OBJECTIVE:Patient-physician relationships are central to effective healthcare, yet the role of older adults' proactive health behaviors in shaping trust in communication remains unclear. Guided by the health care partnership model and communication accommodation theory, this study examined the association between proactive health behaviors and trust in physician communication over time, and whether perceived physician caring and partnership moderate this association. METHODS:Data were drawn from a three-wave longitudinal survey of 292 community-dwelling older adults in Miami, Florida (M = 76.4 years, SD = 7.9), and analyzed using multilevel modeling to capture both within-person and between-person effects. RESULTS:Results indicated that higher proactive health behaviors were associated with lower trust in physician communication at both within-person (B = -0.20, p < .001) and between-person levels (B = -0.33, p < .001). Perceived caring from the physician mitigated this negative association at within-person (B = 0.32, p < .001) and between-person levels (B = 0.15, p < .001). In contrast, perceived partnership moderated the association only at the between-person level (B = 0.11, p < .001). CONCLUSIONS:These findings underscore that the association between proactive behaviors and trust in physician communication is context dependent. Physician caring and partnership can mitigate the negative association between proactivity and trust. The study highlights the unique perspectives of older adults, emphasizing the importance of fostering physician receptiveness, recognizing patients' proactive health behaviors, and collaborative communication to support effective patient-centered care.

Caregiving is a demanding role that can result in significant psychological strain. Many caregivers experience increased stress, depression, and other negative psychological outcomes due to the intensity and duration of their caregiving responsibilities. Guided by social exchange theory (Thibaut & Kelley, 1959) and the stress process model (Pearlin et al., 1990), this study examines perceived appreciation role as a psychological resource that can impact caregivers' well-being and work as a positive caregiving environment. Further, we aim to provide insights into gender differences by examining caregiving intensity and perceived appreciation from the caregivers' perspective. Using data from 2015 and 2017 waves of the National Study of Caregiving (NSOC), we analyzed responses from 3,061 informal caregivers (Mean age = 61.96 years) through moderating regression analysis. Findings indicated that high levels of perceived appreciation mitigate the negative effects of caregiving intensity on role overload while promoting mental health and self-realization. Notably, perceived appreciation promoted self-realization in male caregivers, whereas it more strongly buffered the negative effects of caregiving intensity on mental health and role overload among female caregivers. These results highlight the importance of fostering environments where caregivers feel valued and recognized, with particular attention to gender differences in psychological well-being and caregiving experiences.

OBJECTIVES:We examine the association between formal support and caregiver well-being. The extant literature indicates that formal support often correlates with worse caregiver mental health outcomes. We tested whether timing of formal support use, rather than the services themselves explain prior findings. METHOD:Using National Study of Caregivers data (NSOC 2015, 2017, & 2021), we analyzed the association between formal support utilization and caregiver mental health. We employed linear regression and Two-Stage Least Squares (N = 3,963) approach to address endogeneity and unobserved caregiver demand. RESULTS:The results indicated positive or non-significant associations between formal support and mental health outcomes. However, formal support is negatively associated with depressive symptoms (β = -0.40) and generalized anxiety (β = -0.44) when instrumentalizing formal support as a function of caregiver demand for services. When strain on a caregiver is high (i.e. high overload, working, and high frequency caregiving activity), there is a higher propensity for utilizing formal support. Caregivers with high strain showed higher propensity for formal support utilization. CONCLUSION:The results highlight that underlying demand functions are important mental health predictors as the negative impacts of caregiver strain may limit the efficacy of formal support services.

Respite care provides a relief to family caregivers by temporarily stepping in to provide care for older adults. Prior literature has shown that respite care services can improve both physical and mental health outcomes for caregivers and care recipients. Despite these benefits, respite utilization remains low, and little is known about the profiles of caregivers and care recipients who uses respite care. Using 2015, 2017 and 2021 National Health and Aging Trends Study (NHATS) and National Study of Caregiving (NSOC), we examined the prevalence and associates of respite usage among family caregivers of older adults. Our study sample represented weighted 15,329,939 caregivers, with average age around 59.14 years. 16.45% caregivers used respite care services. Findings revealed that caregivers with higher income and education levels were more likely to use respite. Those with higher emotional burdens, including feeling little joy in caregiving (6.0 percentage points more, p < 0.001), and struggling emotionally with caregiving responsibilities (5.62 percentage points more, p < 0.001), were more likely to use respite. Older care recipients with Medicaid coverage (5.8 percentage point more, p < 0.01), dementia diagnosis (9.76 percentage points more, p < 0.001) and more chronic conditions (5.23 percentage points more, p = 0.02) were positively associated with respite usage of caregivers. Our results suggests the current respite care demand is driven by caregivers’ desire to reduce caregiving burden, as well as the care recipient’s Medicaid status. The results underscore the need for expanded respite care funding and policies to improve access for low-income caregivers and those with emotionally and financially challenging circumstances.

OBJECTIVES:This study examines the extent to which communications via social networking sites (SNS) ameliorates the emotional distress associated with isolation and loneliness among older adults. METHOD:We utilize the Health and Retirement Study (HRS) for survey years 2014, 2016, and 2018 (N = 8,466). The sample consists of adults (55+) who participated in the Psycho-Social module. Utilizing random-effects linear regression models, we test associations of isolation and loneliness on emotional distress outcomes, including depression, negative affect, and positive affect. Additionally, we assessed whether communications via SNS moderate these relationships. RESULTS:Loneliness, compared to isolation, is consistently associated with emotional distress among older adults. SNS attenuates mental and emotional distress among those who are objectively isolated while magnifying the negative impacts of loneliness. The associations between SNS communications and emotional distress are conditional on degrees of isolation and loneliness. In particular, greater SNS use is associated with higher negative affect among those who feel lonely but higher positive affect among those who are isolated. CONCLUSION:SNS may offset social isolation among older adults, whereas heavy reliance on SNS when one feels lonely may amplify that internalization. Assessments of social technology would benefit from distinguishing isolation and loneliness conditions.

Caregivers increasingly experience disruptions to their social activities due to their caregiving responsibilities. While previous studies have highlighted the negative impact of such disruptions on caregivers’ quality of life, the longitudinal relationship between disrupted activities and the values caregivers place on those activities remains underexplored. Using data from the National Study of Caregiving (NSOC) across three waves (N = 2328), this study examines how disrupted activities and their value change over time and their interaction with caregiver outcomes. Findings from multilevel modeling reveal that caregivers who experienced significant disruptions to their activities while attaching a high value to them reported a rapid increase in negative relationships and burnout over time. Conversely, caregivers who experienced high disruption but placed lower value on these activities showed a more moderate increase in both negative relationships and burnout. Caregivers with lower disruption and lower attachment to activities experienced only a slight increase in these outcomes. These findings underscore the critical role that the interruption of activities and the value placed on those activities play in shaping caregivers’ mental health outcomes. From a practical perspective, this study highlights the importance of considering the meaning caregivers attach to their activities when developing interventions to support their mental well-being. Practitioners should be aware that caregivers who find meaning in their social activities may be at greater risk for burnout and adverse relational outcomes when disrupted. Thus, strategies should focus on providing support for both activity continuity and emotional attachment to activities.

Certain personality types (i.e. neuroticism) are often accompanied by higher risks of cognitive decline, whereas others of the “big five” (i.e. conscientiousness) correspond with lower risks. However, such associations largely focus on independent associations of personality types and cognitive health. We extend this literature by focusing on the connections between personality types and personal behaviors, specifically the extent to which older adults engage in social and non-social activities. Utilizing a person-environmental fit perspective, this study examines not only the associations between activity associations and cognitive decline but also whether the configurations of personality-activity dimensions amplify such activity effects. Using the Health and Retirement Study (N = 3,380), we run a series of logistic regressions results predicting dementia. Preliminary findings suggest that social activities significantly correspond with reduced odds of dementia. However, the positive and significant interaction of neuroticism and social activities (OR = 1.63) indicate that social activities have increasingly reduced benefits for those with higher levels of neuroticism. Conversely, those with the lowest conscientiousness scores, social activities increase dementia risk by 461% (OR = 5.61) with the caveat that each additional unit increase in conscientiousness scores reduce the odds of social activities by 42% (OR = 0.58). In other words, conscientiousness appears to enhance the protective effects of social activities against dementia risk. The observed relationships highlight that social engagement or activities and their alignments with personality types may represent modifiable factors associated with dementia risk. Thus, future research may benefit from more nuanced understandings of activities as conditional to personal and environmental fits.

OBJECTIVES:In this study, we examined the extent to which older adult social activity participation and perceptions of neighborhoods correspond with risks of cognitive impairment with no dementia (CIND) and dementia. METHODS:We predicted the risk of both CIND and dementia in a series of Cox proportional hazards analyses among older adults across a 10-year period. Utilizing data from the Health and Retirement Study (HRS, N = 15,020), we examined whether social activity participation corresponded with reduced risk of CIND and dementia, as well as whether perceptions of neighborhood conditions, social cohesion, and neighborhood disorder moderated the effects of social activity participation. RESULTS:The results showed that the hazards of both CIND and dementia were reduced with successive increases in social activity participation. However, those risks, particularly for dementia risk, were further reduced when older adults perceived their neighborhoods to be more cohesive (hazard ratio [HR] = 0.75). On the other hand, older adults who perceived their neighborhoods to have high disorder were observed to have an amplified risk of dementia (HR = 1.36). DISCUSSION:The findings suggest that social activity participation confers important protections against cognitive decline and dementia risk; however, such protections may also be conditional on perceptions of neighborhood characteristics. Thus, how older adults interact with their social environments, understood as a meso-scale interaction that links micro and macro systems, can characterize the impacts and opportunities of individual social and health behavior.

ObjectiveThis study assesses the role of retirement as an equalizer for couple's housework production in tandem with changing demands for different types of housework after retirement.BackgroundRetirement has received attention as an equalizer for household gender inequality. Among various changes brought by retirement, changing demands for housework can have different implications depending on chore types due to gender task segregation.MethodsUsing the Health and Retirement Study from 976 couples (N = 3,404) and fixed effects models, we predict the difference between husbands' and wives' housework time among different-gender married dual-earner couples as a function of retirement arrangements, time spent on feminine- and masculine-typed chores, controlling for sociodemographic characteristics and time.ResultsCouple's retirement arrangements were generally not independently associated with housework gender inequality, but they moderated the effects of demands for gender-normative tasks. Consistent with the prediction that feminine-typed chores fall upon wives and masculine-typed chores on husbands, couples were more egalitarian when there was less feminine-typed chore to distribute. More masculine-typed chore contributed to gender equality but only under limited circumstances.ConclusionWe found some evidence of gender task segregation but limited support for retirement as an equalizer. Even though husbands' retirement brings an opportunity to improve housework gender equality, the success depends on the level of demands for gender-normative tasks.ImplicationsThis study highlights how gender ideological scripts can frame relational expectations and persist despite shifts in economic contributions to the household.

Research on grandparenting has found seemingly contradictory patterns: grandparental childcare is often linked to poorer well-being, but grandparenting is also associated with reduced loneliness. These inconsistencies highlight that grandparenting is not a monolithic experience. However, little attention has been paid to the different profiles of grandparent–grandchild interaction, as prior work has typically treated it as either caregiving or leisure. This study identifies profiles of grandparenting—care only, activity only, and care combined with activity—and examines how these relate to grandparents’ loneliness. Using the last four waves of the Health and Retirement Study (2016, 2018, 2020, 2022; N = 7,586), we estimate random-effects panel models with clustered standard errors. We find that providing care in the absence of activities was associated with significantly greater loneliness, suggesting that purely instrumental caregiving can be burdensome. In contrast, engaging in activities with grandchildren was consistently linked to reduced loneliness, with the strongest protective effect at moderate activity levels. At higher activity levels, caregiving embedded in shared interactions buffers the negative effect of caregiving alone, and in some cases caregivers report less loneliness compared to non-caregiver grandparents. These findings suggest that the well-being consequences of grandparenting are conditional on the balance between caregiving and activity. This study underscores the importance of supporting shared, meaningful activities to strengthen intergenerational ties and reduce loneliness among older adults.

The gap between the need for respite services and caregiver abilities to access them is well documented. (AARP, 2024). One reason for this gap is that many caregivers lack information regarding the cost and availability of respite services (Castro et al., 2023). Previous studies found that getting information on respite services can be cumbersome and the accessed information may be incomplete. (Leocadie et al., 2018). Drawing on institutional models of organizational behavior, we distinguish among three major types of information contexts: 1) Individualized, 2) Community-Level, and 3) Public-Level. The objective of our study is to examine the impact of information gathering on utilization of respite care among caregivers. Using data from the National Study of Caregivers (NSOC), we found that caregivers who seek information in the individual sphere have 16% higher odds (OR = 1.16) of using respite services whereas those who received information from community (OR = 0.82) or public (OR = 0.86) spheres have between 18% and 14% lower odds of using respite services. Rather, caregivers relying on community and public sphere for information had higher odds of receiving caregiving training and utilizing support group services. The results suggest that while individuals are more likely to seek functional, and costly, support via respite, public information sources are more likely to direct caregivers toward individualized self-help approaches via training to enhance caregiving activities or support group coping. These findings suggest that caregiver support policies should account for how informational disparities can create qualitative differences in formal support use.

Abstract The rise of health care consumerism, facilitated by the internet use, empowers patients to seek information beyond their physicians (Martijn et al., 2020). Extant studies have shown that this shift toward healthcare consumerism, characterized by self-care movements such as proactive attitude and seeking health information (Haug, 1979), could challenge the patient-physician relationship (Haluza et al., 2017). On the other hand, the patient-physician relationship could be strengthened when patients feel a connection with their physician who show caring attitudes (Takeshita et al., 2020). Drawing data from 232 older adults (M= 76.16 years, SD= 8.27) in Miami, we examined the association between healthcare consumerism and patient-physician relationships using multiple linear regression. Respondents were randomly sampled from a probability-based research panel of community-dwelling older residents of Miami, Florida. The data showed that higher healthcare consumerism was linked with lower levels of patient-physician relationships. A moderation analysis revealed that greater perceived care from physicians and partnership attenuated the association between health consumerism (e.g., proactive attitude, health information seeking) and the patient-physician relationship. The findings highlight the significance of perceived caring and partnership in fostering strong patient-physician relationships. Findings suggest that healthcare consumerism, a growing trend, does not have to come at the expense of patient-physician relationships. By cultivating a sense of caring and patient-physician partnerships, healthcare providers can help build trust and collaboration, culminating into a more positive healthcare experience for patients.

The present study examines the extent to which a two-factor model of affect explains how caregiving appraisals experienced by caregivers influence their own well-being. We used data from three waves of Nation Study of Caregiving (NSOC) to conduct latent growth curve models with the time-varying predictors to investigate the effect of between-person (BP) and within-person (WP) caregiving appraisals on positive and negative affect. Furthermore, we simultaneously modeled WP differences in activity participation and affective experience with multilevel modeling. Then, we tested the moderating effect of activity participation in the association between WP caregiving appraisals and emotional valence. We found that BP and WP caregiving negative appraisal also contribute to caregiver positive affect similar to that of negative affect. Time-varying effects of negative appraisals and emotional valence are consistent with the two-factor model. Future longitudinal investigations could target WP and BP activity participation to alleviate caregiving cognitive appraisal among caregivers.

Abstract A growing body of research indicates that caregiver networks constitute an important resource for older adult well-being as well as the adult caregivers themselves. Among dementia patients, caregiver networks often face heightened strain and burdens which correspond with poor overall health of all caregivers. However, the condition of a caregiver network is also shown in the literature to have a direct impact on the quality of care that is provided. This study examines the bi-directional nature of caregiver and care-recipient outcomes by examining the extent to which lagged measures of caregiver network burden corresponds with current dementia risk for older adults. We utilize data from the National Health and Aging Studies (NHATS) and the National Study of Caregiving (NSOC) to test associations of lagged caregiver burden within networks (e.g., financial, emotional, or physical difficulties) with care recipient dementia classifications (e.g. no dementia, possible dementia, probable dementia). Results from multinomial logistic regressions of four NSOC-NHATS data waves (N = 1,343) indicate that the odds of older adult possible dementia increase by 1% (OR = 1.01, p < 0.01) with each additional percentage increase in emotional difficulty shares within networks from the previous wave. Moreover, the odds of probable dementia increase by 2% (OR = 1.02, p < 0.01) with regards to both emotional and physical difficulty shares within caregiver networks. These findings suggest the importance of developing interventions that address diverse burdens by strengthening care coordination, communication, and support across network members to improve the cognitive health outcomes of older adults.

Civil engineering students in the United States rarely receive instruction about how their work affects social inequities. Indeed, research reveals that most engineering students lack critical consciousness and fail to recognize and analyze real social inequity challenges as they arise in engineering contexts. As history demonstrates, this can lead to engineering projects that exacerbate inequality, ignore community questions and concerns, or fail to consider the consequences of communities when assessing project success. A key component to addressing these issues includes educators' ability to evaluate the critical consciousness (CC) of civil engineering students using survey approaches. Toward this goal, this research tested a critical consciousness scale for civil engineers (CCSCE). The CCSCE scale summarizes and factorizes 46 items that capture systems of oppression in civil engineering. The instrument included three indicators measuring critical consciousness (i.e., Critical Reflection: Perceived Inequality; Critical Reflection: Egalitarianism; and Critical Action: Sociopolitical Perception). The CCSCE scale was tested with 150 students at two universities in the United States. Exploratory factor analysis revealed a set of 15 items measuring critical reflection and action items. This study supports the development of concise measures of CC for civil engineers that is valid and reliable. The development of a CCSCE scale is vital for civil engineering education as it provides educators with an instrument to assess whether any educational interventions aimed at enhancing CC are indeed efficacious. The instrument can also be used to assess Accreditation Board of Engineering & Technology (ABET) learning Outcomes 2 and 4.

OBJECTIVES:This study seeks to assess whether and to what extent caregiver work strain is ameliorated by the presence of additional family caregivers and formal service use. Building on the stress process model and stress-appraisal moderation, we examine how formal and informal support varies in associations with caregiver distress for men and women. METHODS:This study utilizes data provided by the National Study of Caregiving, which is linked with care-recipient information from the National Health and Aging Trends Study. Using panel methods for the pooled waves, we estimated caregiver outcomes of emotional well-being on the intersection of experiences of work strain and (a) the number of additional caregivers and (b) utilization of 6 different types of formal support. RESULTS:Additional informal caregivers for each respective care recipient are associated with lower levels of distress, although utilization of formal services (paid help and Medicaid funding) is positively associated with caregiver distress. Informal support can offset the impact of work strain, but interactions are only evident for women caregivers. DISCUSSION:The findings suggest that informal support, exemplified by the number of additional caregivers, corresponds with reduced emotional distress among employed caregivers and can mitigate the negative impacts of work strain. However, positive associations between formal support and male and female caregiver distress suggest that the context of formal services may offer limited or untimely support. This study is expected to broaden our understanding of informal caregiving in later life and provide practical implications on how to sustain informal care.

Abstract Numerous studies indicate that social isolation and loneliness are crucial predictors of cognitive decline among older adults. Specifically, cognitive functioning (i.e. memory) is positively linked with robust social connections (Kang and Oremus, 2023). While social isolation and loneliness have gained considerable attention in recent literature, there remains substantial ambiguity in the distinct impacts of isolation and loneliness where both are often treated as part of a similar construct or examined separately (Boss et al., 2015). Given the potential ramifications for cognitive functioning, as well as implications for pragmatic solutions regarding social, environmental, and technological approaches, this study seeks to examine and investigate both the independent and concurrent effects of isolation and loneliness on cognitive functioning. Using data from eight waves of Health and Retirement Study (HRS) data, we utilize fixed effects linear regression models of older adults’ (60 years or older) immediate and delayed memory recall score on measures of social isolation, feelings of loneliness, as well as their interactions (N = 44,170). Analyses emphasize within-person associations of memory and covariates. We observe significant and negative associations of isolation (coeff = -0.02, p < 0.01) and loneliness (coeff = -0.08, p < 0.01) for both immediate and delayed recall score. However, a positive and significant interaction of loneliness and isolation indicates that feelings of loneliness is more strongly associated with immediate and delayed memory when social isolation is low (frequently meets with family or friends) – when social isolation is high, the association of loneliness and cognitive functioning is limited.

Recently published professional learning outcomes require future engineers to think of the impacts that engineering decisions have on society. History shows that construction and civil engineering projects can exacerbate inequality by ignoring community concerns and failing to consider the impacts on marginalized and vulnerable stakeholders, among other factors. How might construction engineering professors help students meet these standards, and how do construction and civil engineering students respond when construction engineering is framed as inextricably linked to these obligations? We designed and evaluated curriculum modules aimed at helping develop a critical consciousness with construction and civil engineering students (N=177) in three construction and civil engineering courses at two universities in the midwestern region between 2020 and 2021. The curriculum builds on a three-phase framework aimed at encouraging students to see social inequities and their impacts, finding social inequities unjust, and enhancing reflective self-awareness. Post-implementation responses to the case study designed to make clear the need for a critical consciousness in engineering found that students responded positively to both the instructional approach of a case study and the content connected to critical consciousness. We discuss implications for the development of further curriculum and the implementation of such an approach.

Abstract Current literature on caregiving support indicates a mixed association between formal support (e.g., paid help, respite, training) and caregiver well-being. Compared to informal support from family and friends, formal support often comes with additional costs to caregivers in the form of financial, knowledge, and time barriers to access. This study seeks to examine those barriers, particularly the issue of when caregivers seek and utilize formal support as a predictor of its effectiveness. We utilize four waves of data from the National Study of Caregivers (NSOC) toward a series of fixed-effect linear regression models for caregiver emotional distress and physical health on formal support usage (N = 2,083). The dependent variable, experiencing any financial, emotional, or physical difficulties (M = 0.83, SD = 0.87), is regressed on whether the caregiver received support from paid help, financial help, or respite (M = 0.51, SD = 0.77). The findings show that formal support is positively associated with higher levels of caregiving difficulty (coeff = 0.22, p < 0.05); however, when controlling for past levels of difficulty (previous wave difficulty) and past usage of formal support (previous wave formal support), the positive association of formal support is mitigated. This suggests that the timing of adopting formal support can play a role in the challenges faced by caregivers, with earlier adoption potentially leading to reduced burdens of informal caregivers. While formal support remains positively associated with perceived difficulty, the mitigated coefficient when including lagged variables suggests that formal support effectiveness is also time sensitive.