Formal and Informal Care Use Over the Course of Cognitive Deterioration Among Adults With a Disability

Abstract The dynamics between formal and informal care among persons with a disability may substantially differ over the course of their cognitive decline. Based on a nationally representative study of older adults, the analysis sample included 3,685 individuals who had at least one activity of daily living (ADL) limitation. We estimated probabilities of using formal care and informal care in the years before and over the course of dementia after controlling for sociodemographic factors, survey mode, and proxy interview status. The adjusted probability of receiving care from an informal helper increased before the onset of dementia: 36% in 4 years prior to the onset (T=-4); 46% at T=-2. In contrast, the increase in the probability of using formal care was pronounced primarily at the onset of dementia; for example, the probability of overnight nursing home stay was 12% at T=-2 vs. 31% at T=0, which continued to increase over the subsequent years (39% at T=6). The probability of using nursing home care at the onset was significantly greater for women vs. men (Adjusted risk ratio (ARR)=1.21; p=0.010); non-Hispanic white vs. Hispanic (ARR=1.62; p=0.004); those with low vs. high wealth (ARR=1.60; p < 0.001); those without a spouse vs. with a spouse prior to the onset (ARR=1.39; p < 0.001); and those with all adult children living far vs. at least one coresident adult child prior to the onset (ARR=1.51; p= < 0.001). Public policies and interventions aimed at providing for the needs of people with dementia should consider disparities in care use across racial/ethnic and socioeconomic groups.


FORMAL AND INFORMAL CARE USE OVER THE COURSE OF COGNITIVE DETERIORATION AMONG ADULTS WITH A DISABILITY
HwaJung Choi, 1 Kenneth Langa, 1 Edward Norton, 1 Tsai-Chin Choi, 1 and Cathleen Connell, 2 1.University of Michigan,Ann Arbor,Michigan,United States,2. University of Michigan School of Public Health,Ann Arbor,Michigan,United States The dynamics between formal and informal care among persons with a disability may substantially differ over the course of their cognitive decline.
Based on a nationally representative study of older adults, the analysis sample included 3,685 individuals who had at least one activity of daily living (ADL) limitation.We estimated probabilities of using formal care and informal care in the years before and over the course of dementia after controlling for sociodemographic factors, survey mode, and proxy interview status.
The adjusted probability of receiving care from an informal helper increased before the onset of dementia: 36% in 4 years prior to the onset (T=-4); 46% at T=-2.In contrast, the increase in the probability of using formal care was pronounced primarily at the onset of dementia; for example, the probability of overnight nursing home stay was 12% at T=-2 vs. 31% at T=0, which continued to increase over the subsequent years (39% at T=6).The probability of using nursing home care at the onset was significantly greater for women vs. men (Adjusted risk ratio (ARR)=1.21;p=0.010); non-Hispanic white vs. Hispanic (ARR=1.62;p=0.004); those with low vs. high wealth (ARR=1.60;p < 0.001); those without a spouse vs. with a spouse prior to the onset (ARR=1.39;p < 0.001); and those with all adult children living far vs. at least one coresident adult child prior to the onset (ARR=1.51;p= < 0.001).
Public policies and interventions aimed at providing for the needs of people with dementia should consider disparities in care use across racial/ethnic and socioeconomic groups.

GENDER DIFFERENCES IN AVOIDING LATER-LIFE DISABILITY: A LIFE COURSE PERSPECTIVE Patricia Morton, Wayne State University, Detroit, Michigan, United States
Identifying the early origins of adult health has underscored how experiences in the earliest stages of life can have lasting consequences.Whereas most research on the early origins of adult health has linked childhood conditions to worse health in adulthood, this study considered whether childhood conditions are associated with healthy aging.Guided by the World Health Organization's emphasis on functional ability as a core component of healthy aging, the present study investigated the association between childhood social conditions and avoiding later-life limitations in basic and instrumental activities of daily living, referred to as disability-free status.This study also tested potential health-related and socioeconomic mediators and examined whether these life course antecedents of healthy aging vary by gender.Analyzing a sample of 9,376 adults over age 50 from the Health and Retirement Study over 10 years (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) revealed that childhood socioeconomic disadvantage reduced the odds of avoiding disability over time.For women, adult health lifestyles mediated this relationship whereas adult socioeconomic status (SES) mediated this relationship for men.Conditional indirect effects indicated that the mediational effects of body mass and education differed between men and women (i.e., moderated mediation).The direct effects of childhood and adult SES also varied by Innovation in Aging, 2021, Vol. 5, No. S1 201