JHU Housing & Health Collaborative
Older Adults
Reducing racial disparities in Alzeheimer’s Disease and Alzheimer’s Disease Related Dementias: Addressing structural discrimination and resilience
Develops a life course measure of structural racial discrimination and structural resilience.
Background: Most measures of racial discrimination are of interpersonal discrimination. The few measures of more systemic discrimination are cross-sectional. This project is developing a life course measure of structural racial discrimination in the US.
Approach: Using life course addresses of older adults and matching to multiple public data sources for each domain of structural discrimination (education, employment, income/credit/wealth, media, criminal justice, neighborhood, xxx and xxx) across the life course, we are iteratively developing and refining a measure of structural racial discrimination and structural resilience.
Team: The study team includes Sarah Szanton (PI), Roland Thorpe, Deidra Crews, Gil Gee, Karen Bandeen-Roche, Laura Samuel, Melissa Hladek.
Funding: The study is funded by a grant from National Institute on Aging (DP1AG069874).
Predictors of housing deficiencies among older adults in the United States
Examines the joint contribution of financial resources, social environment, and functional abilities to the probability of living in a home with housing deficiencies, among older adults.
Background: Housing quality is a recognized social determinant of health. Qualitative evidence suggests the ability of older adults to maintain their homes is affected by the domains of financial resources, social environment, and functional abilities, but this conceptualization has not been tested quantitatively.
Approach: This cross-sectional study examined associations between financial resources, social environment, and functional abilities with deficient housing among 6,489 community-living adults ≥ 65 years participating in the nationally representative 2015 National Health and Aging Trends Study.
Team: The study team incudes Safiyyah Okoye (PI), Sarah Szanton, Laura Samuel and Jennifer Wolff at Johns Hopkins.
Funding: The project is supported by the Training Program in Health Service and Outcomes Research for Aging Populations (NIA T32AG066576).
How do low income older adults cope with financial strain and financial shocks?
Examine how low-income older adults handle financial challenges, the ways that those experiences affect their health and well-being and the social norms that may influence their decisions and/or constrain options for handling financial challenges.
Background: About one-third of U.S. older adults report experiencing financial challenges, such as financial strain or a financial shock, each year. Although there are many programs intended to help these older adults, many programs are under-utilized and many programs have barriers to accessing them. As examples, less than half of older adults who are eligible for the Supplemental Nutrition Assistance Program use the benefits and many individuals who are eligible for housing assistance are placed on long waiting lists across the country. Overall, little is known about the day-to-day experiences of older adults facing financial challenges, the strategies that are useful to handle the challenges, and the social norms that may constrain their options for handling financial challenges.
Approach: Our team has explored these research questions through qualitative research in two phases. Phase 1 comprised in-depth individual interviews with low income older adults in Baltimore to understand their experiences with financial challenges, the strategies they employed to address the challenges and how the financial challenges affected their health and well-being. Phase 2 consisted of focus groups and sought to examine the social norms relevant to financial challenges, to better understand the role of stigma, perceptions of supportive resources and perceived best practices for handling financial challenges.
Team: Laura Samuel, Rebecca Wright, Marianne Granbom (Lund University, Sweden), Janiece Taylor, Ciara Hupp (Boston University), Laken Roberts Lavigne, Sarah Szanton.
Funding: The project is supported by the National Institute on Aging (K01AG054751) and pilot funding from Funded by the Center for Innovative Care in Aging.
Media & Publications:
Inter-relationships between financial strain, housing and mobility for older adults
Tests cross-lagged associations between financial strain, home disorder, relocation, home modifications and mobility.
Background: Socioeconomic resources, such as education, prevent disability but are not readily modifiable. However, household and neighborhood conditions may be modifiable and may account for some of the educational disparities in disability for older adults.
Approach: The National Health and Aging Trends Study measured education, household and neighborhood conditions, and physical capacity, including lower extremity function, hand grip strength and lung function. Structural equation models were used to decompose total educational effects into direct effects and indirect effects via household and neighborhood conditions in 6874 community-dwelling participants.
Findings: Education was directly associated with lower extremity function and lung function, but not hand grip strength. Indirect effects were found for household disorder with lower extremity function, hand grip strength and lung function and between street disorder with lower extremity function. Results show that these indirect effects accounted for approximately 35%, 27% and 14% of the total association between education and SPPB scores, grip strength level, and peak expiratory flow level, respectively. These results suggest that household and neighborhood conditions account for a non-trial proportion of educational disparities in disability among older adults.
Team: The study team includes Laura Samuel, Thomas Glass, Roland Thorpe, Sarah Szanton and David Roth.
Funding: The project was supported by the National Institute on Aging (T32AG000247).
Media & Publications:
Household and neighborhood characteristics and their role in explaining educational disparities in late-life disability
Examined whether household and neighborhood conditions partially account for associations between education and physical capacity in a population-based sample of older adults.
Background: Socioeconomic resources, such as education, prevent disability but are not readily modifiable. However, household and neighborhood conditions may be modifiable and may account for some of the educational disparities in disability for older adults.
Approach: The National Health and Aging Trends Study measured education, household and neighborhood conditions, and physical capacity, including lower extremity function, hand grip strength and lung function. Structural equation models were used to decompose total educational effects into direct effects and indirect effects via household and neighborhood conditions in 6874 community-dwelling participants.
Findings: Education was directly associated with lower extremity function and lung function, but not hand grip strength. Indirect effects were found for household disorder with lower extremity function, hand grip strength and lung function and between street disorder with lower extremity function. Results show that these indirect effects accounted for approximately 35%, 27% and 14% of the total association between education and SPPB scores, grip strength level, and peak expiratory flow level, respectively. These results suggest that household and neighborhood conditions account for a non-trial proportion of educational disparities in disability among older adults.
Team: The study team includes Laura Samuel, Thomas Glass, Roland Thorpe, Sarah Szanton and David Roth.
Funding: The project was supported by the National Institute on Aging (T32AG000247).
Media & Publications:
Housing Predictors of Adverse Consequences of Unmet Care Needs Among Low and Moderate Income Older Adults with Disabilities
Determines whether of housing cost burden and structural housing deficiencies are associated with adverse consequences of having unmet care needs (such as going without a hot meal, or without bathing).
Background: An important metric of LTSS delivery, quality, and access is the occurrence of unmet care needs, defined by going without needed assistance with activities of daily living, household activities, and mobility tasks. Unmet care needs are more prevalent among lower income older adults.The home environment is an increasingly important setting for the receipt of LTSS and while housing related risk-factors (e.g., housing cost burden and housing of inadequate quality) are relevant to health and function outcomes—such as accidental falls, the ability to perform self-care activities, and moving to a nursing home—it is not understood how housing related risk-factors affect LTSS outcomes among older adults.
Approach: A secondary analysis of data from 5,041 low and moderate income participants in the 2015 National Health and Aging Trends Study, a population-based national survey that comprehensively assesses characteristics of older adults (≥65 years) and their households in a two-hour in-home interview.
Team: The study team incudes Safiyyah Okoye (PI), Sarah Szanton, Laura Samuel and Jennifer Wolff at Johns Hopkins.
Funding: The project is supported by a pilot award from Center for Innovative Care in Aging, School of Nursing, Johns Hopkins University, and the Training Program in Health Service and Outcomes Research for Aging Populations (NIA T32AG066576).
Social Connections and Health among Older Adults Living in Low-Income Housing
Mixed methods study to examine the factors that affect social connections of older adults living in subsidized housing.
Background: Social isolation in older adults has become a rising public health concern as it has been found to be correlated with deficits in physical and mental health. Low-income older adults are at increased risk of experiencing the consequences of social isolation as limited resources poses a threat to social mobility.
Approach: Semi-structured qualitative interviews are conducted to explore perspectives and preferences in order to gain insights into how social connections are formed and maintained in these residential communities, facilitators and barriers of social connection, and resources that impact connections. A social network inventory is administered which includes validated social network and loneliness scales, an ADL and IADL assessment, record of physical health, list of community housing features, and a detailed account of members of the participant’s social network.
Team: The study team includes Thomas Cudjoe, Nicole Williams, Sarah Szanton, Joe Gallo, Carl Latkin, Roland Thorpe, and Cynthia Boyd.
Funding: The project is supported by the National Institute of Health.
Connecting, COVID-19, and Aging: Challenges and Opportunities for Older Adults in Subsidized Housing
Explores perspectives of older adults living in Mercy Housing properties regarding social connectedness experiences during the COVID-19 pandemic.
Background: Mercy Housing Incorporated is one of the nation’s largest affordable housing organizations. Approximately one-quarter of all Mercy Housing residents are low-income older adults (65+). The Coronavirus pandemic has likely impacted prevalence and perceptions of social isolation, health, wellbeing, and healthcare utilization is this population.
Approach: This study uses qualitative and quantitative methods with Mercy Housing residents (aged 62+) to explore the impact of the COVID-19 pandemic on social isolation and overall wellbeing. Along with a semi-structured interview, participants will complete a contextual survey that inquires building, site, and mobility factors.
Team: Thomas Cudjoe, Marcela Blinka, Cynthia Boyd, Suzanne Greib, Carl Latkin, Laura Prichett, Harshini Devi, and Nicole Williams.
Funding: This project is supported by the AARP Foundation.