Testing Associations Between Key Precarities and Adverse Outcomes in Older Adults Without Care Partners

TL;DR

This study explores how lack of care partners affects older adults' health outcomes, finding that social isolation and poor care planning increase risks of hospitalization and daily living difficulties.

Contribution

The study identifies specific precarities and their associations with adverse outcomes in older adults without care partners using longitudinal data and mixed-effects models.

Findings

Higher perceived constraints and lower future care planning increase hospitalization odds.

Social isolation and lower self-efficacy are linked to greater ADL dependency risks.

Hispanic individuals and those in poverty face heightened risks of ADL dependency.

Abstract

Many older adults in the U.S. rely on care partners such as a spouse, child, kin, or other social network member to assist with daily needs, yet demographic trends are leaving more individuals without such vital support. This study builds on a scoping review that identified social isolation, future care planning (e.g., advance directives), self-efficacy, and engagement in preventive services as key precarities for older adults without care partners, and hospitalization and functional decline as potential adverse outcomes. Using longitudinal data from the Health and Retirement Study (2006–2020), hybrid mixed-effects logistic regression models with random intercepts estimated within- and between-person effects of these precarities on hospitalization and incident activities of daily living (ADL) dependency among respondents without care partners, controlling for age, sex, race, Hispanic ethnicity, and poverty status. For hospitalization, higher perceived constraints (OR = 1.27, 95% CI = 1.11–1.46) and lower average future care planning (OR = 0.77, 95% CI = 0.68–0.88) were associated with greater odds. For ADL dependency, higher perceived constraints (OR = 1.49, 95% CI = 1.14–1.94), greater social isolation (OR = 1.32, 95% CI = 1.04–1.68), and lower perceived mastery (OR = 0.63, 95% CI = 0.49–0.82) were associated with greater odds, with heightened risks for Hispanic respondents (OR = 3.27, 95% CI = 1.43–7.51) and those experiencing poverty (OR = 2.52, 95% CI = 1.45–4.37). Findings suggest interventions targeting self-efficacy, social isolation, and care planning may reduce risks of hospitalization and ADL dependency among older adults aging without care partners.