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. 2023 Mar 21;7(4):igad028.
doi: 10.1093/geroni/igad028. eCollection 2023.

Trends in Gender and Racial/Ethnic Disparities in Physical Disability and Social Support Among U.S. Older Adults With Cognitive Impairment Living Alone, 2000-2018

Shanquan Chen  1   2 , Huanyu Zhang  3 , Benjamin R Underwood  1   4 , Dan Wang  5   6 , Xi Chen  7 , Rudolf N Cardinal  1   4
Affiliations

Trends in Gender and Racial/Ethnic Disparities in Physical Disability and Social Support Among U.S. Older Adults With Cognitive Impairment Living Alone, 2000-2018

Shanquan Chen et al. Innov Aging. .

Abstract

Background and objectives: Informal care is the primary source of support for older adults with cognitive impairment, yet is less available to those who live alone. We examined trends in the prevalence of physical disability and social support among older adults with cognitive impairment living alone in the United States.

Research design and methods: We analyzed 10 waves of data from the U.S. Health and Retirement Survey spanning 2000-2018. Eligible people were those aged ≥65, having cognitive impairment, and living alone. Physical disability and social support were measured via basic and instrumental activities of daily living (BADLs, IADLs). We estimated linear temporal trends for binary/integer outcomes via logistic/Poisson regression, respectively.

Results: A total of 20 070 participants were included. Among those reporting BADL/IADL disability, the proportion unsupported for BADLs decreased significantly over time (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.97-0.99), and the proportion unsupported for IADLs increased (OR = 1.02, CI 1.01-1.04). Among those receiving IADL support, the number of unmet IADL support needs increased significantly over time (relative risk [RR] 1.04, CI 1.03-1.05). No gender disparities were found for these trends. Over time, Black respondents had a relatively increasing trend of being BADL-unsupported (OR = 1.03, CI 1.0-1.05) and Hispanic and Black respondents had a relatively increasing trend in the number of unmet BADL needs (RR = 1.02, CI 1.00-1.03; RR = 1.01, CI 1.00-1.02, respectively), compared to the corresponding trends in White respondents.

Discussion and implications: Among lone-dwelling U.S. older adults with cognitive impairment, fewer people received IADL support over time, and the extent of unmet IADL support needs increased. Racial/ethnic disparities were seen both in the prevalence of reported BADL/IADL disability and unmet BADL/IADL support needs; some but not all were compatible with a reduction in disparity over time. This evidence could prompt interventions to reduce disparities and unmet support needs.

Keywords: Cognitive impairment; Gender disparity; Physical disability; Racial/ethnic disparity; Social support.

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Conflict of interest statement

Authors of this article have the following competing interests: S.C., H.Z., B.R.U., D.W., and X.C. declare no conflict of interest with this work. R.N.C. consults for Campden Instruments Ltd and receives royalties from Cambridge University Press, Cambridge Enterprise, and Routledge.

Figures

Figure 1.
Figure 1.
Time trends in the prevalence of BADL or IADL disability and social support among cognitively impaired older adults living alone in the United States, biennially from 2000 to 2018. BADL = basic activity of daily living; IADL = instrumental activity of daily living. The left panel presents the weighted percentage of BADL or IADL disability estimated from raw data, with error bars represent 95% confidence intervals (CIs). The dotted lines in the left panel show linear regression on the weighted percentage of BADL or IADL disability. The right panel shows the estimated time trend in the prevalence of BADL or IADL disability. Trends were measured via the adjusted odds ratio (OR) and its 95% CI, obtained from the coefficient of the “year” predictor in the logistic regression, controlling for age, gender, race/ethnicity, whether a proxy response was required, and dementia status. OR > 1 indicates an increasing trend in the prevalence across the study years, and OR < 1 indicates a decreasing trend.
Figure 2.
Figure 2.
Time trends in the number of unmet BADL or IADL support needs among cognitively impaired adults living alone who were receiving BADL or IADL support, biennially from 2000 to 2018. BADL = basic activity of daily living; IADL = instrumental activity of daily living. The left panel presents the weighted mean number of unmet BADL or IADL support needs estimated from raw data, with error bars representing 95% confidence intervals (CIs). The dotted lines in the left panel show linear regression on the weighted mean number of unmet BADL or IADL support needs. The right panel shows the estimated time trend in the number of unmet BADL or IADL support needs. Trends were measured via the adjusted relative risk (RR) and its 95% CI, which was obtained from the coefficient of the “year” predictor in the Poisson regression, controlling for age, gender, race/ethnicity, whether a proxy response was required, and dementia status. RR > 1 indicates an increasing trend in the number of unmet BADL or IADL support needs across the study years, and RR < 1 is the converse.
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