Exploring the Social Determinants of Recovery among Older Adults

Over the past few years, I have pursued a research agenda that focuses on identifying the social determinants of recovery from physical impairment among older adults. This line of research is unique because recovery is typically overlooked by social scientists. Much of current research applies a biomedical perspective to recovery, which stresses individual-level risk factors such as disease symptoms and lifestyle, while neglecting social factors.

 

Source: Healthy People 2020: Social Determinants of Health

However, using a sociological perspective, I have identified important social determinants of recovery from physical impairment (specifically mobility limitation) among older adults. Three published articles exemplify how social factors (i.e., socioeconomic status, neighborhoods, and social relationships) shape recovery from mobility limitation (i.e., difficulty walking and climbing stairs). Below I describe the major findings from each article:

---

Latham-Mintus, K., & Aman, K. M. (2019). Childhood Disadvantage, Psychosocial Resiliency, and Later Life Functioning: Linking Early-Life Circumstances to Recovery From Mobility Limitation. Journal of Aging and Health, 31(3), 463–483. https://doi.org/10.1177/0898264317733861

This research examined the association between childhood disadvantage and recovery from mobility limitation. In general, economic and health disadvantage before age 16 was associated with lower odds of recovery from mobility limitation.

We also investigated whether certain psychosocial factors buffered the effect of childhood disadvantage on recovery outcomes. High levels of mastery protected older adults from the negative effects of financial hardship in childhood. However, low levels of mastery were particularly harmful effects among those with childhood disadvantage experiences.

This research stresses that socioeconomic status (in both childhood and adulthood) is a salient social determinant of recovery from mobility limitation. Not only do socioeconomic inequalities shape risk of mobility limitation, they also influence risk of recovery. Affluent older adults are less likely to develop mobility limitation *and* more likely to recovery when they do develop mobility limitation—ultimately contributing to socioeconomic disparities in mobility limitation and disability.

---

Latham, K., & Williams, M. M. (2015). Does Neighborhood Disorder Predict Recovery From Mobility Limitation? Findings From the Health and Retirement Study. Journal of Aging and Health, 27(8), 1415–1442. https://doi.org/10.1177/0898264315584328

This research investigated whether perceived neighborhood disorder (i.e., amount of vacant homes/buildings, litter/rubbish, vandalism/graffiti, and crime) was associated with recovery from mobility limitation. We found that higher levels of perceived neighborhood disorder decreased the odds of recovery among older adults. This suggests that an older adult’s neighborhood environment can influence whether they experience recovery from mobility limitation.

Furthermore, we tested whether psychosocial (i.e., mastery and depressive symptoms) and behavioral (i.e., physical activity) indicators were significant mediators. Both psychosocial indicators and physical activity were significant individual partial mediators. This research provides evidence that neighborhood disorder influences recovery from physical impairment via psychosocial processes and barriers to physical activity. In other words, older adults who lived in disordered neighborhoods were more likely to have low mastery, more depressive symptoms, and participate in less physical activity, which all contributed to lower odds of recovery.

“Place matters” is a key concept within the social determinants of health (SDoH) framework. A person’s environment shapes their risk of disease and disability. This research extends this line of thinking to include recovery as well.

---

Latham, K., Clarke, P. J., & Pavela, G. (2015). Social relationships, gender, and recovery from mobility limitation among older Americans. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 70(5), 769-781. https://doi.org/10.1093/geronb/gbu181

This research examined multiple dimensions of social relationships including familial social network, neighborhood engagement and embeddedness, community engagement, and instrumental support (both giving and receiving) and recovery from severe mobility limitation (i.e., difficulty walking one block or across the room). We find that providing instrumental support (i.e., helping friends and family) was associated with increased odds of partial and complete recovery from severe mobility limitation. We also examined whether there were any differences in recovery between men and women. In general, married or partnered men were more likely to recover relative to married or partnered women.

Additionally, we documented differences among men and women with regard to visiting neighbors and partial recovery. Staying engaged in the neighborhood was beneficial to both men and women, but the association was stronger in men. Disengaged women appeared to be the most vulnerable as they were the least likely to experience partial recovery.

Our findings underscore the potential for social relationships to facilitate recovery from mobility limitation. In particular, encouraging older adults with mobility limitation to provide help to friends and family may be an especially fruitful avenue for intervention.

Like the two prior articles, this research connects the social determinants of health to recovery outcomes. The social and community context can facilitate recovery from severe mobility limitation.

---

In sum, these publications underscore that social factors shape patterns of recovery among older adults, which solidly places recovery under the purview of sociologists. Given that recovery from physical impairment is largely ignored by social scientists, this line of research enables me to bring to light the social determinants that underlie the recovery process and to inform health-promotion strategies.

GSA Member Spotlight (February 2018)

Want to learn more about The Gerontological Society of America (GSA) or my research? Check out this month’s GSA Member Spotlight!

Mastery and Health Over the Life Course

Much of my recent research has explored the links between mastery and health across the life course. In general, mastery, defined as feeling like you have control over your life circumstances, is a robust predictor of better health outcomes including morbidity and mortality (Latham-Mintus & Clarke, 2017; Latham-Mintus, Vowels, & Huskins, 2017; Pearlin et al., 2007).

Mastery is thought to be an important coping resource that encourages positive health behaviors and also alleviates the effects of stress on the body. Because of the connections between mastery and health-promoting behaviors, it is often viewed as a potential avenue for intervention among older adults.

My own research, along with Philippa J. Clarke, has demonstrated that high levels of life course mastery is predictive of mobility device use among older adults with functional limitations (Latham-Mintus & Clarke, 2017). Older adults with a history of high life course mastery were more likely to use mobility devices such as walkers, wheelchairs, or canes in the face of functional impairment (see figure below).  The use of assistive technology is a health-promoting behavior, which encourages independence and greater wellbeing among older adults. This research shows that mastery across the life course has the capacity to influence health behaviors and disease/impairment management in later life.

More recent research, along with Katelyn M. Aman, examined the association between childhood disadvantage and recovery from mobility limitation (i.e., difficulty walking and climbing stairs) (Latham-Mintus & Aman, 2017). In general, economic and health disadvantage before age 16 was associated with lower odds of recovery from mobility limitation. However, we also investigated whether certain psychosocial factors buffered the effect of childhood disadvantage on recovery outcomes. Mastery was a significant moderator of childhood disadvantage (i.e., moving for financial reasons) and recovery (see figure below). Mastery may be able to diminish the negative effects of financial hardship in childhood on recovery outcomes in later life. However, it also underscores the particularly harmful effects of low mastery among those with childhood disadvantage experiences.

Source: Latham-Mintus, K. & Aman, K. M. (2017). Childhood Disadvantage, Psychosocial Resiliency, and Later Life Functioning: Linking Early-Life Circumstances to Recovery from Mobility Limitation. Journal of Aging and Health.

 

While it appears that mastery has the capacity to improve the health and wellbeing of older adults including encouraging adoption of assistive technology and buffering the adverse effects of childhood economic disadvantage, it also important to note that feelings of mastery reflect structural conditions. In other words, those who have been exposed to discrimination and constrained economic opportunities such as people with low socioeconomic status or minorities typically report less mastery (Latham-Mintus, Vowels, & Huskins, 2017).

Furthermore, it appears that the effect of mastery on health varies by sex and race. To illustrate, research completed with two IUPUI Sociology graduate students (Ashley Vowels and Kyle Huskins) documented that mastery was a strong predictor of healthy aging among older white men, but a weak predictor among older black men (see figure below).

Source: Latham-Mintus, K., Vowels, A. L., & Huskins, K. (2017). Healthy aging among Black and White older American men: What is the role of mastery? The Journals of Gerontology, Series B: Psychological Sciences.

 

We posit that mastery may be a less effective coping resource for reducing stress reactivity among older black men because of limited opportunities to exert control over their environment throughout the life course. Equally, a lack of mastery may be exceptionally detrimental to older white men’s health because there is a higher expectation of having control over their environment due to structural advantages over the life course.

In sum, mastery may hold the potential to improve health and wellbeing of older adults; however, it is vital to recognize that mastery is not equally distributed among populations (i.e., those with marginalized statuses tend to have less mastery) and that the health-promoting effect of mastery on health is concentrated among the advantaged.

Because mastery develops over the life course, it has its roots in childhood. Exposing children and young adults to environments that embolden feelings of confidence and perceptions of control may have long-lasting impact on health and health behaviors in older ages. Giving individuals in early life the opportunities to achieve status attainment in home, school, or work environments and exposing them to mastery experiences may promote high levels of mastery throughout their lives. Early investments in fostering life course mastery, particularly in socially disadvantaged groups, may have larger gains for population health in the long term.

This should not take away from policies and interventions that seek to enhance current mastery or sense of control among older adults. Interventions aimed at improving current mastery and increasing participation in health behaviors may ameliorate the impact of childhood disadvantage. For example, previous research has documented successful interventions by empowering older adults through peer-to-peer support, increasing knowledge, and fostering increased decision-making opportunities. Enabling people, old and young, to feel empowered in their lives may be an important piece of the puzzle for future population health promotion.

References

Latham-Mintus, K. & Aman, K. M. (2017). Childhood Disadvantage, Psychosocial Resiliency, and Later Life Functioning: Linking Early-Life Circumstances to Recovery from Mobility Limitation. Journal of Aging and Health.

Latham-Mintus, K. & Clarke, P. J. (2017). Linking Mastery across the Life Course to Mobility Device Use in Later Life. The Journals of Gerontology, Series B: Social Sciences.

Latham-Mintus, K., Vowels, A. L., & Huskins, K. (2017). Healthy aging among Black and White older American men: What is the role of mastery? The Journals of Gerontology, Series B: Psychological Sciences.

Pearlin, L. I., Nguyen, K. B., Schieman, S., & Milkie, M. A. (2007). The Life-Course Origins of Mastery among Older People∗. Journal of health and social behavior, 48(2), 164-179.

Featured Research: Staying connected with friends and family can aid in recovery from severe mobility limitation

The National Institutes of Health (NIH)’s Office of Behavioral and Social Sciences Research (OBSSR) is featuring early stage investigators. My post on the OBSSR Connector Blog highlights the benefits of social relationships including being partnered or staying connected with neighbors for recovery from severe mobility limitation (i.e., difficulty walking one block or shorter distances). One of the more interesting findings underscores the health-promoting potential of giving unpaid help to friends and family. Older adults who reported helping their friends and family were more likely to recover from severe mobility limitation, controlling for a multitude of social and health risk factors.

This research suggests that older adults with disability may be an untapped resource for communities–encouraging older adults to provide aid to those in need may prove to be mutually beneficial. To see this idea in action, watch “What happens when a nursing home and a day care center share a roof?” from PBS Newshour.

New Research: Does Neighborhood Disorder Predict Recovery From Mobility Limitation?

Latham, K. & Williams, M. M. (2015). “Does neighborhood disorder predict recovery from mobility limitation? Findings from the Health and Retirement Study.” Advance access at Journal of Aging and Health. 

Recent research highlights the importance of neighborhood disorder for recovery from mobility limitation (i.e., difficulty walking and climbing stairs). Older adults who reported higher levels of neighborhood disorder (i.e., graffiti/vandalism, vacant/deserted homes, litter, and crime) were less likely to recover from mobility limitation. However, physical activity and psychosocial factors were significant mediators, which suggests neighborhood disorder influences recovery from physical impairment via psychosocial processes and barriers to physical activity.

Reducing neighborhood disorder may enhance older residents’ psychosocial well-being and improve participation in physical activity, thus increasing recovery from mobility limitation and preventing subsequent disability.

New Research: Social Relationships, Gender, and Recovery From Mobility Limitation Among Older Americans

Latham, K., Clarke, P. J. & Pavela, G. (2015). Social relationships, gender and, recovery from mobility limitation among older Americans. Advanced access The Journals of Gerontology, Series B: Social Sciences.

New coauthored research, forthcoming in the Journals of Gerontology, Series B: Social Sciences, highlights the role of social relationships for recovery from mobility limitation (i.e., difficulty walking) among older Americans. Additionally, this research explores whether the influence of social relationships on recovery varies by gender.

Highlights from this research include:

• Providing non-paid help to friends and family increased the odds of recovering from mobility limitation for both older men and women.
• Having relatives living nearby decreased the odds of complete recovery for older men and women.
• Partnered men were more likely to experience recovery relative to partnered women.
• Women who said that they did not visit friends in their neighborhood were the least likely to experience partial recovery compared with both men and women who visited friends and men who did not visit friends in the neighborhood.

This research underscores the potential for social relationships to facilitate recovery from mobility limitation. Interventions aimed at encouraging older adults with mobility limitation to visit neighborhoods and provide help to peers may improve functional health outcomes.  Additionally, this research speaks to possible vulnerabilities among older women with limited social ties.

WalletHub’s 2014’s Best & Worst Cities for People with Disabilities–“Ask the Experts” Response

WalletHub has created a list of the best and worst cities for people with disabilities. They reached out to me and other researchers to weigh in on financial and non-financial advice for residents with disabilities.

2014′s Best & Worst Cities for People with Disabilities

My responses can be found at the bottom of the  webpage or by clicking “Ask the Experts” link.  I focused my answers on the advantages of walkable communities because the policies that would directly benefit residents with disabilities would benefit all members of the community. Safe and walkable environments help promote the health and wellbeing of whole communities.

 

New Publication in The Journals of Gerontology: Social Sciences

Latham, K. (2014). Racial and educational disparities in mobility limitation among older women: What is the role of modifiable risk factors? The Journals of Gerontology, Series B: Social Science. Advance online publication. doi: 10.1093/geronb/gbu028

My recent publication examines whether modifiable risk factors such as smoking status, participation in vigorous physical activity, or body mass index mediates or moderates racial and educational disparities in mobility limitation (i.e., difficulty walking or climbing stairs) among older women. Body mass index was a significant partial mediator for race and mobility limitation–suggesting that higher levels of body mass index among older Black women,  relative to older White women, contributes to excess mobility impairment. Another interesting finding highlights racial variation in the effect of modifiable risk factors on mobility limitation; the benefit of vigorous physical activity for preventing mobility limitation varied by race. Physical activity among older Black women was not as advantageous for preventing mobility limitation compared with older White women.

Thinking about Disability over the Life Course: Aging with Disability Publications

Two recent publications highlight potential disparities among individuals with disabilities in childhood and young adulthood. Those aging with disability may experience greater socioeconomic disadvantage, poorer self-rated health, and higher levels of depressive symptoms in later life. (Clarke & Latham, 2014; Latham, 2014).  Individuals with early-onset of disability often have increased barriers to socioeconomic achievement, which may lead to fewer opportunities to manage the underlying condition(s). These publications underscore the importance of viewing disability with a life course lens.

Clarke, P. J. & Latham, K. (2014). Life course health and social economic profiles of Americans aging with disability. Disability and Health Journal, 7, 1, S15-S23.

Latham, K. (2014). The “long arm” of childhood health: Linking childhood disability to late midlife mental health. Research on Aging. Advance online publication.

New Transitions: Welcome to Indy!

Dr. Kenzie Latham recently joined the Department of Sociology at Indiana University-Purdue University Indianapolis (IUPUI). Fall 2013 is in full swing at IUPUI, and  Dr. Latham is excited to be back in the classroom and to be an IUPUI Jag!