Toward a Multidimensional Understanding of Later Life Disability: A Latent Profile Analysis

Abstract Disability is difficult to define succinctly. Current literature on disability has primarily focused on physical functional limitations. However, relying on a single dimension or index cannot accurately represent disability as the experience of disability is nuanced and complex. To address these gaps, this study aims to understand the multidimensional nature of disability among retired, community-dwelling older adults. Using a sample of 414 older adults between the ages of 72 and 106 years (M=84.84, SD=4.56), latent profile analysis was employed to identify classes based on five indicators of disability across three domains. The five indicators of disability included difficulties with activities of daily living (ADLs), cognitive impairment, physical impairment, sensory impairment, and participation restrictions. Three classes were found to represent the data best. The most favorable and highly functioning group comprised the highest number of participants (n=242, 59.5%). The next group, class 2 (n=157, 37.9%), was characterized by high physical impairment and ADL-difficulty. The smallest group, class 3 (n=15, 3.6%), had the highest ADL-difficulty and participation restrictions but drastically lower cognitive and sensory impairment. Multinomial logistic regression revealed that class membership was related to sociodemographic characteristics. Finally, class membership predicted several mental health outcomes such as depressive symptoms, positive affect, and life satisfaction in the expected direction. If supported by future work, these findings could inform practitioners in developing more specific interventions relevant to older adults based on their disability profiles. Understanding various combinations of disablement has potential implications for services and interventions to be tailored to individuals’ distinct disability-related needs.

insecurity (economic obstacles, logistical obstacles) during the early months of the COVID-19 pandemic. We evaluated the extent to which associations are moderated by three personal characteristics (age, sex, race/ethnicity) and two pandemic-specific risk factors (job loss, COVID-19 diagnosis). Data were from a random 25 percent subsample of the Health and Retirement Study participants who completed a COVID-19 module administered in 2020. Our analytic sample included 3,166 adults aged 51 and older. We estimated logistic regression models to document the odds of experiencing each hardship. Persons with three or more functional limitations reported significantly higher odds of both types of food insecurity, and difficulty paying regular and medical bills, relative to those with no limitations. After controlling for health conditions, effects were no longer significant for paying medical bills, and attenuated yet remained statistically significant for other outcomes. Patterns did not differ significantly on the basis of the moderator variables. Older adults with more functional limitations are vulnerable to economic and food insecurity during the pandemic, potentially exacerbating the physical and emotional health threats imposed by the pandemic. Our findings reveal an urgent need to promote policies and procedures to protect older adults with disability from economic and food insecurity. Supports for older adults with disability should focus on logistical as well as financial support for ensuring food security. Disability is difficult to define succinctly. Current literature on disability has primarily focused on physical functional limitations. However, relying on a single dimension or index cannot accurately represent disability as the experience of disability is nuanced and complex. To address these gaps, this study aims to understand the multidimensional nature of disability among retired, community-dwelling older adults. Using a sample of 414 older adults between the ages of 72 and 106 years (M=84.84, SD=4.56), latent profile analysis was employed to identify classes based on five indicators of disability across three domains. The five indicators of disability included difficulties with activities of daily living (ADLs), cognitive impairment, physical impairment, sensory impairment, and participation restrictions. Three classes were found to represent the data best. The most favorable and highly functioning group comprised the highest number of participants (n=242, 59.5%). The next group, class 2 (n=157, 37.9%), was characterized by high physical impairment and ADL-difficulty. The smallest group, class 3 (n=15, 3.6%), had the highest ADL-difficulty and participation restrictions but drastically lower cognitive and sensory impairment. Multinomial logistic regression revealed that class membership was related to sociodemographic characteristics. Finally, class membership predicted several mental health outcomes such as depressive symptoms, positive affect, and life satisfaction in the expected direction. If supported by future work, these findings could inform practitioners in developing more specific interventions relevant to older adults based on their disability profiles. Understanding various combinations of disablement has potential implications for services and interventions to be tailored to individuals' distinct disability-related needs.

Session 2270 (Symposium)
NEW BRAIN AGING CENTER Chair: Feng Lin Co-Chair: Yeates Conwell Discussant: Janine Simmons Evidence indicates an association between emotional well-being (EWB) and underlying brain processes, and that those processes change with both normal and pathological brain aging. However, the nature of these associations, the mechanisms by which EWB and its component domains change with brain aging, and how those changes may be associated with common neuropathologies like Alzheimer's disease and related dementias (ADRD), are largely unexplored. The NIA-funded Network for Emotional Wellbeing and Brain Aging (NEW Brain Aging) has the goal of developing a nationwide community of investigators dedicated to research that identifies and tests mechanisms by which brain aging influences EWB and how EWB may impact risk for and progression of ADRD. Synthesizing human and animal literature, our premise is that relationships between EWB and ADRD are bidirectional -normal and pathological changes in aging brain influence EWB and EWB contributes to brain health and illness, such as ADRD. NEW Brain Aging will identify and coalesce resources for interested investigators and provide pilot funding opportunities to stimulate research and development of the field. Component presentations of this symposium will include (1) an overview by Dr. Robert Kaplan of the current state of research on EWB; (2) the role of animal studies (Kuan Hong Wang) and (3) human subjects research (Feng Vankee Lin) in EWB and aging; and (4) design of NEW Brain Aging and resources it will provide (Yeates Conwell). Janine Simmons will explain NIA's vision for EWB research and lead open discussion.

EMOTIONAL WELL-BEING HUMAN STUDIES Feng Lin, University of Rochester Medical Center, Rochester, New York, United States
Early evidence indicates an association between EWB and underlying brain processes, and that those processes change with both normal and pathological brain aging. However, the nature of these associations, the mechanisms by which EWB and its component domains change with brain aging, and how those changes may be associated with common neuropathologies in ADRD, are largely unexplored. We propose an appraisal-adaptation model in understanding relationships between EWB and ADRD. For human models, we encourage the use of well-established measures that directly assess eudaimonic and hedonic EWB, including abnormal scenarios (e.g., neuropsychiatric symptoms, anhedonia, loneliness, etc.), as well as older adults with exceptional cognition (i.e., superagers or supernormals). Dr. Lin will review premises associated with the appraisal-adaptation model in conducting human research on EWB, aging, and ADRD.

ACTIVITIES OF NEW BRAIN AGING Yeates Conwell, University of Rochester Medical Center, Rochester, New York, United States
The Network for Emotional Well-being and Brain Aging (NEW Brain Aging) was funded by NIA with the goal of forming a national, transdisciplinary collaborative that includes investigators with research expertise in emotional well-being (EWB), Alzheimer's disease and related dementias (ADRD), human and animal neuroimaging, stress regulation, and computational/quantitative methods. Our objective is to stimulate mechanistic research identifying and testing mechanisms by which brain aging influences EWB and how EWB may impact risk for and progression of ADRD. This presentation will explain the structure and functions of the network that serve as a resource for investigators interested in EWB and aging research, and how to access them: a transdisciplinary community of scholars interested in brain, aging, and EWB research from both human and animal fields; webinars; workgroups to establish priorities for NEW Brain Aging activities; a resource repository; and pilot project funding opportunities to which network members can apply.

EMOTIONAL WELL-BEING ANIMAL MODELS Kuan Wang, University of Rochester, Rochester, New York, United States
Clinical studies suggest an association between EWB and the risk or progression of AD. However, the mechanistic link and causal relationship between EWB and AD remain unknown, due to limited experimental access and control of the underlying human brain processes. Animal models offer genetic control of AD mutations and neural circuit analysis tools, but subjective feelings of EWB cannot be assessed through self-report. To study EWB across species, we adopt a theoretical framework that views emotions as central brain states that respond to exteroceptive or interoceptive stimuli and cause multiple cognitive, somatic and behavioral changes. Recent neuroanatomical and functional imaging studies have identified evolutionarily related brain circuits in the encoding and regulation of central emotional states in animals. Dr. Wang will review progress in elucidating the functional activities of these circuits and discuss the challenges and opportunities to link these neural representations to EWB and AD related pathological progression.

OVERVIEW OF EWB AND AGING Robert Kaplan, Stanford University, Stanford University, California, United States
The accumulation of scientific knowledge has been hampered by inconsistent usage of terms and categories. Ontology is the study of categories, their properties, and the relations between them. This presentation considers the definition and measurement of emotional well-being (EWB), a term that has been used inconsistently in research and clinical practice. The category contains eudaimonic and hedonic well-being that represent interrelated but conceptually distinct aspects of mental health. This presentation will review the definition