentation examines differences in PUSH versus PULSE on cognition and the impact of cognition on community ambulation. In CAP, the Innovation in Aging, 2019, Vol. 3, No. S1