@article {12636, title = {Leisure Activity, Leisure Satisfaction, and Hedonic and Eudaimonic Well-Being Among Older Adults With Cancer Experience.}, journal = {Psychological Reports}, year = {Forthcoming}, abstract = {

Older adults with cancer experience are more likely to encounter a notable reduction of participation in physical and social leisure activities, which may threaten their overall well-being. The purpose of this study was to explore how specific types of leisure activities and leisure satisfaction were linked to hedonic and eudaimonic well-being among older adults who had experienced cancer. A nationally representative sample of 2,934 older adults with lifetime cancer experience was retained from the Health and Retirement Study. The results of regression analysis revealed that walking for 20 minutes was reported as the only type of leisure activity related to hedonic well-being for the oldest-old (85+ years old). The current study also found that TV watching was significantly, but negatively associated with eudaimonic well-being for the young-old (50-74 years of age). In contrast, using a computer was positively linked to hedonic and eudaimonic well-being among the young-old and old-old (75-84 years of age). The current study made a significant contribution to build the body of knowledge that the different age groups of older adults who had experienced cancer can enhance eudaimonic and hedonic well-being by participating in different types of leisure activities. Implications for further research are discussed.

}, keywords = {Cancer, eudaimonic and hedonic well-being, Internet use, leisure activity, TV watching}, issn = {1558-691X}, doi = {10.1177/00332941221123236}, author = {Chun, Sanghee and Lee, Sunwoo and Heo, Jinmoo and Ryu, Jungsu and Lee, Kyung Hee} } @article {13557, title = {Loneliness and Depressive Symptoms Are High Among Older Adults With Digestive Disease and Associated With Lower Perceived Health.}, journal = {Clin Gastroenterol Hepatol}, year = {Forthcoming}, abstract = {

BACKGROUND \& AIMS: Current approaches to managing digestive disease in older adults fail to consider the psychosocial factors contributing to a person{\textquoteright}s health. We aimed to compare the frequency of loneliness, depression, and social isolation in older adults with and without a digestive disease and to quantify their association with poor health.

METHODS: We conducted an analysis of Health and Retirement Study data from 2008 to 2016, a nationally representative panel study of participants 50 years and older and their spouses. Bivariate analyses examined differences in loneliness, depression, and social isolation among patients with and without a digestive disease. We also examined the relationship between these factors and health.

RESULTS: We identified 3979 (56.0\%) respondents with and 3131 (44.0\%) without a digestive disease. Overall, 60.4\% and 55.6\% of respondents with and without a digestive disease reported loneliness (P < .001), 12.7\% and 7.5\% reported severe depression (P < .001), and 8.9\% and 8.7\% reported social isolation (P~= NS), respectively. After adjusting for covariates, those with a digestive disease were more likely to report poor or fair health than those without a digestive disease (odds ratio [OR], 1.25; 95\% CI, 1.11-1.41). Among patients with a digestive disease, loneliness (OR, 1.43; 95\% CI, 1.22-1.69) and moderate and severe depression (OR, 2.93; 95\% CI, 2.48-3.47; and OR, 8.96; 95\% CI, 6.91-11.63, respectively) were associated with greater odds of poor or fair health.

CONCLUSIONS: Older adults with a digestive disease were more likely than those without a digestive disease to endorse loneliness and moderate to severe depression and these conditions are associated with poor or fair health. Gastroenterologists should feel empowered to screen patients for depression and loneliness symptoms and establish care pathways for mental health treatment.

}, keywords = {Epidemiology, General Practice, Outcomes Research, Psychiatric Disorders}, issn = {1542-7714}, doi = {10.1016/j.cgh.2023.08.027}, author = {Cohen-Mekelburg, Shirley and Jordan, Ariel and Kenney, Brooke and Burgess, Helen J and Chang, Joy W and Hu, Hsou Mei and Tapper, Elliot and Kenneth M. Langa and Levine, Deborah A and Waljee, Akbar K} } @article {13843, title = {Loneliness in midlife: Historical increases and elevated levels in the United States compared with Europe.}, journal = {The American Psychologist}, year = {Forthcoming}, abstract = {

Loneliness is gaining attention globally as a public health issue because elevated loneliness increases one{\textquoteright}s risk for depression, compromised immunity, chronic illness, and mortality. Our objective is to zoom into how loneliness has historically evolved through midlife and investigate whether elevations in loneliness are confined to the United States or are similarly transpiring across peer European nations. We use harmonized data on loneliness from nationally representative longitudinal panel surveys from the United States and 13 European nations to directly quantify similarities and differences in historical change of midlife loneliness trajectories. Compared with any other European nation/region, overall levels of loneliness in the United States are consistently higher by a magnitude of 0.3-0.8 . Middle-aged adults in the United States, England, and Mediterranean Europe today report higher levels of loneliness than earlier born cohorts, whereas no historical changes (if not historically lower levels) were observed in Continental and Nordic Europe. Our discussion focuses on possible reasons for cross-national differences in midlife loneliness, including cultural factors, social and economic inequalities, and differences in social safety nets. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

}, keywords = {Chronic illness, depression, Europe, Loneliness, midlife, Mortality, US}, issn = {1935-990X}, doi = {10.1037/amp0001322}, author = {Infurna, Frank J and Dey, Nutifafa E Y and Gonzalez Avil{\'e}s, Tita and Grimm, Kevin J and Lachman, Margie E and Gerstorf, Denis} } @article {13857, title = {A Longitudinal Dose-Response Curve Between Leisure-Time Physical Activity and the Prevalence of Diabetes Based on the Different Levels of Cognitive Function Among Older Adults.}, journal = {American Journal of Alzheimer{\textquoteright}s Disease and other Dementia}, volume = {39}, year = {2024}, pages = {15333175241241891}, abstract = {

This study investigated a dose-response relationship between Leisure-Time Physical Activity participation (LTPA) and the risk of diabetes and a comparison of the risk across different cognitive function groups among older adults. The Health and Retirement Study data were used from 2012 to 2020 (n = 18~746). This study conducted a Cox Proportional Hazard Regression to investigate the Dose-Response Curve between the prevalence of diabetes and the covariates following a level of LTPA participation. The result presented that the Odds Ratio continuously decreased as the level of LTPA participation increased. Among the three cognitive function groups, the high group (OR = .43, < .05) and the mid group (OR = .71, < .05) had a larger negative slope coefficient than the low group. This study found that LTPA participation reduces the risk of diabetes and gives evidence for the importance of cognitive function in reducing the prevalence of diabetes.

}, keywords = {Aged, Cognition, Diabetes Mellitus, Exercise, Humans, Leisure activities, Prevalence}, issn = {1938-2731}, doi = {10.1177/15333175241241891}, author = {Lee, Jungjoo and Kim, Junhyoung and Ju, Hyo Jin and An, Sang Joon and Woo, Bomi} } @article {13617, title = {Life-Sustaining Treatments Among Medicare Beneficiaries with and without Dementia at the End of Life.}, journal = {Journal of Alzheimer{\textquoteright}s Disease : JAD}, volume = {96}, year = {2023}, pages = {1183-1193}, abstract = {

BACKGROUND: Older adults with dementia including Alzheimer{\textquoteright}s disease may have difficulty communicating their treatment preferences and thus may receive intensive end-of-life (EOL) care that confers limited benefits.

OBJECTIVE: This study compared the use of life-sustaining interventions during the last 90 days of life among Medicare beneficiaries with and without dementia.

METHODS: This cohort study utilized population-based national survey data from the 2000-2016 Health and Retirement Study linked with Medicare and Medicaid claims. Our sample included Medicare fee-for-service beneficiaries aged 65 years or older deceased between 2000 and 2016. The main outcome was receipt of any life-sustaining interventions during the last 90 days of life, including mechanical ventilation, tracheostomy, tube feeding, and cardiopulmonary resuscitation. We used logistic regression, stratified by nursing home use, to examine dementia status (no dementia, non-advanced dementia, advanced dementia) and patient characteristics associated with receiving those interventions.

RESULTS: Community dwellers with dementia were more likely than those without dementia to receive life-sustaining treatments in their last 90 days of life (advanced dementia: OR = 1.83 [1.42-2.35]; non-advanced dementia: OR = 1.16 [1.01-1.32]). Advance care planning was associated with lower odds of receiving life-sustaining treatments in the community (OR = 0.84 [0.74-0.96]) and in nursing homes (OR = 0.68 [0.53-0.86]). More beneficiaries with advanced dementia received interventions discordant with their EOL treatment preferences.

CONCLUSIONS: Community dwellers with advanced dementia were more likely to receive life-sustaining treatments at the end of life and such treatments may be discordant with their EOL wishes. Enhancing advance care planning and patient-physician communication may improve EOL care quality for persons with dementia.

}, keywords = {Aged, Alzheimer disease, Cohort Studies, Death, Humans, Medicare, Terminal Care, United States}, issn = {1875-8908}, doi = {10.3233/JAD-230692}, author = {Zhu, Yingying and Olchanski, Natalia and Cohen, Joshua T and Freund, Karen M and Jessica Faul and Fillit, Howard M and Neumann, Peter J and Lin, Pei-Jung} } @article {10.1093/geroni/igad055, title = {Living Alone, Environmental Hazards, and Falls among US Older Adults}, journal = {Innovation in Aging}, year = {2023}, abstract = {Physical conditions of living environments can impact the incidence of falls; however, prior work has focused typically on one domain at a time{\textemdash}either neighborhood or home, capturing limited environmental boundaries of older adults. We examined how neighborhood together with home environment impact the incidence of falls over time and whether living arrangement modifies the influence of the environmental risks on falls.Using the 2012-2020 waves of the Health and Retirement Study (HRS; N=1,893), we fitted logistic regression to estimate the incidence of falls over an 8-year study period. We used the neighborhood and housing data that are collected systematically by trained observers in the HRS to assess environmental hazards. Sidewalk quality, neighborhood disorder, and presence of green space were measured to capture outdoor environmental hazards. Indoor environmental hazards included presence of housing decay and poorly maintained stairways. All models were stratified by living arrangement.Neighborhood and housing environment were independently associated with the odds of falls net of demographic characteristics and preexisting health conditions, and effects were significant for people living alone only. The presence of green space and poorly maintained stairways were associated with greater odds of falling, net of covariates during 8 years of follow-up (odds ratios [OR]=2.10 and 2.65, p\<0.05, respectively). None of the environmental risk factors were significant for those living with others.Falls in old age may be determined in part by a combination of outdoor and indoor risk factors. More research is needed to understand pathways that lead to greater vulnerability among older adults living alone to environmental hazards.}, issn = {2399-5300}, doi = {10.1093/geroni/igad055}, author = {Lee, Haena and Lim, Justin H} } @article {13451, title = {Loneliness, Purpose in Life, and Protective Behaviors: Examining Cross-Sectional and Longitudinal Relationships in Older Adults Before and During COVID-19.}, journal = {J Gerontol B Psychol Sci Soc Sci}, year = {2023}, abstract = {

OBJECTIVES: Existing literature on the effects of psychological resources on health-protective behaviors in COVID-19 and other contexts has focused heavily on cross-sectional relationships. Informed by self-determination theory (SDT), the current study aims to overcome this limitation by investigating the cross-sectional and longitudinal relationships among loneliness, purpose in life, and protective behaviors before and during the COVID-19 pandemic in the US older adults.

METHOD: This study uses data from the 2016 and 2020 waves of the Health and Retirement Study (HRS), a nationally representative longitudinal panel study of older adults in the US. The working sample size was 2649. A path model and a cross-lagged panel model (CLPM) were applied for the analyses.

RESULTS: Purpose in life fully mediated the negative impact of loneliness on protective behaviors when measured cross-sectionally. Moreover, pre-pandemic loneliness was associated with a decrease in purpose in life over time. On the other hand, pre-pandemic purpose in life was associated with a decrease in loneliness and an increase in protective behaviors over time.

DISCUSSION: Our cross-sectional finding on the mediating role of purpose in life reveals a psychological mechanism useful for future interventions. Furthermore, the longitudinal influence of pre-pandemic loneliness on purpose in life deserves both scholarly and clinical attention. Most importantly, the longitudinal effects of purpose in life on loneliness and protective behaviors provide guidance for preparing older adults during normal times to cope with loneliness and to comply more with recommended measures during future health crises (such as the COVID-19 pandemic).

}, keywords = {Health risk behaviors; longitudinal change; well being.}, issn = {1758-5368}, doi = {10.1093/geronb/gbad117}, author = {Ma, Xin and Yang, Yin and Lin, Tong and Zhang, Yan and Zheng, En} } @article {13117, title = {Longitudinal Associations Between Loneliness and Prescription Medication Use.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {78}, year = {2023}, month = {2023 Apr 01}, pages = {730-735}, abstract = {

OBJECTIVES: Both loneliness and the use of psychotropic drugs are common in later life. Although loneliness has been found to be associated with psychotropic drug use, most studies have been cross-sectional, and we know less about their longitudinal associations.

METHODS: Drawing on five waves of data from the Health and Retirement Study and two statistical approaches (fixed-effects and cross-lagged panel models), we examine longitudinal associations between loneliness and the use of prescription pain and depression/anxiety medications.

RESULTS: Across 57,654 observations among 20,589 respondents, 22.8\% reported regular use of pain prescription medications, 17.8\% regular use of depression/anxiety prescription medication, and 15.6\% feeling lonely in the past week. Loneliness and the use of depression/anxiety medications were associated according to both modeling approaches, net of covariates. In years when a respondent reported feeling lonely, the odds of regular use of depression/anxiety medications were 1.42 times higher (p < .001) than in years when they did not feel lonely. Regarding reciprocation, odds of regular depression/anxiety medication use in a given wave range from 1.3 to 1.5 times higher if loneliness was reported in the prior wave. Likewise, the odds of reporting loneliness in a given wave range from 1.5 to 1.8 times higher if regular depression/anxiety medication was reported in the prior wave.

DISCUSSION: Prior loneliness predicts contemporaneous regular use of depression/anxiety prescription medications. Although this confirms the directional association found in prior studies, we found prior use of depression/anxiety medications is also associated with increased odds of loneliness, suggesting further research is needed to understand mechanisms that explain their associations and potential interventions.

}, keywords = {Cross-Sectional Studies, depression, Humans, Loneliness, Longitudinal Studies, pain, Prescriptions}, issn = {1758-5368}, doi = {10.1093/geronb/gbad010}, author = {Lam, Jack and Vuolo, Michael} } @article {13628, title = {A longitudinal study of polygenic score and cognitive function decline considering baseline cognitive function, lifestyle behaviors, and diabetes among middle-aged and older US adults.}, journal = {Alzheimer{\textquoteright}s research \& therapy}, volume = {15}, year = {2023}, pages = {196}, abstract = {

BACKGROUND: Genomic study of cognition decline while considering baseline cognition and lifestyle behaviors is scarce. We aimed to evaluate the impact of a polygenic score for general cognition on cognition decline rate, while considering baseline cognition and lifestyle behaviors, among the general population and people with diabetes, a patient group commonly affected by cognition impairment.

METHODS: We tested associations of the polygenic score for general cognition with annual changing rates of cognition measures in 8~years of follow-up among 12,090 White and 3100 Black participants of the Health and Retirement Study (HRS), a nationally representative sample of adults aged 50~years and older in the USA. Cognition measures including word recall, mental status, and total cognitive score were measured biannually. To maximize sample size and length of follow-up, we treated the 2010 wave of survey as baseline, and follow-up data until 2018 were analyzed. Baseline lifestyle behaviors, APOE status, and measured cognition were sequentially adjusted. Given racial differences in polygenic score, all analyses were conducted by race.

RESULTS: The polygenic score was significantly associated with annual changing rates of all cognition measures independent of lifestyle behaviors and APOE status. Together with age and sex, the polygenic score explained 29.9\%, 15.9\%, and 26.5\% variances of annual changing rates of word recall, mental status, and total cognitive scores among Whites and explained 17.2\%, 13.9\%, and 18.7\% variance of the three traits among Blacks. Among both White and Black participants, those in the top quartile of polygenic score had the three cognition measures increased annually, while those in the bottom quartile had the three cognition measures decreased annually. After further adjusting for the average cognition assessed in 3 visits around baseline, the polygenic score was still positively associated with annual changing rates of all cognition measures for White (P <= 2.89E - 19) but not for Black (P >= 0.07) participants. In addition, among participants with diabetes, physical activity offset the genetic susceptibility to decline of mental status (interaction P <= 0.01) and total cognitive scores (interaction P = 0.03).

CONCLUSIONS: Polygenic score predicted cognition changes in addition to measured cognition. Physical activity offset genetic risk for cognition decline among diabetes patients.

}, keywords = {Adult, Aged, Apolipoproteins E, Cognition, Cognitive Dysfunction, Diabetes Mellitus, Humans, Life Style, Longitudinal Studies, Middle Aged}, issn = {1758-9193}, doi = {10.1186/s13195-023-01343-1}, author = {Liu, Tingting and Li, Changwei and Zhang, Ruiyuan and Millender, Eugenia Flores and Miao, Hongyu and Ormsbee, Michael and Guo, Jinzhen and Westbrook, Adrianna and Pan, Yang and Wang, Jing and Kelly, Tanika N} } @article {12251, title = {A Lasting Legacy of the Great Recession: How Changes in Wealth Were Associated with Changes in Bequest Expectations.}, journal = {Journal of Financial Planning}, volume = {35}, year = {2022}, pages = {64-84}, abstract = {Between 2007 and 2009, American aggregate household wealth declined by 20 percent (Dettling, Hsu, and Llanes 2018). By 2012, however, aggregate household wealth surpassed its 2007 peak and continued to increase through 2016. Although the Great Recession and its subsequent recovery has been extensively studied, little is known about the association between changes in wealth during these periods and changes in bequest expectations. {\textbullet} Based on Hurd and Smith{\textquoteright}s (2001) model of consumption and saving, we expected a positive relationship between changes in wealth and changes in bequest expectations. The purpose of this study was, however, to explore whether a modest or significant decline in wealth that occurred during the Great Recession was linked with a drop in bequest expectations. Similarly, this study investigated the magnitude of wealth increases during the recovery that were associated with a return to expectations held prior to the Great Recession. {\textbullet} Using data from the Health and Retirement Study (HRS), this research found that during the Great Recession, both significant and modest declines in wealth were associated with a drop in bequest expectations. However, no relationship was found between increases in wealth and a rise in bequest expectations. Following the Great Recession, only wealth increases at the highest end of the distribution were associated with a return to previously held bequest expectations. {\textbullet} Financial planners can use these results to better understand shifts in bequest expectations during various economic cycles and provide the necessary interventions to help clients meet their long-term wealth transfer goals and objectives.}, keywords = {Bequests, Financial planning, Great Recession, Wealth}, url = {https://www.proquest.com/docview/2629422282?pq-origsite=gscholar\&fromopenview=true}, author = {Sommer, Matthew and Lim, HanNa} } @article {11766, title = {Later-Life Living Arrangements of Americans with and without Children: A Lifetable Approach.}, journal = {The Journals of Gerontology, Series B }, volume = {77}, year = {2022}, pages = {181-190}, abstract = {

OBJECTIVES: This study describes living arrangement-specific life expectancy for older Americans with and without children, by sex and race/ethnicity.

METHODS: We use life tables from the Human Mortality Database and data from the Health and Retirement Study over a 17 -year period (2000-2016) to calculate living arrangement-specific life expectancy at age 65 using Sullivan{\textquoteright}s method. Results describe the lives of older Americans age 65 and above with and without children in terms of the number of expected years of life in different living arrangements.

RESULTS: With the exception of Hispanic men, older Americans without children spend over half of their remaining life living alone. Childless White women and Black men spend the largest percent of remaining life living alone (65\% and 57\%, respectively). Relative to parents, childless older Americans have an overall life expectancy at age 65 that is one year lower and spend 5-6 years more living alone and fewer years living with a spouse (8 years less for men and 5 years less for women). Childless older Americans spend more time in nursing homes, but average expected duration in this living arrangement is short and differences between those with and without children are small.

DISCUSSION: This descriptive analysis demonstrates the fundamental ways in which children shape the lives of older Americans by showing that later-life living arrangements of childless Americans differ markedly from their counterparts with children. These results provide a valuable empirical foundation for broader efforts to understand relationships between childlessness, living arrangements, and well-being at older ages.

}, keywords = {Demography, family structure, Minority aging, Race/ethnicity}, issn = {1758-5368}, doi = {10.1093/geronb/gbab133}, author = {James M Raymo and Xiao Xu and Kim, BoRin and Jersey Liang and Mary Beth Ofstedal} } @article {12320, title = {Later-life transitions and changes in prescription medication use for pain and depression.}, journal = {BMC Geriatrics}, volume = {22}, year = {2022}, pages = {222}, abstract = {

BACKGROUND: Over the past two decades, prescription medication use for pain and depression increased dramatically. Most studies consider the early life course, despite a similar increase among those in later life. In this paper, we examine whether and how later life transitions may relate to changes in medication use.

METHODS: We draw on data from the Health and Retirement Study and fixed-effects models to examine whether work, family, and civic transitions in later life are related to changes in the usage of prescription pain and depression medication.

RESULTS: Results show that individuals had higher odds of regularly using prescription pain and depression medications in periods when out of the labor market. Higher odds of depression medication use were also associated with periods of widowhood, and lower odds of use when frequently volunteering. Such relations persist adjusting for reported levels of pain and depression.

CONCLUSION: Our findings call attention to the importance of social ties and the presence of actors that may regulate health behaviors, as well as a change in social context, that may shape medication use in later life.

}, keywords = {depression, pain, prescription drugs, Prescriptions, Retirement}, issn = {1471-2318}, doi = {10.1186/s12877-022-02921-y}, author = {Lam, Jack and Vuolo, Mike} } @article {11465, title = {Leisure and Social Supports in Relation to Positive Affect Among Older Adults.}, journal = {Journal of Applied Gerontology}, volume = {41}, year = {2022}, pages = {551-559}, abstract = {

The current study examined the extent to which leisure activities were related to different forms of social support and its association with positive affect. A secondary data analysis was employed using data drawn from the Health and Retirement Study (HRS) in 2014. The study sample was composed of 4,303 individuals whose ages ranged from 65 to 105 ( = 75.78, = 7.42; 57.8\% females). Employing bootstrapping technique, the hypothesized relationship between leisure, social support, and positive affect was examined. Mediating effect of social support was also determined. Results indicated that leisure activity, social support, and positive affect were significantly associated, but the relationship varied. The study findings expanded our understanding of the divergent leisure paths to positive social support and emotional well-being of the older adults. Promoting diverse recreational settings is necessary in leisure interventions that can facilitate frequent and positive social exchanges in both in-home and out-of-home environments.

}, keywords = {leisure activity, perceived social support, Positive affect}, issn = {1552-4523}, doi = {10.1177/0733464821990485}, author = {Lee, Sunwoo and Ryu, Jungsu and Jinmoo Heo} } @article {12726, title = {Leisure, Mental Health, and Life Satisfaction among Older Adults with Mild Cognitive Impairment.}, journal = {American Journal of Health Behavior}, volume = {46}, year = {2022}, pages = {477-487}, abstract = {

Little research has investigated the relationship between types of leisure activities and mental health outcomes among older adults with mild cognitive impairment (MCI). The purpose of this study was to investigate how certain leisure activities are associated with life satisfaction, anxiety, loneliness, happiness, and positive and negative affect. In this study, we used the 2020 Health and Retirement Study Core Early data and conducted a hierarchical regression analysis to investigate the different effects of the 3 types of leisure activities on the mental health of older adults with MCI (N=901). We found that leisure-time physical activity was the strongest predictor of enhanced life satisfaction, positive affect, and happiness, and reduced anxiety and loneliness. In addition, sedentary leisure was associated with reduced anxiety and loneliness and increased happiness. These findings suggest that engagement in leisure-time physical activity and sedentary leisure can be instrumental in promoting the life satisfaction and mental health of older adults with mild cognitive impairment.

}, keywords = {Cognition, Cognitive Dysfunction, Leisure activities, Mental Health, Personal Satisfaction}, issn = {1945-7359}, doi = {10.5993/AJHB.46.4.8}, author = {Kim, Junhyoung and Lee, Jungjoo and Ko, Myung Jin and Min Oh, Seok} } @article {12731, title = {Level of Concern, Spending, and External Support Related to COVID-19: A Comparison between Working and Non-Working Older Adults.}, journal = {International Journal of Environmental Research and Public Health}, volume = {19}, year = {2022}, pages = {11375}, abstract = {

This study compared levels of concern, spending, and use of external support by working status among older adults in the U.S. during the COVID-19 pandemic. It assessed whether work influences these variables related to wellness. Data from 2489 older adults from the 2020 U.S. Health and Retirement Study were analyzed using multiple linear and logistic regression. Older adults who worked had lower concerns about the pandemic (β = -0.28, = 0.048), were less likely to increase their spending (OR = 0.74, = 0.041), and were less likely to use external support (OR = 0.50, \< 0.001). Use of external support increased with age (OR = 1.04, \< 0.001) and increased spending (OR = 1.32, = 0.019). Married older adults were less likely to increase spending (OR = 0.75, = 0.007) and had lower concerns toward COVID-19 (β = -0.28, = 0.011). Higher levels of concern were reported among women (β = 0.31, = 0.005) and participants who had friends or family members diagnosed with COVID-19 (β = 0.51, \< 0.001). Women were more likely to use support (OR = 1.80, \< 0.001). Work appears to bolster older adult wellness outcomes.

}, keywords = {COVID-19, Logistic Models, Pandemics, Retirement}, issn = {1660-4601}, doi = {10.3390/ijerph191811375}, author = {Yu, Zuojin and Le, Aurora B and Doerr, Alexa and Smith, Todd D} } @article {12749, title = {LHMS User Guide 2015-2017}, year = {2022}, institution = {Institute for Social Research, University of Michigan }, address = {Ann Arbor, MI}, keywords = {life history, mail survey, User guide}, author = {Jacqui Smith and Ofstedal, Mary Beth and Larkina, Marina and Helppie-McFall, Brooke and Amanda Sonnega and David R Weir} } @article {12712, title = {Life Expectancy Tool May Improve Quality of Life for Patients With Dementia}, journal = {News}, year = {2022}, publisher = {University of California, San Francisco}, address = {San Francisco, CA}, keywords = {Dementia, Life Expectancy, Quality of Life}, url = {https://www.ucsf.edu/news/2022/09/423821/life-expectancy-tool-may-improve-quality-life-patients-dementia$\#$:~:text=Life\%20Expectancy\%20Tool\%20May\%20Improve\%20Quality\%20of\%20Life\%20for\%20Patients\%20With\%20Dementia,-UCSF\%2DLed\%20Study\&text=A\%20mortality\%20pre}, author = {Leigh, Suzanne} } @article {12665, title = {Linear linking for related traits (LLRT): A novel method for the harmonization of cognitive domains with no or few common items.}, journal = {Methods}, volume = {204}, year = {2022}, pages = {179-188}, abstract = {

Harmonization means to make data comparable. Recent efforts to generate comparable data on cognitive performance of older adults from many different countries around the world have presented challenges for direct comparison. Neuropsychological instruments vary in many respects, including language, administration techniques and cultural differences, which all present important obstacles to assumptions regarding the presence of linking items. Item response theory (IRT) methods have been previously used to harmonize cross-national data on cognition, but these methods rely on linking items to establish the shared metric. We introduce an alternative approach for linking cognitive performance across two (or more) groups when the fielded assessments contain no items that can be reasonably considered linking items: Linear Linking for Related Traits (LLRT). We demonstrate this methodological approach in a sample from a single United States study split by educational attainment, and in two sets of cross-national comparisons (United States to England, and United States to India). All data were collected as part of the Harmonized Cognitive Assessment Protocol (HCAP) and are publicly available. Our method relies upon strong assumptions, and we offer suggestions for how the method can be extended to relax those assumptions in future work.

}, keywords = {Cognition, HCAP, Research Design}, issn = {1095-9130}, doi = {10.1016/j.ymeth.2021.11.011}, author = {Nichols, Emma L and Cadar, Dorina and Lee, Jinkook and Richard N Jones and Gross, Alden L} } @article {socsci11010027, title = {Linked Lives: Does Disability and Marital Quality Influence Risk of Marital Dissolution among Older Couples?}, journal = {Social Sciences}, volume = {11}, year = {2022}, pages = {27}, abstract = {Using fourteen waves of data from the Health and Retirement Study (HRS), a longitudinal panel survey with respondents in the United States, this research explores whether marital quality\—as measured by reports of enjoyment of time together\—influences risk of divorce or separation when either spouse acquires basic care disability. Discrete-time event history models with multiple competing events were estimated using multinomial logistic regression. Respondents were followed until they experienced the focal event (i.e., divorce or separation) or right-hand censoring (i.e., a competing event or were still married at the end of observation). Disability among wives was predictive of divorce/separation in the main effects model. Low levels of marital quality (i.e., enjoy time together) were associated with marital dissolution. An interaction between marital quality and disability yielded a significant association among couples where at least one spouse acquired basic care disability. For couples who acquired disability, those who reported low enjoyment were more likely to divorce/separate than those with high enjoyment; however, the group with the highest predicted probability were couples with low enjoyment, but no acquired disability.}, keywords = {Disability, marital dissolution, Marital quality}, issn = {2076-0760}, doi = {10.3390/socsci11010027}, author = {Kenzie Latham-Mintus and Holcomb, Jeanne and Zervos, Andrew P.} } @article {12167, title = {Lonely older adults are more likely to delay or avoid medical care during the coronavirus disease 2019 pandemic.}, journal = {International Journal of Geriatric Psychiatry}, volume = {37}, year = {2022}, abstract = {

OBJECTIVES: To examine the relationship between loneliness and self-reported delay or avoidance of medical care among community-dwelling older adults during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS: Analyses of data from a nationally representative survey administered in June of 2020, in COVID-19 module of the Health and Retirement Study. Bivariate and multivariable analyses determined associations of loneliness with the likelihood of, reasons for, and types of care delay or avoidance.

RESULTS: The rate of care delay or avoidance since March of 2020 was 29.1\% among all respondents (n~=~1997), and 10.1\% higher for lonely (n~=~1,150\%, 57.6\%) versus non-lonely respondents (33.5\% vs. 23.4\%; odds ratio~=~1.59, p~=~0.003 after covariate adjustment). The differences were considerably larger among several subgroups such as those with emotional/psychiatric problems. Lonely older adults were more likely to cite "Decided it could wait," "Was afraid to go," and "Couldn{\textquoteright}t afford it" as reasons for delayed or avoided care. Both groups reported dental care and doctor{\textquoteright}s visit as the two most common care delayed or avoided.

CONCLUSIONS: Loneliness is associated with a higher likelihood of delaying or avoiding medical care among older adults during the pandemic.

}, keywords = {Aged, COVID-19, Humans, Independent Living, Loneliness, Pandemics, SARS-CoV-2}, issn = {1099-1166}, doi = {10.1002/gps.5694}, author = {Li, Yue and Cheng, Zijing and Cai, Xueya and Holloway, Melissa and Maeng, Daniel and Simning, Adam} } @article {12226, title = {Longitudinal association between depressive symptoms and cognitive decline among middle-aged and elderly population.}, journal = {Journal of Affective Disorders}, volume = {303}, year = {2022}, pages = {18-23}, abstract = {

BACKGROUND: Depression is considered a risk factor for cognitive decline. The long-term impact of depressive symptoms on cognitive performance has not been established thus far.

OBJECTIVES: This study aimed to determine the longitudinal associations between depressive symptoms and cognitive performance among middle-aged and elderly population.

METHODS: We included 10,387 adults aged >=45 years from the Health and Retirement Study (2004 to 2014) in this study. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CESD) scale. Participant{\textquoteright}s cognitive function was assessed via the telephone interview for cognitive status (TICS); the total cognitive score ranged from 0 to 35. We classified the participants into four clusters according to the quartile of the total cognitive score (TCS). We examined the change of depressive symptoms and cognitive performance by using the unconditional latent growth curve modeling (LGCM) method, and a parallel LGCM method was used to examine the longitudinal associations between depressive symptoms and cognitive performance among middle-aged and elderly adults in each cluster.

RESULTS: Participants with lower levels of cognitive performance were associated with a greater risk of high depressive symptoms. Results from unconditional LGCM showed a sustained decline in cognitive performance and an increasing trend in depressive symptoms per 2 years for each cluster of participants. The parallel LGCM indicated that baseline levels of depression showed a significant negative correlation with the cognitive performance at baseline (β [95\% CI] of intercept predicting intercept were -0.33 [-0.41, -0.26], -0.03[-0.06, -0.00], -0.05 [-0.07, -0.02] and -0.64 [-0.70,-0.58], for clusters of Q1 to Q3 and the entire population, respectively). Further, a significant positive prospective association was observed between baseline levels of depression and changes in cognitive performance (intercept predicting slope were -0.05 [-0.08, -0.02], -0.09[-0.13, -0.05], -0.12 [-0.15, -0.08], -0.11 [-0.15, -0.06] and -0.04 [-0.06,-0.02] for clusters of Q1 to Q4 and the entire population, respectively). Moreover, for participants with the highest quartile of TCS, the rising trend of depressive symptoms accelerated the decline of cognitive performance during the follow-up period (Slope predicting Slope: -0.44 [-0.86, -0.01]).

CONCLUSION: Our results suggest that depressive symptoms were associated with lower cognitive performance and larger subsequent decline during follow-up period. Adults with depression may require more medical attention, and early intervention is required to delay the development of cognitive impairment and dementia.

}, keywords = {Cognitive decline, Depressive symptoms, Latent growth curve modeling, Longitudinal association}, issn = {1573-2517}, doi = {10.1016/j.jad.2022.01.107}, author = {Huang, Wentao and Zhu, Wenjing and Chen, Hongyan and Li, Feng and Huang, Jingxin and Zhou, Ye and Sun, Xibin and Lan, Yutao} } @article {11561, title = {A longitudinal study shows stress proliferation effects from early childhood adversity and recent stress on risk for depressive symptoms among older adults.}, journal = {Aging \& Mental Health}, volume = {26}, year = {2022}, pages = {870-880}, abstract = {

We evaluated whether the effects of recent stressful life events (SLEs) and early childhood adversities (ECAs) on depressive symptoms are consistent between men and women and across older age, and whether there was evidence for the following: stress sensitization, whereby the psychological impact of SLEs is greater for individuals with ECAs compared with those without; or stress proliferation effect, whereby those with ECAs are more likely to report more SLEs than those without ECAs to effect depressive symptoms. ECAs, SLEs in the past two years, and current depressive symptoms through a modified CES-D were obtained from 11,873 individuals participating in a population representative study of older adults, yielding 82,764 observations. Mixed-effects regression models on depressive symptoms were constructed to control for multiple observations per participant and evaluate within-person effects over time, thereby reducing bias from reverse causation. Results suggest a stress proliferation effect and do not support stress sensitization. ECAs contribute to vulnerability for depressive symptoms, with a dosage effect for each additional ECA. Recent SLEs result in greater depressive symptom risk, with stable effects over age and dosage effects for each additional SLE that were smaller than the effects of ECAs among men, but not women. Belonging to an ethnic minority group, having less education, and less household income at baseline were associated with greater depressive symptom risk. Findings suggest the importance of addressing early childhood adversity and sociodemographic factors, among at-risk older adults to mitigate life-course stress proliferative processes and thereby reduce disparate risk for depression in older age.

}, keywords = {adverse child events, depression, Mental Health, stress generation, Trauma}, issn = {1364-6915}, doi = {10.1080/13607863.2021.1904379}, author = {Thalida E. Arpawong and Mekli, Krisztina and Lee, Jinkook and Drystan F. Phillips and Margaret Gatz and Carol A Prescott} } @article {https://doi.org/10.1002/aepp.13229, title = {The long-run prevalence of food insufficiency among older Americans}, journal = {Applied Economic Perspectives and Policy}, volume = {44}, year = {2022}, pages = {575-590}, abstract = {The prevalence of food insufficiency among seniors in any given year is well-documented, but the prevalence of this hardship over a longer time period in later life is unknown. Using panel data from the Health and Retirement Study, I find that about 8\% of seniors report food insufficiency over a 2-year recall window, while 22\% experience it at some point over the two decades of their 60s and 70s. Food insufficiency is not concentrated among a small group of persistently disadvantaged elderly, but is instead a surprisingly common feature of the later life course.}, keywords = {Aging, Food insecurity, food insufficiency, hardship}, doi = {https://doi.org/10.1002/aepp.13229}, author = {Helen G Levy} } @article {13507, title = {The Long-Run Prevalence of Food Insufficiency among Older Americans.}, journal = {Applied Economic Perspectives and Policy}, volume = {44}, year = {2022}, pages = {575-590}, abstract = {

The prevalence of food insufficiency among seniors in any given year is well-documented, but the prevalence of this hardship over a longer time period in later life is unknown. Using panel data from the Health and Retirement Study, I find that about 8\% of seniors report food insufficiency over a two-year recall window, while 22\% experience it at some point over the two decades of their sixties and seventies. Food insufficiency is not concentrated among a small group of persistently disadvantaged elderly, but is instead a surprisingly common feature of the later life course.

}, keywords = {Food insecurity, food insufficiency, hardship}, issn = {2040-5790}, doi = {10.1002/aepp.13229}, author = {Helen G Levy} } @article {12370, title = {Long-term weight change and its temporal relation to later-life dementia in the Health and Retirement Study.}, journal = {The Journal of Clinical Endocrinology \& Metabolism}, volume = {107}, year = {2022}, pages = {e2710-e2716}, abstract = {

BACKGROUND: Weight loss among middle and older adults has been associated with a higher risk of subsequent dementia. However, most of studies have limited follow-up time or suboptimal control for the potential influence of physical frailty (PF).

OBJECTIVES: Our study aimed to investigate the long-term and temporal relation of weight change to risk of dementia among U.S. middle-aged and older adults.

METHODS: A total of 5985 participants aged 50 years and older were included from the Health and Retirement Study (HRS). History of long-term weight change was calculated using nine repeated BMI measurements from 1992-2008. We then followed their dementia status from 2008 to 2018. Multivariable cox proportional hazard models were used.

RESULTS: During the study follow-up (mean = 7.54 years), a total of 682 (11.39\%) dementia cases were documented. After controlling for basic demographic and lifestyle, participants with weight loss (median: -0.23~kg/m 2 per year) were at a significantly higher risk of dementia (HR = 1.60, 95\% CI, 1.33, 1.92), compared with the stable-weight group (median: 0.11~kg/m 2 per year). This association was attenuated but remained strong and significant after further adjustment for PF (HR = 1.57, 95\% CI, 1.30, 1.89). The significant association was observed for weight loss assessed approximately 14-18 years preceding dementia diagnosis (HR = 1.30, 95\% CI, 1.07, 1.58), and was consistent for that closer to diagnosis.

CONCLUSIONS: Both recent and remote weight loss were associated with a higher risk of later-life dementia among middle-aged and older adults independent of the status of physical frailty.

}, keywords = {Dementia, physical frailty, prospective cohort, Weight Change}, issn = {1945-7197}, doi = {10.1210/clinem/dgac229}, author = {Shen, Jie and Chen, Hui and Zhou, Tianjing and Zhang, Simei and Huang, Liyan and Lv, Xiaozhen and Ma, Yuan and Zheng, Yan and Yuan, Changzheng} } @article {12465, title = {Love and Legacy: Are Children{\textquoteright}s Affections Related to Parents{\textquoteright} Bequest Intentions?}, journal = {Journal of Financial Service Professionals}, volume = {76}, year = {2022}, pages = {59-72}, abstract = {This study investigated whether positive and negative affection shown by children towards their parents was associated with their parents{\textquoteright} bequest intentions. In a final sample of 1,534 adults aged 50 and older, a positive relationship was found between positive affection and bequest intentions. Surprisingly, no relationship was found between negative affection and bequest intentions. These results suggest that in cases of a distant or strained relationship, parents are reluctant to disinherit their children. Based upon these findings, financial service professionals should not assume that challenged parent-child relationships warrant the need for alternative beneficiaries. Instead, given the clients{\textquoteright} potential lack of strong emotional bonds with their children, financial service professionals are encouraged to help clients consider other opportunities to maximize emotional well-being and overall life satisfaction.}, keywords = {Bequests, children, positive affection}, author = {Sommer, Matthew and Lim, HanNa} } @article {11818, title = {The Longitudinal Association of Vision Impairment with Transitions to Cognitive Impairment and Dementia: Findings from The Aging, Demographics and Memory Study.}, journal = {The Journals of Gerontology - Series A }, volume = {76}, year = {2021}, pages = {2187-2193}, abstract = {

BACKGROUND: Vision impairment (VI) is associated with incident cognitive decline and dementia. However, it is not known whether VI is associated only with the transition to cognitive impairment, or whether it is also associated with later transitions to dementia.

METHODS: We used data from the population-based Aging, Demographics and Memory Study (ADAMS) to investigate the association of visual acuity impairment (VI; defined as binocular presenting visual acuity <20/40) with transitions from cognitively normal (CN) to cognitive impairment no dementia (CIND) and from CIND to dementia. Multivariable Cox proportional hazards models and logistic regression were used to model the association of VI with cognitive transitions, adjusted for covariates.

RESULTS: There were 351 participants included in this study (weighted percentages: 45\% male, 64\% age 70-79 years) with a mean follow-up time of 4.1 years. In a multivariable model, the hazard of dementia was elevated among those with VI (HR=1.63, 95\%CI=1.04-2.58). Participants with VI had a greater hazard of transitioning from CN to CIND (HR=1.86, 95\%CI=1.09-3.18). However, among those with CIND and VI a similar percentage transitioned to dementia (48\%) and remained CIND (52\%); there was no significant association between VI and transitioning from CIND to dementia (HR=0.94, 95\%CI=0.56-1.55). Using logistic regression models, the same associations between VI and cognitive transitions were identified.

CONCLUSIONS: Poor vision is associated with the development of CIND. The association of VI and dementia appears to be due to the higher risk of dementia among individuals with CIND. Findings may inform the design of future interventional studies.

}, keywords = {blindness, cognitive transitions, Epidemiology}, issn = {1758-535X}, doi = {10.1093/gerona/glab157}, author = {Joshua R Ehrlich and Bonnielin K Swenor and Zhou, Yunshu and Kenneth M. Langa} } @article {11778, title = {Longitudinal associations between C-reactive protein and cognitive performance in normative cognitive ageing and dementia.}, journal = {Age and Ageing}, volume = {50}, year = {2021}, pages = {2199-2205}, abstract = {

BACKGROUND: systemic inflammation appears to play an important role in the pathogenesis and expression of Alzheimer{\textquoteright}s disease and other dementias. Previous research has found that elevated levels of serum C-reactive protein (CRP) is associated with poorer cognitive functioning and increased risk for dementia. However, most studies are limited by single CRP measurements, which fail to capture long-term inflammatory exposures or dynamic changes in inflammation and cognition which may occur across repeated measurements.

METHODS: using data from 3,563 older adults aged 65-101 from the Health and Retirement Study, we examined bivariate changes in CRP and cognition measured repeatedly over a 10-year follow-up. Bivariate multilevel models estimated the effect of time-varying CRP on cognition among cognitively healthy older adults and in a subset of 427 participants who reported incident dementia onset during the follow-up period.

RESULTS: in cognitively healthy participants, CRP was associated with lower level of cognitive functioning, but not rate of change over time. This effect was significant in participants under 80~years of age (b = -0.09, standard error (SE) = 0.05, P = 0.04), but not in older participants. In participants with incident dementia, those with higher CRP experienced smaller rates of cognitive decline, leading up to dementia diagnosis.

CONCLUSIONS: elevated levels of CRP predict poorer cognition and increased dementia risk in cognitively healthy adults under the age of 80. Conversely, increased CRP may confer protective effects on cognition in the prodromal stage of dementia.

}, keywords = {Biomarkers, bivariate growth model, Cognition, Dementia, Inflammation}, issn = {1468-2834}, doi = {10.1093/ageing/afab152}, author = {Nathan A Lewis and Knight, Jamie E} } @article {11664, title = {Long-term care service mix in the Veterans Health Administration after home care expansion}, journal = {Health Services Research}, volume = {56}, year = {2021}, pages = {1126-1136}, abstract = {Objective To determine whether the Veterans Health Administration{\textquoteright}s (VHA) efforts to expand access to home- and community-based services (HCBS) after the 2001 Millennium Act significantly changed Veterans{\textquoteright} utilization of institutional, paid home, and unpaid home care relative to a non-VHA user Medicare population that was not exposed to HCBS expansion efforts. Data Sources We used linkages between the Health and Retirement Study and VHA administrative data from 1998 until 2012. Study Design We conducted a retrospective-matched cohort study using coarsened exact matching to ensure balance on observable characteristics for VHA users (n =?943) and nonusers (n =?6106). We used a difference-in-differences approach with a person fixed-effects estimator. Data Collection/Extraction Methods Individuals were eligible for inclusion in the analysis if they were age 65 or older and indicated that they were covered by Medicare insurance in 1998. Individuals were excluded if they were covered by Medicaid insurance at baseline. Individuals were considered exposed to VHA HCBS expansion efforts if they were enrolled in the VHA and used VHA services. Principal Findings Theory predicts that an increase in the public allocation of HCBS will decrease the utilization of its substitutes (e.g., institutional care and unpaid caregiving). We found that after the Millennium Act was passed, there were no observed differences between VHA users and nonusers in the probability of using institutional long-term care (0.7\% points, 95\% CI: ?0.009, 0.022) or in receiving paid help with activities of daily living (0.06\% points, 95\% CI: ?0.011, 0.0125). VHA users received more hours of unpaid care post-Millennium Act (1.48, 95\% CI: ?0.232, 3.187), though this effect was not significant once we introduced controls for mental health. Conclusions Our findings indicate that mandating access to HCBS services does not necessarily imply that access to these services will follow suit.}, keywords = {home- and community-based services, institutional care, Long-term Care, unpaid caregiving, Veterans Health Administration}, isbn = {0017-9124}, doi = {10.1111/1475-6773.13687}, author = {Jacobs, Josephine C. and Wagner, Todd H. and Trivedi, Ranak and Karl A Lorenz and Courtney Harold Van Houtven} } @article {11433, title = {Low levels of low-density lipoprotein cholesterol and cognitive decline}, journal = {Science Bulletin}, volume = {66}, year = {2021}, pages = {1684-1690}, abstract = {The relationship between low levels of serum low-density lipoprotein cholesterol (LDL-C) and subsequent cognitive decline remains conflicting and unclear. The present study aimed to evaluate the longitudinal association between low LDL-C levels and cognition decline in the context of the current aggressive guideline-recommended targets (LDL-C levels less than 55 mg/dL for individuals at very high risk of cardiovascular events, and less than 70 mg/dL for high risk individuals). Data from wave 13 (2016) to wave 14 (2018) of the Health and Retirement Study (HRS) were utilized. LDL-C concentrations measured at wave 13 were categorized into 5 levels, reflecting currently recommended values for lipid lowering treatment. Of 7129 included participants (mean age: 69.0 {\textpm} 9.9 years, 60.3\% female), we found that compared to participants with LDL-C levels 70{\textendash}99.9 mg/dL, those with LDL-C levels < 55 mg/dL had significantly slower 2-year decline rates in global cognitive function (0.244 point/year; 95\% confidence interval (CI): 0.065, 0.422, P = 0.008), working memory (0.068 point/year; 95\% CI: 0.004, 0.133, P = 0.038), and borderline significantly in episodic memory (0.155 point/year; 95\% CI: -0.004, 0.315, P = 0.057). Similarly, significantly slower decline rates were observed in those with LDL-C levels 55{\textendash}69.9 mg/dL. The present study demonstrated that compared with LDL-C levels 70{\textendash}99.9 mg/dL, low LDL-C levels (< 70 mg/dL, especially < 55 mg/dL) were associated with significantly slower cognitive decline in population-based setting. Future randomized controlled trials are warranted to ascertain the safety and benefit of current aggressive guideline-recommended targets on cognitive function.}, keywords = {Cognitive decline, Longitudinal cohort study, Low-density lipoprotein cholesterol}, isbn = {2095-9273}, doi = {https://doi.org/10.1016/j.scib.2021.02.018}, author = {Hua, Rong and Ma, Yanjun and Li, Chenglong and Zhong, Baoliang and Xie, Wuxiang} } @article {10747, title = {Legal Access to Reproductive Control Technology, Women{\textquoteright}s Education, and Earnings Approaching Retirement}, journal = {American Economic Association Papers and Proceedings}, volume = {110}, year = {2020}, pages = {231-35}, abstract = {What do historical changes in legal access to reproductive health care technology tell us about the long-run effects of such changes? We investigate this question using data from the Health and Retirement Study and an identification strategy leveraging variation in exposure to legal changes in access across cohorts born in the same states. We find positive effects on educational attainment that align with prior work but are not statistically significant. We also find positive effects on working in a Social Security-covered job in women{\textquoteright}s 20s and 30s but no evidence of positive effects on women{\textquoteright}s earnings in their 50s.}, keywords = {Reproduction, Retirement Planning, women{\textquoteright}s education, Women{\textquoteright}s Health}, doi = {10.1257/pandp.20201108}, author = {Jason Lindo and Mayra Pineda-Torres and David Pritchard and Hedieh Tajali} } @article {9833, title = {Life transitions and leisure activity engagement among older Americans: findings from a national longitudinal study}, journal = {Ageing and Society}, volume = {40}, year = {2020}, pages = {537-564}, type = {Journal}, abstract = {One of the major aspects of successful ageing is active engagement in later life. Retirement and widowhood are two significant life transitions that may largely influence leisure engagement patterns among older adults. Limited findings exist regarding the impact of life transitions on leisure activity engagement due to the scarcity of longitudinal data with repeated measurement of older individuals{\textquoteright} leisure engagement. This study longitudinally examined changes in leisure activity engagement as influenced by retirement and widowhood using five waves of national panel data from the Health and Retirement Study and its supplementary Consumption and Activities Mail Survey. Multi-level modelling was conducted with retirement and widowhood status as time-varying variables. Socio-economic status, depressive symptoms, cognitive function, self-rated health and functional limitations were also included as time-varying and time-invariant covariates. Findings show that engagement in mental, physical, social and household activities significantly decreased during an eight-year period. Moreover, transition from working to retired status was associated with increased engagement in mental, social and household activities but decreased engagement in physical activities among men only. Transition from married to widowhood status was associated with decreased engagement in household activities among women only. Encouraging active leisure engagement among individuals who experience either or both life transitions may help maintain their health after transition.}, keywords = {CAMS, Leisure activities, Life transitions, Widowhood}, issn = {0144-686X}, doi = {10.1017/S0144686X18001101}, url = {https://www.cambridge.org/core/journals/ageing-and-society/article/life-transitions-and-leisure-activity-engagement-among-older-americans-findings-from-a-national-longitudinal-study/4660EFBC38391378EE45D4BDD860943E}, author = {Yura Lee and Iris Chi and Jennifer A Ailshire} } @article {11181, title = {Life-course risk factors are associated with activity of daily living disability in older adults.}, journal = {European Journal of Public Health}, year = {2020}, abstract = {

BACKGROUND: Multiple risk factors accumulate over the life-course and contribute to higher rates of disability at older ages. This study investigates whether three life-course risk factors (low educational attainment, poor health in childhood and multimorbidity) are associated with increased risk of disability [defined as any limitation in basic activities of daily living (BADL)] in older adults and whether this relationship is moderated by the national socioeconomic context, measured by the Human Development Index (HDI).

METHODS: Data include 100~062 adults (aged 50 and over) participating in longitudinal studies of aging conducted in 19 countries. Analyses include multivariable Poisson models with robust standard errors to assess the associations between HDI, life-course risk factors and other individual-level control variables (sex and age) with any BADL disability.

RESULTS: In country-specific analyses, both educational attainment and multimorbidity are independently associated with disability in nearly every country. The interaction between these risk factors further increases the magnitude of this association. In pooled regression analyses, the relationship between life-course risk factors and disability is moderated by a country{\textquoteright}s HDI. For individuals with all three life-course risk factors, the predicted probability of disability ranged from 36.7\% in the lowest HDI country to 21.8\% in the highest HDI country.

CONCLUSIONS: Social and health system policies directed toward reducing the development of life-course risk factors are essential to reduce disability in all countries, but are even more urgently needed in those with lower levels of socioeconomic development.

}, keywords = {Activities of Daily Living, Aging, Child, Disability, Educational Status, human development index, multimorbidity, Older adult, Socioeconomic factors}, issn = {1464-360X}, doi = {10.1093/eurpub/ckaa156}, author = {Macinko, James and Vaz de Melo Mambrini, Juliana and Bof de Andrade, Fab{\'\i}ola and Drumond Andrade, Flavia Cristina and Lazalde, Gabriela E and Lima-Costa, Maria Fernanda} } @article {10837, title = {Living Longer, With or Without Disability? A Global and Longitudinal Perspective}, journal = {The Journals of Gerontology: Series A}, volume = {75}, year = {2020}, pages = {162-167}, abstract = {Background Significant gains in life expectancy have been achieved, but living longer does not necessarily mean the years gained are productive and healthy. Different theories predict different patterns of time trends in old-age disability prevalence. Methods Using the Gateway to Global Aging Data, which provides internationally harmonized longitudinal data from the Health and Retirement Study and its sister surveys, we compare time trends (from 2004 to 2014) in disability prevalence across countries. Results Disability prevalence varies greatly across countries, and divergent time trends are observed across countries. For countries such as Belgium, Czechia, and Mexico, we observe an increase of disability prevalence, whereas in countries such as Denmark, England, Greece, Korea, Poland, and Sweden, we observe a substantial decrease in disability prevalence. Looking further into the severity of disability, we often observe differential trends in prevalence, but there is no evidence supporting the dynamic equilibrium hypothesis that predicts increased prevalence of modest disability but a decrease in severe disability prevalence. Conclusions Significant gains in life expectancy have translated into different gains in healthy years of life across different countries. Diverse time trends in disability prevalence across countries reaffirm that the expansion of late-life disability is not inevitable.}, keywords = {Activities of Daily Living, CHARLS, Cross-country comparison, Disability, ELSA, KLoSA, MHAS, SHARE, Trends}, issn = {1079-5006}, doi = {10.1093/gerona/glz007}, url = {https://pubmed.ncbi.nlm.nih.gov/30629214/}, author = {Jinkook Lee and Lau, Samuel and Erik Meijer and Hu, Peifeng} } @article {9873, title = {Loneliness and Risk of Dementia}, journal = {The Journals of Gerontology: Series B}, volume = {75}, year = {2020}, pages = {1414-1422}, abstract = {Objective The present study tests whether loneliness is associated with risk of dementia in the largest sample to date and further examines whether the association is independent of social isolation, a related but independent component of social integration, and whether it varies by demographic factors and genetic vulnerability. Method Participants from the Health and Retirement Study (N = 12,030) reported on their loneliness, social isolation, and had information on clinical, behavioral, and genetic risk factors. Cognitive status was assessed at baseline and every 2 years over a 10-year follow-up with the modified Telephone Interview for Cognitive Status (TICSm). A TICSm score of 6 or less was indicative of dementia. Results Cox proportional hazards regression indicated that loneliness was associated with a 40\% increased risk of dementia. This association held controlling for social isolation, and clinical, behavioral, and genetic risk factors. The association was similar across gender, race, ethnicity, education, and genetic risk. Discussion Loneliness is associated with increased risk of dementia. It is one modifiable factor that can be intervened on to reduce dementia risk.}, keywords = {Dementia, Depressive symptoms, Loneliness, Risk Factors}, issn = {1079-5014}, doi = {10.1093/geronb/gby112}, author = {Angelina R Sutin and Yannick Stephan and Martina Luchetti and Antonio Terracciano} } @article {10804, title = {Long working hours and change in body weight: analysis of individual-participant data from 19 cohort studies}, journal = {International Journal of Obesity}, volume = {44}, year = {2020}, pages = {1368 - 1375}, abstract = {Objective To examine the relation between long working hours and change in body mass index (BMI). Methods We performed random effects meta-analyses using individual-participant data from 19 cohort studies from Europe, US and Australia (n = 122,078), with a mean of 4.4-year follow-up. Working hours were measured at baseline and categorised as part time (<35 h/week), standard weekly hours (35{\textendash}40 h, reference), 41{\textendash}48 h, 49{\textendash}54 h and >=55 h/week (long working hours). There were four outcomes at follow-up: (1) overweight/obesity (BMI >= 25 kg/m2) or (2) overweight (BMI 25{\textendash}29.9 kg/m2) among participants without overweight/obesity at baseline; (3) obesity (BMI >= 30 kg/m2) among participants with overweight at baseline, and (4) weight loss among participants with obesity at baseline. Results Of the 61,143 participants without overweight/obesity at baseline, 20.2\% had overweight/obesity at follow-up. Compared with standard weekly working hours, the age-, sex- and socioeconomic status-adjusted relative risk (RR) of overweight/obesity was 0.95 (95\% CI 0.90{\textendash}1.00) for part-time work, 1.07 (1.02{\textendash}1.12) for 41{\textendash}48 weekly working hours, 1.09 (1.03{\textendash}1.16) for 49{\textendash}54 h and 1.17 (1.08{\textendash}1.27) for long working hours (P for trend <0.0001). The findings were similar after multivariable adjustment and in subgroup analyses. Long working hours were associated with an excess risk of shift from normal weight to overweight rather than from overweight to obesity. Long working hours were not associated with weight loss among participants with obesity. Conclusions This analysis of large individual-participant data suggests a small excess risk of overweight among the healthy-weight people who work long hours.}, keywords = {Preventive medicine, Risk Factors}, isbn = {1476-5497}, doi = {10.1038/s41366-019-0480-3}, author = {Virtanen, Marianna and Markus Jokela and Lallukka, Tea and Magnusson Hanson, Linda and Pentti, Jaana and Solja T. Nyberg and Alfredsson, Lars and G David Batty and Casini, Annalisa and Clays, Els and DeBacquer, Dirk and Ervasti, Jenni and Fransson, Eleonor and Halonen, Jaana I. and Head, Jenny and Kittel, France and Knutsson, Anders and Leineweber, Constanze and Nordin, Maria and Oksanen, Tuula and Pietil{\"a}inen, Olli and Rahkonen, Ossi and Salo, Paula and Archana Singh-Manoux and Stenholm, Sari and Suominen, Sakari B. and Theorell, T{\"o}res and Vahtera, Jussi and Westerholm, Peter and Westerlund, Hugo and Mika Kivim{\"a}ki} } @article {Lappan202018, title = {Longitudinal and Reciprocal Relationships Between Psychological Well-Being and Smoking}, journal = {Nicotine \& tobacco research : official journal of the Society for Research on Nicotine and Tobacco}, volume = {22}, year = {2020}, note = {cited By 1}, pages = {18-23}, abstract = {INTRODUCTION: Smoking cessation treatments currently succeed at a rate of approximately 20\%-30\%, underscoring the importance of exploring factors that might increase intervention effectiveness. Although negative affect has been studied extensively in relation to smoking cessation, psychological well-being (PWB; eg, life satisfaction, optimism, positive affect, purpose in life) has received little attention. This study tested longitudinal and reciprocal relationships between PWB and smoking status in older adults. METHODS: Panel data were obtained from the biennial, longitudinal Health and Retirement Study. Using structural equation modeling, we developed cross-lagged models to examine the relationships of PWB in 2006 with smoking status in 2010 and of smoking status in 2006 with PWB in 2010 while controlling for covariates (Ns = 2939-4230, 55\% women, 89\% white, mean age = 64 years, mean years of education = 13, 25\% smokers in 2006 and 21\% smokers in 2010). Separate cross-lagged models were developed for each of the PWB variables: life satisfaction, optimism, positive affect, and purpose in life. RESULTS: Greater life satisfaction (standardized path coefficient = -0.04), optimism (standardized path coefficient = -0.07), and positive affect (standardized path coefficient = -0.08) in 2006 predicted a reduced likelihood of smoking in 2010. Being a smoker in 2006 predicted lower life satisfaction (standardized path coefficient = -0.25), optimism (standardized path coefficient = -0.10), positive affect (standardized path coefficient = -0.10), and purpose in life (standardized path coefficient = -0.13) in 2010. CONCLUSIONS: Findings warrant further exploration of the relationships between PWB and smoking, and support the incorporation of PWB-boosting components into existing treatments. IMPLICATIONS: Given the relatively low success rate of current smoking cessation treatments, the present results suggest that increasing PWB might promote abstinence and therefore warrant consideration as a focus of future cessation treatment research. Moreover, these results suggest that smoking might inhibit PWB, illuminating a negative consequence of smoking not previously identified. Helping smokers increase their PWB may benefit them beyond promoting cessation and contribute to a flourishing society. These results warrant further investigation of PWB and smoking, and support the continued evaluation of PWB-boosting components in smoking cessation treatments. {\textcopyright} The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.}, keywords = {Adult, Aged, Article, Education, Female, human, Life Satisfaction, Male, Middle Aged, Optimism, people by smoking status, psychological well-being, Retirement, Smoking cessation, structural equation modeling}, issn = {1469994X}, doi = {10.1093/ntr/nty185}, author = {Lappan, S. and Thorne, C.B. and Long, D. and Hendricks, P.S.} } @article {10507, title = {Long-term Functional Decline After High-Risk Elective Colorectal Surgery in Older Adults}, journal = {Diseases of the colon and rectum}, volume = {63}, year = {2020}, month = {2020}, pages = {75 - 83}, abstract = {BACKGROUND: Although most surgical outcomes research focuses on clinical end points and complications, older adult patients may value functional outcomes more. However, little is known about the risk of long-term functional disability after colorectal procedures. OBJECTIVE: The purpose of this research was to understand the incidence and likelihood of functional decline after high-risk (ie, >=1\% inpatient mortality) colorectal operations both without and with complications. DESIGN: This was a retrospective matched cohort study. SETTINGS: The Health and Retirement Study, a nationally representative, longitudinal survey of adults >50 years of age, collects data on functional status, cognition, and demographics, among other topics. The survey was linked with Medicare claims and National Death Index data from 1992 to 2012. PATIENTS: Patients >=65 years of age who underwent elective high-risk colorectal surgery with functional status measured before and after surgery were included. These patients were matched 1:3 to survey respondents who did not undergo major surgery, based on propensity scores. MAIN OUTCOME MEASURES: Functional decline, the primary outcome, was defined as an increase in the number of activities of daily living and instrumental activities of daily living requiring assistance before and after surgery. Using logistic regression, we examined whether surgery without or with complications was associated with functional decline. RESULTS: We identified 289 patients who underwent high-risk colorectal surgery and 867 matched control subjects. Of the surgery patients, 90 (31\%) experienced a complication. Compared with the control subjects, surgery patients experienced greater likelihood of functional decline (without complications: OR = 1.82 (95\% CI, 1.22-2.71), and with complications: OR = 2.96 (95\% CI, 1.70-5.14)). Increasing age also predicted greater odds of functional decline (OR = 2.09, per decade (95\% CI, 1.57-2.80)). LIMITATIONS: The functional measures were self-reported by survey participants. CONCLUSIONS: High-risk colorectal surgery, without or with complications, is associated with increased likelihood of functional decline in older adults. Patient-centered decision-making should include discussion of expected functional outcomes and long-term disability. }, keywords = {Colon, Postoperative Complications, Surgery}, isbn = {15300358 (ISSN)}, doi = {10.1097/DCR.0000000000001541}, author = {De Roo, A.C. and Yun Li and Abrahamse, P.H. and Regenbogen, S.E. and Suwanabol, P.A.} } @article {10061, title = {Late life disability and experienced wellbeing: Are economic resources a buffer?}, journal = {Disability and Health Journal}, year = {2019}, abstract = {

BACKGROUND: Disablement has been linked to compromised wellbeing in later life, but whether material resources buffer these negative effects is unclear.

OBJECTIVE: Drawing upon conceptual models of stress and coping, we analyze experienced wellbeing data from time diary interviews with adults ages 60 and older. We expect that experienced wellbeing will be influenced by each stage of the disablement process and that higher income and wealth will buffer the negative effects of disability on experienced wellbeing. Because income is a better reflection of one{\textquoteright}s liquid resources while assets reflect lifetime accumulation, we expect income to be a more substantial buffer than assets.

METHODS: We use the Disability and Use of Time Supplement to the Panel Study of Income Dynamics (N = 1607). We consider several measures of the disablement process (activity limitations, impairment severity, duration of limiting condition) and history of work limitation and evaluate both pre-tax income and net worth quartiles. We estimate a series of multi-level regression models that account for clustering of individuals within couples. We calculate the marginal effects of disability on wellbeing at different quartiles of economic resources.

RESULTS: We find that impairment severity is associated with worse experienced wellbeing before and after adjusting for covariates, and income buffers these negative effects for those in the middle-income quartiles.

CONCLUSIONS: Future research should further explore the mechanisms through which income buffers the negative effects of impairment severity and specify the accommodations that enable economically disadvantaged and advantaged older adults alike to withstand physical declines while maintaining wellbeing.

}, keywords = {Disabilities, Financial Health, Well-being}, issn = {1876-7583}, doi = {10.1016/j.dhjo.2019.02.003}, author = {Vicki A Freedman and Jennifer C. Cornman and Deborah Carr and Richard E Lucas} } @article {10106, title = {A life course approach to total tooth loss: Testing the sensitive period, accumulation, and social mobility models in the Health and Retirement Study.}, journal = {Community Dentistry and Oral Epidemiology}, year = {2019}, abstract = {

OBJECTIVES: Childhood socio-economic status (SES) has long been associated with later-life oral health, suggesting that childhood is a sensitive period for oral health. Far less attention has been given to the long-term impact of childhood trauma, abuse, and smoking on later-life oral health. This study fills the gap in the literature by examining how adverse childhood experiences-social, psychological, and behavioral-shape total tooth loss over the life course, with an assessment of the sensitive period, accumulation, and social mobility models from life course research.

METHODS: Data are drawn from the 2012 Health and Retirement Study (HRS) merged with multiple HRS data sources to obtain childhood information (N~=~6,427; age~>~50). Adverse childhood experiences include childhood financial hardship, trauma, abuse, and smoking. Total tooth loss is measured to assess poor oral health in later life. Educational attainment and poverty status (since age 51) are measured as adult adversity. Current health conditions and health behaviors are assessed to reflect the correlates of oral health in later life.

RESULTS: The sensitive period model indicates that childhood trauma such as parental death or divorce (odds ratio [OR]~=~1.37, 95\% confidence interval [CI]~=~1.04, 1.80), physical abuse (OR~=~1.17, 95\% CI~=~1.03, 1.34), and low educational attainment (<= high school; OR~=~1.52, 95\% CI~=~1.04, 2.22) are associated with higher odds of total tooth loss in later life. Poverty status was not associated with the outcome. There was a clear graded relationship between accumulation of adverse experiences and oral health, which supports the accumulation model. In the social mobility model, older adults who occupied a stable disadvantageous position were more likely to be toothless (OR~=~1.77, 95\% CI~=~1.08, 2.90) compared to those who did not face adversity in any case. Neither upward nor downward mobility mattered.

CONCLUSIONS: Failing oral health in older adults, especially total tooth loss, may have its roots in adverse experiences such as childhood trauma, abuse, and low educational attainment. Findings also suggest that oral health in later life may be more influenced by accumulation of adversity rather than changes in social and economic position over the life course.

}, keywords = {Childhood adversity, Dental Care, Life trajectories}, issn = {1600-0528}, doi = {10.1111/cdoe.12463}, author = {Lee, Haena} } @article {10171, title = {Life-Cycle Consumption Patterns at Older Ages in the United States and the United Kingdom: Can Medical Expenditures Explain the Difference?}, journal = {American Economic Journal: Economic Policy}, volume = {11}, year = {2019}, pages = {27 - 54}, abstract = {This paper documents significantly steeper declines in nondurable expenditures at older ages in the United Kingdom compared to the United States, in spite of income paths being similar. Several possible causes are explored, including different employment paths, housing ownership and expenses, levels and paths of health status, number of household members, and out-of-pocket medical expenditures. Among all the potential explanations considered, those relating to health care{\textemdash}differences in levels and age paths in medical expenses and medical expenditure risk{\textemdash}can fully account for the steeper declines in nondurable consumption in the United Kingdom compared to the United States.}, keywords = {Consumption and Savings, Cross-National, Medical Expenses, Spending}, issn = {1945-7731}, doi = {10.1257/pol.20170182}, url = {https://pubs.aeaweb.org/doi/10.1257/pol.20170182https://pubs.aeaweb.org/doi/pdf/10.1257/pol.20170182}, author = {James Banks and Richard Blundell and Levell, Peter and James P Smith} } @article {9804, title = {Light-Intensity Physical Activity and Cardiometabolic Risk Among Older Adults With Multiple Chronic Conditions.}, journal = {American Journal of Health Promotion}, volume = {33}, year = {2019}, pages = {507-515}, abstract = {

PURPOSE: To assess the relationship between light-intensity physical activity (LIPA) and cardiometabolic risk factors among middle-aged and older adults with multiple chronic conditions.

DESIGN: Cross-sectional design utilizing data from the Health and Retirement Study (2010, 2012).

SETTING: Laboratory- and survey-based testing of a nationally representative sample of community-dwelling middle aged and older adults.

PARTICIPANTS: Adults aged 50 years and older (N = 14 996).

MEASURES: Weighted metabolic equivalent of tasks was calculated using self-reported frequency of light, moderate, and vigorous physical activity. Cardiometabolic risk factors (systolic and diastolic blood pressure, glycosylated hemoglobin [HbA], high-density lipoprotein cholesterol [HDL-C], total cholesterol, and non-HDL-C) were objectively measured. A multiple chronic condition index was based on 8 self-reported chronic conditions.

ANALYSIS: Weighted multivariate linear regression models.

RESULTS: Light-intensity physical activity was independently associated with favorable HDL-C (β = 1.25; 95\% confidence interval [CI]: 0.46-2.05) and total cholesterol (β = 2.72; 95\% CI: 0.53-4.90) after adjusting for relevant confounders. The HDL-C health benefit was apparent when stratified by number of chronic conditions, for individuals with 2 to 3 conditions (β = 1.73; 95\% CI: 0.58-2.89). No significant associations were observed between LIPA and blood pressure, HbA, or non-HDL-C.

CONCLUSIONS: Engaging in LIPA may be an important health promotion activity to manage HDL-C and total cholesterol. Additional longitudinal research is needed to determine the causal association between LIPA and cardiometabolic risk which can potentially inform physical activity guidelines targeting older adults with multiple chronic conditions.

}, keywords = {Community-dwelling, Comorbidity, Physical activity}, issn = {2168-6602}, doi = {10.1177/0890117118796459}, author = {Yueyao Li and White, Kellee and Katherine R O{\textquoteright}Shields and Alexander C McLain and Anwar T Merchant} } @article {9547, title = {Loneliness as a Mediator of Perceived Discrimination and Depression: Examining Education Contingencies.}, journal = {Int Journal of Aging \& Human Development}, year = {2019}, abstract = {This study examines whether loneliness explains the association between perceived everyday discrimination and depressive symptoms among older adults as well as whether this indirect pathway differs by education. Three waves (2006, 2010, and 2014) of the Health and Retirement Study ( N = 7,130) are analyzed with random-effects models that adjust for repeated observations and fixed-effects models that control for all time-stable influences. Everyday discrimination is associated with loneliness and depressive symptoms but more weakly in fixed-effects models. The association between discrimination and loneliness is stronger at low educational attainment, leading discrimination to be indirectly associated with depressive symptoms through loneliness only at low education. The consequences of everyday discrimination for depression in late life are limited to older adults with low education due to education-contingent associations with loneliness. Perceived discrimination may have broad health consequences through loneliness, especially for older adults at low education.}, keywords = {Depressive symptoms, Discrimination, Education, Loneliness}, issn = {1541-3535}, doi = {10.1177/0091415018763402}, author = {Lee, Yeonjung and Bierman, Alex} } @mastersthesis {10246, title = {Longitudinal associations between functional disability, depression, and suicide in middle-aged and older adults.}, volume = {Ph.D.}, year = {2019}, month = {2019}, pages = {88}, school = {West Virginia University}, address = {Morgantown, WV}, abstract = {Suicide is a significant public health problem among older adults in the United States and around the world. There has been little research to date on longitudinal change in functional disability and depressive symptoms, both of which have been posited to be associated with suicide risk among middle-aged and older adults, and their association with death by suicide. The aims of this study were to 1) characterize longitudinal change in functional disability and depressive symptoms separately; 2) characterize the directional associations between functional disability and depressive symptoms in bivariate models; and 3) determine how different patterns of change among these variables are associated with risk for death by suicide. The study used two larger population-based longitudinal datasets, the Health and Retirement Study (HRS) in the United States, and the Swedish Twin Registry (STR). Results from HRS indicated that change in functional disability and depressive symptoms is characterized by a complex system of effects, including both systematic, linear change effects and proportional change based on the level of each variable at each wave. Functional disability generally increased across time and depressive symptoms remained relatively stable, with some slight increases. A bivariate model where level of disability was associated with subsequent change in depressive symptoms was supported by the data, and latent class membership representing group differences in patterns of change within this model predicted risk for death by suicide. Cognitive impairment was significantly associated with lower risk for death by suicide, and appeared to have a suppressor effect on the association of class membership with death by suicide. In STR, functional disability did not predict risk for death by suicide. Further research is needed to characterize the complex longitudinal associations between disability and depression and their effects on suicide risk, taking into account cognitive status.}, keywords = {Depressive symptoms, functional disability, Middle age, Older Adults, suicide}, url = {https://researchrepository.wvu.edu/etd/4122/}, author = {Lutz, Julie Ann} } @article {10182, title = {The Longitudinal Associations between Physical Health and Mental Health among Older Adults.}, journal = {Aging \& Mental Health}, year = {2019}, abstract = {This study examines the lead-lag relationship between physical and mental health among older adults. Data are collected from 16,417 older adults aged 50 years and older participating in the biannual Health and Retirement Study (HRS). Participants were assessed on up to 11 measurement points over a 21-year period from 1994 to 2014. Physical health was measured as a composite of chronic diseases, functional limitations, and difficulties in basic and instrumental activities of daily living. Mental health was measured with the modified CES-D. Bivariate latent change score models (BLCSM) were estimated. : Both physical and mental health declined in the observed years, with slower declining rates over time. A reciprocal relationship emerged, with the prior level of physical health acting as the leading indicator of subsequent change in mental health, and the prior mental health state acting as the leading indicator of subsequent changes in physical health. Additionally, the influence of physical health on mental health changes was larger than the corresponding effect of mental health on subsequent physical health. This study demonstrates the reciprocal relationship between physical and mental health in later adulthood and highlights the need to pay attention to the mental health of older people with physical health problems.}, keywords = {Depressive symptoms, Mental Health, Physical Ability, Physical Health}, issn = {1364-6915}, doi = {10.1080/13607863.2019.1655706}, author = {Luo, Meng Sha and Ernest Wing Tak Chui and Lydia W Li} } @article {9769, title = {Latent Profiles of Macronutrient Density and their Association with Mobility Limitations in an Observational Longitudinal Study of Older U.S. Adults.}, journal = {The Journal of Nutrition, Health and Aging}, volume = {22}, year = {2018}, pages = {645-654}, abstract = {

OBJECTIVES: Our first objective was to estimate empirically-derived subgroups (latent profiles) of observed carbohydrate, protein, and fat intake density in a nationally representative sample of older U.S. adults. Our second objective was to determine whether membership in these groups was associated with levels of, and short term change in, physical mobility limitations.

DESIGN AND SETTING: Measures of macronutrient density were taken from the 2013 Health Care and Nutrition Study, an off-year supplement to the Health and Retirement Study, which provided indicators of physical mobility limitations and sociodemographic and health-related covariates.

PARTICIPANTS: 3,914 community-dwelling adults age 65 years and older.

MEASUREMENTS: Percent of daily calories from carbohydrate, protein, and fat were calculated based on responses to a modified Harvard food frequency questionnaire. Latent profile analysis was used to describe unobserved heterogeneity in measures of carbohydrate, protein, and fat density. Mobility limitation counts were based on responses to 11 items indicating physical limitations. Poisson regression models with autoregressive controls were used to identify associations between macronutrient density profile membership and mobility limitations. Sociodemographic and health-related covariates were included in all Poisson regression models.

RESULTS: Four latent subgroups of macronutrient density were identified: "High Carbohydrate", "Moderate with Fat", "Moderate", and "Low Carbohydrate/High Fat". Older adults with the lowest percentage of daily calories coming from carbohydrate and the greatest percentage coming from fat ("Low Carbohydrate/High Fat") were found to have greater reported mobility limitations in 2014 than those identified as having moderate macronutrient density, and more rapid two-year increases in mobility limitations than those identified as "Moderate with Fat" or "Moderate".

CONCLUSION: Older adults identified as having the lowest carbohydrate and highest fat energy density were more likely to report a greater number of mobility limitations and experience greater increases in these limitations than those identified as having moderate macronutrient density. These results suggest that the interrelation of macronutrients must be considered by those seeking to reduce functional limitations among older adults through dietary interventions.

}, keywords = {Activities of Daily Living, Nutrition, Physical limitations}, issn = {1760-4788}, doi = {10.1007/s12603-017-0986-0}, author = {Nicholas J Bishop and Krystle E Zuniga and Lucht, A. L.} } @article {6515, title = {Later Life Marital Dissolution and Repartnership Status: A National Portrait.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 Aug 14}, pages = {1032-1042}, abstract = {

OBJECTIVES: Our study compares two types of later life marital dissolution that occur after age 50-divorce and widowhood-and their associations with repartnership status (i.e., remarried, cohabiting, or unpartnered).

METHOD: We used data from the Health and Retirement Study to provide a portrait of later life divorce and widowhood for women and men. Next, we tested whether marital dissolution type is related to women{\textquoteright}s and men{\textquoteright}s repartnered status, distinguishing among remarrieds, cohabitors, and unpartnereds, net of key sociodemographic indicators.

RESULTS: Divorcees are more often repartnered through either remarriage or cohabitation than are widoweds. This gap persists among women net of an array of sociodemographic factors. For men, the differential is reduced to nonsignificance with the inclusion of these factors.

DISCUSSION: Later life marital dissolution increasingly occurs through divorce rather than widowhood, and divorce is more often followed by repartnership. The results from this study suggest that gerontological research should not solely focus on widowhood but also should pay attention to divorce and repartnering during later life.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Divorce, Female, Humans, Longitudinal Studies, Male, Marriage, Middle Aged, Socioeconomic factors, Spouses, United States, Widowhood}, issn = {1758-5368}, doi = {10.1093/geronb/gbw051}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2016/04/29/geronb.gbw051.abstract}, author = {Susan L. Brown and Lin, I-Fen and Anna M Hammersmith and Matthew R Wright} } @article {9054, title = {Life transitions and leisure activity engagement in later life: findings from the Consumption and Activities Mail Survey (CAMS)}, journal = {Ageing and Society}, volume = {38}, year = {2018}, pages = {1603-1623}, abstract = {This study examined engagement in leisure activities among older adults, specifically focusing on how life transition factors in later life, including retirement and marital status, are associated with leisure activity engagement using a national sample of older American men and women. We conducted multiple regression analyses with a sample of 5,405 individuals (2,318 men; 3,087 women) from the Consumption and Activities Mail Survey, a supplementary sample of the Health and Retirement Study. We analysed activity engagement in each of four domains of leisure activities: mental, physical, social and religious. Retirement status was categorised into three groups: working (referent), completely retired and partly retired. Marital status was categorised into four groups: married (referent), divorced or separated, widowed and never married. We found an overall trend of a positive relationship between retirement and leisure activity engagement, which suggests that retirement provides a chance for older adults to participate in leisure activities after withdrawal from the labour force. The overall trend of a negative relationship between non-married status and leisure activity engagement suggests that the loss or absence of a spouse may serve as a barrier to participate in leisure activities. Nevertheless, variation among retirees and non-married individuals suggests future studies should compare completely and partly retired individuals or those who are widowed, divorced or separated, or never married to elucidate distinguishable leisure activity profiles. Copyright {\textcopyright} Cambridge University Press 2017}, keywords = {CAMS, Engagement, Leisure activities, Life transitions}, issn = {0144-686X}, doi = {10.1017/S0144686X17000216}, url = {https://www.cambridge.org/core/product/identifier/S0144686X17000216/type/journal_articlehttps://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0144686X17000216}, author = {Yura Lee and Joohong Min and Iris Chi} } @mastersthesis {10281, title = {Lifestyle Activities and Episodic Memory: A Dyadic Approach of Spousal Influence Using the Health and Retirement Study}, volume = {PhD}, year = {2018}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2018-05-21}, month = {04/2018}, pages = {132}, school = {University of Nebraska }, type = {phd}, abstract = {Prior research has identified interindividual variabilities in episodic memory and has explored how many health factors influence individuals{\textquoteright} memory outcomes. Building on existing literature, the current study used a dyadic approach to investigate how specific lifestyle activities and marital relationships are associated with episodic memory among older married couples. Using a national sample from the 2012 Core Health and Retirement Study, a sample of 1,114 couples was examined. Using SAS Proc Mixed, multilevel models were used to evaluate individual and spousal contributions to episodic memory performance. The analyses answered two major questions: 1) What lifestyle activities had an association with individuals{\textquoteright} episodic memory? 2) Using a dyadic approach, which specific spousal lifestyle activities were associated with individuals{\textquoteright} episodic memory? It was hypothesized that individuals{\textquoteright} participation in lifestyle activities would have an association with individuals{\textquoteright} episodic memory. In addition, it was hypothesized that at the couple level, when controlling for the individuals{\textquoteright} lifestyle activities, partners{\textquoteright} participation in lifestyle activities would have an association with individuals{\textquoteright} episodic memory. Results indicated that reading and using a computer were positively associated with individuals{\textquoteright} immediate and delayed recall. Doing word games was positively associated with individuals{\textquoteright} immediate recall. Spouses{\textquoteright} baking/cooking was negatively associated with individuals{\textquoteright} immediate and delayed recall, and sewing/knitting was negatively associated with individuals{\textquoteright} immediate recall. Both individuals{\textquoteright} and partners{\textquoteright} self-rated health and individuals{\textquoteright} rating of their spouses {\textquotedblleft}getting on their nerves{\textquotedblright} were positively associated with immediate recall. The current study demonstrated that individuals{\textquoteright} and spouses{\textquoteright} activities showed an influence on individuals{\textquoteright} episodic memory, though the type of activities differed. Corresponding to Rowe and Kahn{\textquoteright}s successful aging model, having activity engagement, maintaining cognitive functioning, and avoiding diseases are three factors to achieve successful aging. Married couples may have a built-in social relationship and support. Coupled with activity engagement, two out of the three factors bring individuals closer to achieving successful aging.}, keywords = {Dyadic analyses, Episodic Memory, Gerontology, Health and Retirement Study, Lifestyle activities, Social Sciences}, isbn = {9780355864083}, url = {https://proxy.lib.umich.edu/login?url=https://search.proquest.com/docview/2036836323?accountid=14667}, author = {Lai,Khanh P.} } @article {9582, title = {Lifestyle index for mortality prediction using multiple ageing cohorts in the USA, UK and Europe.}, journal = {Scientific Reports}, volume = {8}, year = {2018}, pages = {6644}, abstract = {Current mortality prediction indexes are mainly based on functional morbidity and comorbidity, with limited information for risk prevention. This study aimed to develop and validate a modifiable lifestyle-based mortality predication index for older adults. Data from 51,688 participants (56\% women) aged >=50 years in 2002 Health and Retirement Study, 2002 English Longitudinal Study of Ageing and 2004 Survey of Health Ageing and Retirement in Europe were used to estimate coefficients of the index with cohort-stratified Cox regression. Models were validated across studies and compared to the Lee index (having comorbid and morbidity predictors). Over an average of 11-year follow-up, 10,240 participants died. The lifestyle index includes smoking, drinking, exercising, sleep quality, BMI, sex and age; showing adequate model performance in internal validation (C-statistic 0.79; D-statistic 1.94; calibration slope 1.13) and in all combinations of internal-external cross-validation. It outperformed Lee index (e.g. differences in C-statistic = 0.01, D-statistic = 0.17, P < 0.001) consistently across health status. The lifestyle index stratified participants into varying mortality risk groups, with those in the top quintile having 13.5\% excess absolute mortality risk over 10 years than those in the bottom 50th centile. Our lifestyle index with easy-assessable behavioural factors and improved generalizability may maximize its usability for personalized risk management.}, keywords = {Cross-National, Functional status, Mortality}, issn = {2045-2322}, doi = {10.1038/s41598-018-24778-1}, author = {Liao, Jing and Muniz-Terrera, Graciela and Shaun Scholes and Hao, Yuantao and Chen, Yu-Ming} } @article {8676, title = {Loneliness and depressive symptoms: the moderating role of the transition into retirement.}, journal = {Aging Ment Health}, volume = {22}, year = {2018}, month = {2018 Jan}, pages = {135-140}, abstract = {

OBJECTIVES: The transition to retirement implies significant changes in daily routine and in the social environment. More specifically, it requires more self-directed efforts in order to stay socially engaged. Hence, for those who suffer from loneliness, the transition to retirement could result in increased depressive symptoms due to the lack of structured daily routine.

METHODS: We used two waves of the Health and Retirement Study, and tested whether the transition to retirement between the two waves moderates the effects of loneliness on depressive symptoms.

RESULTS: The transition to retirement moderated the effect of loneliness in wave 1 on depressive symptoms in wave 2, such that for those who retired, the effect was stronger in comparison to those who stayed employed.

CONCLUSIONS: Although many manage to easily transition into retirement, lonely older workers are at increased risk for maladjustment and the experience of depressive symptoms following retirement. This group could perhaps benefit from interventions aimed at increasing daily social interactions and establishing a socially satisfying routine.

}, keywords = {Aged, depression, Female, Humans, Loneliness, Male, Middle Aged, Retirement}, issn = {1364-6915}, doi = {10.1080/13607863.2016.1226770}, author = {Dikla Segel-Karpas and Liat Ayalon and Margie E Lachman} } @article {8683, title = {A Longitudinal Assessment of Perceived Discrimination and Maladaptive Expressions of Anger Among Older Adults: Does Subjective Social Power Buffer the Association?}, journal = {The Journals of Gerontology: Series B}, volume = {73}, year = {2018}, pages = {e120-e130}, abstract = {

Objectives: We examine whether perceived discrimination in older adults is associated with external conflict (anger-out) and internally directed anger (anger-in), as well as how subjective social power-as indicated by a sense of personal control and subjective social status-modifies these associations while holistically controlling for time-stable confounds and the five major dimensions of personality.

Method: The 2006 and 2008 psychosocial subsamples of the Health and Retirement Study were combined to create baseline observations, and the 2010 and 2012 waves were combined to create follow-up observations. Responses were analyzed with random-effects models that adjust for repeated observations and fixed-effects models that additionally control for all time-stable confounds.

Results: Discrimination was significantly associated with anger-in and anger-out. Fixed-effects models and controls for personality reduced these associations by more than 60\%, although they remained significant. Measures of subjective social power weaken associations with anger-out but not anger-in.

Discussion: The mental health consequences of perceived discrimination for older adults may be over-estimated if time-stable confounds and personality are not taken into account. Subjective social power can protect victims of discrimination from reactions that may escalate conflict, but not from internalized anger that is likely to be wearing and cause further health problems.

}, keywords = {African Americans, Aged, Anger, European Continental Ancestry Group, Female, Hispanic Americans, Humans, Longitudinal Studies, Male, Personality Inventory, Power, Psychological, Prejudice, Racism, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbw110}, author = {Lee, Yeonjung and Bierman, Alex} } @article {9484, title = {Longitudinal state-level effects on change in body mass index among middle-aged and older adults in the USA}, journal = {Health Education Journal}, volume = {77}, year = {2018}, pages = {59-72}, abstract = {Objective: The purpose of this longitudinal study was to examine the effects of state-level socioeconomic status (SES), the density of fast food restaurants and walking to work on body mass index (BMI) among US adults aged 50 years and older. The study sought further to account for the interaction effects of three different hierarchical levels of variables, including time-varying variables and time-invariant variables such as individual and state-level variables. Confounding related to environmental/neighbourhood effects was controlled for through sample selection. Methods: Data were drawn from the 2000{\textendash}2010 Health and Retirement Study (HRS) and the 2010 US Census. HRS survey participants aged 50 years and older in 2000, residing in the same census tract during 2000{\textendash}2010 (N = 6,156) comprised the study sample. A three-level growth model was fitted to BMI trajectories. Results: BMI significantly increased over time showing both a linear and quadratic decelerating trajectory (p < .001) where BMI grew faster among sampled adults in their early 50s. Women living in the US states with a lower state-level SES had higher BMIs, while men with higher state-level SES had a higher BMI (b = -.242, p = .013). In states with a higher proportion of people who walked to work, Hispanics had higher BMIs at baseline and a lower BMI growth rate, compared with non-Hispanic whites (b = -.033, p < .001). Conclusions: Obesity interventions specific to adults aged 50 years and older require greater emphasis. Potential health inequalities regarding weight gain can be ameliorated through tailoring interventions based on sex, environmental and state-level SES influences.}, keywords = {BMI, Eating habits, Gender Differences, Health Trajectories, Regional associations, Socioeconomic factors}, issn = {0017-8969}, doi = {10.1177/0017896917733016}, author = {Chen, Cheng-Chia and Seo, Dong-Chul and Hsien-Chang Lin} } @article {8861, title = {Late Career Job Loss and Retirement Behavior of Couples}, journal = {Research on Aging}, volume = {39}, year = {2017}, month = {Jan-01-2017}, pages = {7 - 28}, abstract = {This article argues that wealth uncertainty influences when couples choose to retire. Using data from the Health and Retirement Study, I show that wives delay retirement when their husbands retire following a job loss. This effect is stronger when husbands are the primary earners, and couples are relatively poorer. This provides evidence of intra-household insurance that mitigates the impact of an unexpected earnings shock. I find that wives tend to delay retirement only until they become eligible for social security. This suggests that social security benefits can relax households{\textquoteright} budget constraints and allow wives to join their husbands in retirement}, keywords = {Couples, Employment and Labor Force, Job loss, Marriage, Older Adults, Retirement Planning and Satisfaction}, issn = {0164-0275}, doi = {10.1177/0164027516656136}, url = {http://journals.sagepub.com/doi/10.1177/0164027516656136}, author = {Lee, Ajin} } @article {9245, title = {Late mortality after acute hypoxic respiratory failure.}, journal = {Thorax}, year = {2017}, abstract = {

BACKGROUND: Acute hypoxic respiratory failure (AHRF) is associated with significant acute mortality. It is unclear whether later mortality is predominantly driven by pre-existing comorbid disease, the acute inciting event or is the result of AHRF itself.

METHODS: Observational cohort study of elderly US Health and Retirement Study (HRS) participants in fee-for-service Medicare (1998-2012). Patients hospitalised with AHRF were matched 1:1 to otherwise similar adults who were not currently hospitalised and separately to patients hospitalised with acute inciting events (pneumonia, non-pulmonary infection, aspiration, trauma, pancreatitis) that may result in AHRF, here termed at-risk hospitalisations. The primary outcome was late mortality-death in the 31 days to 2 years following hospital admission.

RESULTS: Among 15 075 HRS participants, we identified 1268 AHRF and 13 117 at-risk hospitalisations. AHRF hospitalisations were matched to 1157 non-hospitalised adults and 1017 at-risk hospitalisations. Among patients who survived at least 30 days, AHRF was associated with a 24.4\% (95\%CI 19.9\% to 28.9\%, p<0.001) absolute increase in late mortality relative to adults not currently hospitalised and a 6.7\% (95\%CI 1.7\% to 11.7\%, p=0.01) increase relative to adults hospitalised with acute inciting event(s) alone. At-risk hospitalisation explained 71.2\% of the increased odds of late mortality, whereas the development of AHRF itself explained 28.8\%. Risk for death was equivalent to at-risk hospitalisation beyond 90 days, but remained elevated for more than 1 year compared with non-hospitalised controls.

CONCLUSIONS: In this national sample of older Americans, approximately one in four survivors with AHRF had a late death not explained by pre-AHRF health status. More than 70\% of this increased risk was associated with hospitalisation for acute inciting events, while 30\% was associated with hypoxemic respiratory failure.

}, keywords = {Health Shocks, Mortality, Respiratory Disease}, issn = {1468-3296}, doi = {10.1136/thoraxjnl-2017-210109}, author = {Hallie C Prescott and Sjoding, Michael W and Kenneth M. Langa and Theodore J Iwashyna and Daniel F McAuley} } @article {9000, title = {Life Course Trajectories of Later-Life Cognitive Functions: Does Social Engagement in Old Age Matter?}, journal = {International Journal of Environmental Research and Public Health}, volume = {14}, year = {2017}, month = {2017 Apr 07}, abstract = {This study identified differential patterns of later-life cognitive function trajectories and examined to what extent life course factors and social engagement are associated with group trajectories. Data came from seven waves of the Health and Retirement Study (HRS 1998-2010; n = 7374; Observations = 41,051). Latent class growth analysis identified cognitive function trajectory groups, and multinomial logistic regression was used to examine the factors associated with group trajectories. Five heterogeneous trajectories were identified: stable high, stable moderate, stable low, high-to-moderate, and moderate-to-low. Findings suggest that, after adjusting for life course factors, individuals who became volunteers were more likely to belong to one of the two least vulnerable trajectories, stable high or high-to-moderate. Our findings suggest that, despite the cumulative life course factors evident in cognitive decline, social engagement in old age may serve as a potential protective resource.}, keywords = {Cognitive Ability, Older Adults, Social Relationships, Trajectories}, issn = {1660-4601}, doi = {10.3390/ijerph14040393}, author = {So Jung Park and Kwon, Eunsun and Lee, Hyunjoo} } @article {9039, title = {The link between discrimination and telomere length in African American adults.}, journal = {Health Psychology}, volume = {36}, year = {2017}, month = {2017 May}, pages = {458-467}, abstract = {

OBJECTIVE: Prior work shows that discrimination is associated with a wide array of negative health outcomes. However, the biological mechanisms through which this link occurs require more study. We evaluated the association between discrimination and leukocyte telomere length (LTL; a biological marker of systemic aging).

METHOD: Cross-sectional data were from the Health and Retirement study, a study of people aged 51+ in the United States, and included 595 African American males and females. Multiple regression analyses were used to evaluate whether discrimination was independently associated with LTL. We also considered the role of potential confounders including sociodemographic factors, health factors, depressive symptoms, and stress.

RESULTS: High discrimination was associated with shorter LTL after controlling for sociodemographic factors (b = -.034, SE = 0.14, p = .017). This association persisted in analyses that further adjusted for health factors, depressive symptoms, and stress.

CONCLUSION: Results suggest that discrimination experiences accelerate biological aging in older African American males and females, alike. This finding helps advance our understanding of how discrimination generates greater disease vulnerability and premature death in African Americans. (PsycINFO Database Record

}, keywords = {Discrimination, Racial/ethnic differences, Telomeres, Women and Minorities}, issn = {1930-7810}, doi = {10.1037/hea0000450}, author = {Daniel B Lee and Eric S Kim and Enrique W Neblett} } @article {9051, title = {Longitudinal associations between marital quality and sleep quality in older adulthood.}, journal = {Journal of Behavioral Medicine}, year = {2017}, month = {2017 Apr 11}, abstract = {The current study examined how changes in marital quality are associated with changes in sleep quality in older adults over an 8-year period. Older adults from the Health and Retirement Study completed measures of both marital support/strain and sleep quality in 2006, 2010, and 2014 (N~=~4981). We used latent growth curve models to examine intraindividual change in support, strain, and sleep quality. Further, we examined interrelationships between changes in each of these three indicators. Results showed that higher marital quality was associated with better sleep at baseline. We also found that marital quality and sleep quality were coordinated over time-as marital quality increased, so did sleep quality. When this covariation was accounted, the prospective effects of baseline marital quality on changes in sleep quality were not found. The current study provided evidence for a long-term temporal coordination of marital quality and sleep quality in older adults.}, keywords = {Marriage, Sleep}, issn = {1573-3521}, doi = {10.1007/s10865-017-9850-2}, author = {Ji Hyun Lee and William J. Chopik and Lawrence B Schiamberg} } @article {9271, title = {The long-term effect of health insurance on near-elderly health and mortality}, journal = {American Journal of Health Economics}, volume = {3}, year = {2017}, pages = {281-311}, abstract = {We use the best available longitudinal data set, the Health and Retirement Study, and a battery of causal inference methods to provide both central estimates and bounds for the long-term effect of health insurance on health and mortality among the near-elderly (initial age 50-61) over a 20-year period. Compared with matched insured persons, those uninsured in 1992 consume fewer health-care services, but their health (while alive) does not deteriorate relative to the insured, and, in our central estimates, they do not die significantly faster than the insured. Our upper and lower bounds suggest that prior studies have greatly overestimated the health and mortality benefits of providing health insurance to the uninsured.}, keywords = {Health Conditions and Status, Medicare/Medicaid/Health Insurance, Mortality}, issn = {2332-3493}, doi = {10.1162/ajhe_a_00076}, url = {http://www.mitpressjournals.org/doi/abs/10.1162/ajhe_a_00076http://www.mitpressjournals.org/doi/pdf/10.1162/AJHE_a_00076}, author = {Black, Bernard and Jos{\'e}-Antonio Esp{\'\i}n-S{\'a}nchez and Eric French and Litvak, Kate} } @article {8542, title = {Lagged Associations of Metropolitan Statistical Area- and State-Level Income Inequality with Cognitive Function: The Health and Retirement Study.}, journal = {PLoS One}, volume = {11}, year = {2016}, month = {2016}, pages = {e0157327}, abstract = {

PURPOSE: Much variation in individual-level cognitive function in late life remains unexplained, with little exploration of area-level/contextual factors to date. Income inequality is a contextual factor that may plausibly influence cognitive function.

METHODS: In a nationally-representative cohort of older Americans from the Health and Retirement Study, we examined state- and metropolitan statistical area (MSA)-level income inequality as predictors of individual-level cognitive function measured by the 27-point Telephone Interview for Cognitive Status (TICS-m) scale. We modeled latency periods of 8-20 years, and controlled for state-/metropolitan statistical area (MSA)-level and individual-level factors.

RESULTS: Higher MSA-level income inequality predicted lower cognitive function 16-18 years later. Using a 16-year lag, living in a MSA in the highest income inequality quartile predicted a 0.9-point lower TICS-m score (β = -0.86; 95\% CI = -1.41, -0.31), roughly equivalent to the magnitude associated with five years of aging. We observed no associations for state-level income inequality. The findings were robust to sensitivity analyses using propensity score methods.

CONCLUSIONS: Among older Americans, MSA-level income inequality appears to influence cognitive function nearly two decades later. Policies reducing income inequality levels within cities may help address the growing burden of declining cognitive function among older populations within the United States.

}, keywords = {Cities, Cognition, Female, health, Humans, Income, Interviews as Topic, Linear Models, Male, Middle Aged, Multivariate Analysis, Residence Characteristics, Retirement, Socioeconomic factors, Statistics as Topic, Telephone, United States}, issn = {1932-6203}, doi = {10.1371/journal.pone.0157327}, url = {http://dx.doi.org/10.1371/journal.pone.0157327}, author = {Kim, Daniel and Griffin, Beth Ann and Mohammed U Kabeto and Jos{\'e} J Escarce and Kenneth M. Langa and Regina A Shih}, editor = {M. Maria Glymour} } @article {8547, title = {Late mortality after sepsis: propensity matched cohort study.}, journal = {BMJ}, volume = {353}, year = {2016}, month = {2016 May 17}, pages = {i2375}, abstract = {

OBJECTIVES: ~To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself.

DEIGN: ~Observational cohort study.

SETTING: ~US Health and Retirement Study.

PARTICIPANTS: ~960 patients aged >=65 (1998-2010) with fee-for-service Medicare coverage who were admitted to hospital with sepsis. Patients were matched to 777 adults not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions.

MAIN OUTCOME MEASURES: ~Late (31 days to two years) mortality and odds of death at various intervals.

RESULTS: ~Sepsis was associated with a 22.1\% (95\% confidence interval 17.5\% to 26.7\%) absolute increase in late mortality relative to adults not in hospital, a 10.4\% (5.4\% to 15.4\%) absolute increase relative to patients admitted with non-sepsis infection, and a 16.2\% (10.2\% to 22.2\%) absolute increase relative to patients admitted with sterile inflammatory conditions (P<0.001 for each comparison). Mortality remained higher for at least two years relative to adults not in hospital.

CONCLUSIONS: ~More than one in five patients who survives sepsis has a late death not explained by health status before sepsis.

}, keywords = {Aged, Aged, 80 and over, Case-Control Studies, Cause of Death, Female, Hospital Mortality, Hospitalization, Humans, Longitudinal Studies, Male, Medicare, Propensity Score, Prospective Studies, Sepsis, Time Factors, United States}, issn = {1756-1833}, doi = {10.1136/bmj.i2375}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27189000}, author = {Hallie C Prescott and Osterholzer, John J and Kenneth M. Langa and Angus, Derek C and Theodore J Iwashyna} } @article {8574, title = {Latino and Black smokers in the Health and Retirement Study are more likely to quit: the role of light smoking.}, journal = {Tob Induc Dis}, volume = {14}, year = {2016}, month = {2016}, pages = {23}, abstract = {

BACKGROUND: Older persons are more vulnerable to tobacco mortality and less likely to make quit attempts. Less is known, however, about the role of race and ethnicity on quit rates in the U.S. Using a nationally representative data source of older adults in U.S., we aimed to study racial and ethnic differences in smoking cessation rates.

METHODS: We used data from all waves of the Health and Retirement Study (HRS) between 1992-2012. The HRS is a longitudinal nationally representative survey of adults over the age of 50 in the United States. We followed current smokers at baseline (year 1992) until time to first quit. Race/ethnicity was the main predictor; gender, age, education, marital status, count of chronic medical conditions, depressive symptoms, and drinking at baseline were control variables. Cox regression was used for analysis of time to quit.

RESULTS: Hazard ratios of quitting during the first ten (Hazard ratio = 1.51, p < 0.05) and 20~years (Hazard ratio = 1.46, p < 0.05) were larger for Latinos over the age of 50 compared to Whites. In addition, hazard ratios of quitting during the first 20~years (Hazard ratio = 1.19, p < 0.05) were larger for Blacks over the age of 50 compared to Whites. These findings were partially explained by cigarette consumption intensity, such that Latinos were lighter smokers and therefore more likely to quit than Whites.

CONCLUSION: Latinos and Blacks were more likely than Whites to quit smoking cigarettes within 20~years. However, this finding may be explained by cigarette consumption intensity.

}, issn = {2070-7266}, doi = {10.1186/s12971-016-0090-y}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27436994}, author = {Frank C. Bandiera and Shervin Assari and Livaudais-Toman, Jennifer and Eliseo J Perez-Stable} } @article {8496, title = {Life Satisfaction and Psychological Well-Being of Older Adults With Cancer Experience: The Role of Optimism and Volunteering.}, journal = {Int J Aging Hum Dev}, volume = {83}, year = {2016}, month = {2016 09}, pages = {274-89}, abstract = {

Promoting health and well-being among individuals of advancing age is a significant issue due to increased incidence of cancer among older adults. This study demonstrates the benefits of expecting positive outcomes and participating in volunteer activities among older adults with cancer. We used a nationally representative sample of 2,670 individuals who have experienced cancer from the 2008 wave of the Health and Retirement Study. We constructed a structural equation model to explore the associations of optimism, volunteerism, life satisfaction, and psychological well-being. The level of optimism was a significant predictor of volunteerism, which in turn affected life satisfaction and psychological well-being. The level of engagement in volunteer activities was found to have significant path coefficients toward both life satisfaction and psychological well-being. Our study provides evidence that older adults who have experienced cancer and maintained a positive outlook on their lives and engaged in personally meaningful activities tended to experience psychological well-being and life satisfaction.

}, keywords = {Aged, Aged, 80 and over, Aging, Female, Humans, Male, Middle Aged, Neoplasms, Optimism, Personal Satisfaction, Volunteers}, issn = {1541-3535}, doi = {10.1177/0091415016652406}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27273518}, author = {Jinmoo Heo and Sanghee Chun and Lee, Sunwoo and Kim, Junhyoung} } @article {8335, title = {A Life-Cycle Model with Ambiguous Survival Beliefs}, journal = {Journal of Economic Theory}, volume = {162}, year = {2016}, pages = {137-180}, publisher = {162}, abstract = {Based on a cognitive notion of neo-additive capacities reflecting likelihood insensitivity with respect to survival chances, we construct a Choquet Bayesian learning model over the life-cycle that generates a motivational notion of neo-additive survival beliefs expressing ambiguity attitudes. We embed these neo-additive survival beliefs as decision weights in a Choquet expected utility life-cycle consumption model and calibrate it with data on subjective survival beliefs from the Health and Retirement Study. Our quantitative analysis shows that agents with calibrated neo-additive survival beliefs (i) save less than originally planned, (ii) exhibit undersaving at younger ages, and (iii) hold larger amounts of assets in old age than their rational expectations counterparts who correctly assess their survival chances. Our neo-additive life-cycle model can therefore simultaneously accommodate three important empirical findings on household saving behavior.}, keywords = {Methodology, Other}, doi = {http://dx.doi.org/10.1016/j.jet.2015.12.008}, url = {http://www.sciencedirect.com/science/article/pii/S0022053115002100}, author = {Groneck, Max and Ludwig, Alexander and Zimper, Alexander} } @mastersthesis {8717, title = {Low-Intensity Physical Activity and Cardiometabolic Risk Factors among Older Adults with Multiple Chronic Conditions}, volume = {M.S.}, year = {2016}, month = {2016}, pages = {73}, school = {University of South Carolina}, type = {Thesis}, abstract = {Introduction Cardiovascular disease (CVD) is the leading cause of death among older adults in the Unites States and is driven largely by cardiometabolic risk factors including elevated blood pressure and blood glucose. Studies have found the protective effect of moderate intensity physical activity (MIPA) and vigorous intensity physical activity (VIPA) on cardiometabolic risk factor; however, the association between light physical activity (LIPA) and cardiometabolic risk factor among older adults is not clear. Objectives 1). Examine the association between LIPA and cardiometabolic risk factors. 2). Examine whether the association between LIPA and cardiometabolic risk factor is moderated by multiple chronic conditions. Methods Data from the Health and Retirement Study (HRS) were used for this study. We ascertained 2006 and 2008 HRS data from the Public Use Dataset, the RAND HRS Data File (Version N), and the HRS Biomarker Dataset. There were11890 participants aged 50 or older for cross-sectional analysis. Physical activity was converted to metabolic equivalent of tasks (METS) and outcome variables (systolic and diastolic blood pressure and HbA1c) were measured objectively. Mean levels of blood pressure and HbA1c were compared across physical activity intensity groups. Separate linear regression models were used to examine the association between LIPA and cardiometabolic risks adjusting for potential sociodemographic, behavioral, and clinical confounders. Results In the final study sample, 28.75\% were sedentary, 9.46\% regularly engaged in LIPA, 34.68\% engaged in MIPA, and 27.12\% engaged in VIPA. We did not find significant associations between LIPA and systolic blood pressure (B 0.235; 95\% confidence interval (CI), -1.127, 1.597), diastolic blood pressure (B = -0.167; 95\% CI, -0.954, 0.621), or HbA1c levels (B -0.009; 95\% CI, -0.049, 0.066). The average HbA1c was significantly lower only among individuals who engaged in MIPA (B -0.097; 95\% CI, -0.174, -0.020) and MIPA ( B -0.140; 95\% CI, -0.218, -0.063) in comparison to individuals who were categorized as in sedentary group Conclusion The findings from our study do not suggest that LIPA is independently associated with lower cardiometabolic risk factors among older adults. Associations between physical activity intensity and cardiometabolic risk factors among older adults with multiple chronic conditions need to be verified in studies using more objective measurement of physical activity.}, keywords = {Comorbidity, Health Conditions and Status, Heart disease, Older Adults, Physical activity, Risk Factors}, isbn = {9781339456591}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1780691559?accountid=14667}, author = {Yueyao Li} } @article {8889, title = {Large-scale genomic analyses link reproductive aging to hypothalamic signaling, breast cancer susceptibility and BRCA1-mediated DNA repair.}, journal = {Nat Genet}, volume = {47}, year = {2015}, month = {2015 Nov}, pages = {1294-303}, abstract = {

Menopause timing has a substantial impact on infertility and risk of disease, including breast cancer, but the underlying mechanisms are poorly understood. We report a dual strategy in \~{}70,000 women to identify common and low-frequency protein-coding variation associated with age at natural menopause (ANM). We identified 44 regions with common variants, including two regions harboring additional rare missense alleles of large effect. We found enrichment of signals in or near genes involved in delayed puberty, highlighting the first molecular links between the onset and end of reproductive lifespan. Pathway analyses identified major association with DNA damage response (DDR) genes, including the first common coding variant in BRCA1 associated with any complex trait. Mendelian randomization analyses supported a causal effect of later ANM on breast cancer risk (\~{}6\% increase in risk per year; P = 3 {\texttimes} 10(-14)), likely mediated by prolonged sex hormone exposure rather than DDR mechanisms.

}, keywords = {Age Factors, Aging, BRCA1 Protein, Breast Neoplasms, DNA Repair, Female, Genome, Genome-Wide Association Study, Genotype, Humans, Hypothalamus, Menopause, Middle Aged, Models, Genetic, Older Adults, Phenotype, Reproduction, Signal Transduction}, issn = {1546-1718}, doi = {10.1038/ng.3412}, author = {Day, Felix R and Ruth, Katherine S and Thompson, Deborah J and Kathryn L Lunetta and Pervjakova, Natalia and Daniel I Chasman and Stolk, Lisette and Finucane, Hilary K and Sulem, Patrick and Bulik-Sullivan, Brendan and T{\~o}nu Esko and Andrew D Johnson and Elks, Cathy E and Franceschini, Nora and He, Chunyan and Altmaier, Elisabeth and Brody, Jennifer A and Lude L Franke and Huffman, Jennifer E and Keller, Margaux F and McArdle, Patrick F and Nutile, Teresa and Porcu, Eleonora and Robino, Antonietta and Rose, Lynda M and Schick, Ursula M and Jennifer A Smith and Teumer, Alexander and Traglia, Michela and Vuckovic, Dragana and Yao, Jie and Wei Zhao and Albrecht, Eva and Amin, Najaf and Corre, Tanguy and Jouke-Jan Hottenga and Mangino, Massimo and Albert Vernon Smith and Toshiko Tanaka and Gon{\c c}alo R Abecasis and Andrulis, Irene L and Anton-Culver, Hoda and Antoniou, Antonis C and Arndt, Volker and Alice M. Arnold and Barbieri, Caterina and Beckmann, Matthias W and Beeghly-Fadiel, Alicia and Benitez, Javier and Bernstein, Leslie and Bielinski, Suzette J and Blomqvist, Carl and Boerwinkle, Eric and Bogdanova, Natalia V and Bojesen, Stig E and Manjeet K. Bolla and Borresen-Dale, Anne-Lise and Boutin, Thibaud S and Brauch, Hiltrud and Brenner, Hermann and Br{\"u}ning, Thomas and Burwinkel, Barbara and Campbell, Archie and Campbell, Harry and Chanock, Stephen J and Chapman, J Ross and Yii-Der I Chen and Chenevix-Trench, Georgia and Couch, Fergus J and Coviello, Andrea D and Cox, Angela and Czene, Kamila and Darabi, Hatef and De Vivo, Immaculata and Ellen W Demerath and Joe G Dennis and Devilee, Peter and D{\"o}rk, Thilo and Dos-Santos-Silva, Isabel and Dunning, Alison M and John D Eicher and Fasching, Peter A and Jessica Faul and Figueroa, Jonine and Flesch-Janys, Dieter and Gandin, Ilaria and Melissa E Garcia and Garc{\'\i}a-Closas, Montserrat and Giles, Graham G and Giorgia G Girotto and Goldberg, Mark S and Gonz{\'a}lez-Neira, Anna and Goodarzi, Mark O and Grove, Megan L and Gudbjartsson, Daniel F and Gu{\'e}nel, Pascal and Guo, Xiuqing and Christopher A Haiman and Hall, Per and Hamann, Ute and Henderson, Brian E and Lynne J Hocking and Hofman, Albert and Homuth, Georg and Hooning, Maartje J and John L Hopper and Hu, Frank B and Huang, Jinyan and Humphreys, Keith and Hunter, David J and Jakubowska, Anna and Jones, Samuel E and Kabisch, Maria and Karasik, David and Knight, Julia A and Kolcic, Ivana and Charles Kooperberg and Kosma, Veli-Matti and Kriebel, Jennifer and Kristensen, Vessela and Lambrechts, Diether and Langenberg, Claudia and Li, Jingmei and Li, Xin and Lindstr{\"o}m, Sara and Yongmei Liu and Luan, Jian{\textquoteright}an and Lubinski, Jan and M{\"a}gi, Reedik and Mannermaa, Arto and Manz, Judith and Margolin, Sara and Marten, Jonathan and Nicholas G Martin and Masciullo, Corrado and Meindl, Alfons and Michailidou, Kyriaki and Mihailov, Evelin and Lili Milani and Milne, Roger L and M{\"u}ller-Nurasyid, Martina and Michael A Nalls and Neale, Benjamin M and Nevanlinna, Heli and Neven, Patrick and Anne B Newman and B{\o}rge G Nordestgaard and Olson, Janet E and Padmanabhan, Sandosh and Peterlongo, Paolo and Peters, Ulrike and Petersmann, Astrid and Peto, Julian and Pharoah, Paul D P and Nicola Pirastu and Pirie, Ailith and Pistis, Giorgio and Polasek, Ozren and David J Porteous and Psaty, Bruce M and Pylk{\"a}s, Katri and Radice, Paolo and Raffel, Leslie J and Fernando Rivadeneira and Rudan, Igor and Rudolph, Anja and Ruggiero, Daniela and Cinzia Felicita Sala and Sanna, Serena and Sawyer, Elinor J and Schlessinger, David and Schmidt, Marjanka K and Schmidt, Frank and Schmutzler, Rita K and Schoemaker, Minouk J and Scott, Robert A and Seynaeve, Caroline M and Simard, Jacques and Sorice, Rossella and Southey, Melissa C and St{\"o}ckl, Doris and Strauch, Konstantin and Swerdlow, Anthony and Kent D Taylor and Thorsteinsdottir, Unnur and Toland, Amanda E and Tomlinson, Ian and Truong, Th{\'e}r{\`e}se and Tryggvadottir, Laufey and Stephen T Turner and Vozzi, Diego and Wang, Qin and Wellons, Melissa and Gonneke Willemsen and James F Wilson and Winqvist, Robert and Wolffenbuttel, Bruce B H R and Alan F Wright and Yannoukakos, Drakoulis and Zemunik, Tatijana and Wei Zhang and Zygmunt, Marek and Bergmann, Sven and Dorret I Boomsma and Buring, Julie E and Luigi Ferrucci and Grant W Montgomery and Gudnason, Vilmundur and Timothy Spector and Cornelia M van Duijn and Alizadeh, Behrooz Z and Ciullo, Marina and Crisponi, Laura and Easton, Douglas F and Paolo P. Gasparini and Gieger, Christian and Tamara B Harris and Caroline Hayward and Sharon L R Kardia and Kraft, Peter and McKnight, Barbara and Andres Metspalu and Alanna C Morrison and Reiner, Alex P and Ridker, Paul M and Rotter, Jerome I and Toniolo, Daniela and Andr{\'e} G Uitterlinden and Ulivi, Sheila and V{\"o}lzke, Henry and Wareham, Nicholas J and David R Weir and Laura M Yerges-Armstrong and Price, Alkes L and Stefansson, Kari and Visser, Jenny A and Ong, Ken K and Chang-Claude, Jenny and Joanne M Murabito and Perry, John R B and Murray, Anna} } @article {8204, title = {Lifetime Socioeconomic Status, Historical Context, and Genetic Inheritance in Shaping Body Mass in Middle and Late Adulthood}, journal = {American Sociological Review}, volume = {80}, year = {2015}, note = {Times Cited: 0 0}, pages = {705-737}, publisher = {80}, abstract = {This study demonstrates that body mass in middle and late adulthood is a consequence of the complex interplay among individuals{\textquoteright} genes, lifetime socioeconomic experiences, and the historical context in which they live. Drawing on approximately 9,000 genetic samples from the Health and Retirement Study, we first investigate how socioeconomic status (SES) over the life course moderates the impact of 32 established obesity-related genetic variants on body mass index (BMI) in middle and late adulthood. We then consider differences across birth cohorts in the genetic influence on BMI, and cohort variations in the moderating effects of life-course SES on the genetic influence. Our analyses suggest that persistently low SES over the life course or downward mobility (e.g., high SES in childhood but low SES in adulthood) amplify the genetic influence on BMI, and persistently high SES or upward mobility (e.g., low SES in childhood but high SES in adulthood) compensate for such influence. For more recent birth cohorts, the genetic influence on BMI becomes stronger, but the moderating effects of lifetime SES on the genetic influence are weaker compared to earlier cohorts. We discuss these findings in light of social changes during the obesity epidemic in the United States.}, keywords = {Demographics, Event History/Life Cycle, Genetics, Health Conditions and Status}, doi = {10.1177/0003122415590627}, author = {Hexuan Liu and Guo, Guang} } @article {8214, title = {Loneliness, eudaimonia, and the human conserved transcriptional response to adversity.}, journal = {Psychoneuroendocrinology}, volume = {62}, year = {2015}, month = {2015 Dec}, pages = {11-7}, publisher = {62}, abstract = {

BACKGROUND: Chronic social adversity activates a conserved transcriptional response to adversity (CTRA) marked by increased expression of pro-inflammatory genes and decreased expression of antiviral- and antibody-related genes. Recent findings suggest that some psychological resilience factors may help buffer CTRA activation, but the relative impact of resilience and adversity factors remains poorly understood. Here we examined the relative strength of CTRA association for the two best-established psychological correlates of CTRA gene expression-the risk factor of perceived social isolation (loneliness) and the resilience factor of eudaimonic well-being (purpose and meaning in life).

METHODS: Peripheral blood samples and validated measures of loneliness and eudaimonic well-being were analyzed in 108 community-dwelling older adults participating in the longitudinal US Health and Retirement Study (56\% female, mean age 73). Mixed effect linear model analyses quantified the strength of association between CTRA gene expression and measures of loneliness and eudaimonic well-being in separate and joint analyses.

RESULTS: As in previous studies, separate analyses found CTRA gene expression to be up-regulated in association with loneliness and down-regulated in association with eudaimonic well-being. In joint analyses, effects of loneliness were completely abrogated whereas eudaimonic well-being continued to associate with CTRA down-regulation. Similar eudaimonia-dominant effects were observed for positive and negative affect, optimism and pessimism, and anxiety symptoms. All results were independent of demographic and behavioral health risk factors.

CONCLUSIONS: Eudaimonic well-being may have the potential to compensate for the adverse impact of loneliness on CTRA gene expression. Findings suggest a novel approach to targeting the health risks associated with social isolation by promoting purpose and meaning in life.

}, keywords = {Aged, Aged, 80 and over, Down-Regulation, Female, Humans, Inflammation, Loneliness, Longitudinal Studies, Male, Mental Health, Middle Aged, social isolation, Social Support, Stress, Psychological, Transcriptome}, issn = {1873-3360}, doi = {10.1016/j.psyneuen.2015.07.001}, url = {http://www.sciencedirect.com/science/article/pii/S0306453015002358}, author = {Steven W. Cole and Morgan E. Levine and Jesusa M. G. Arevalo and Ma, Jeffrey and David R Weir and Eileen M. Crimmins} } @article {8176, title = {The "long arm" of childhood health: linking childhood disability to late midlife mental health.}, journal = {Res Aging}, volume = {37}, year = {2015}, month = {2015 Jan}, pages = {82-102}, publisher = {37}, abstract = {

A growing body of research underscores the early origins of health in later life; however, relatively little is known about the relationship between childhood physical health and adult mental health. This research explores the relationship between childhood disability and depressive symptoms among a nationally representative sample of late midlife adults (N = 3,572). Using data from Waves 8-10 (2006-2010) of the Health and Retirement Study, a series of ordinary least squares regression models were created to assess the number of depressive symptoms. Childhood disability was significantly associated with higher levels of depressive symptoms; however, late midlife social and health factors accounted for differences between those with and without childhood disability. Late midlife physical health appeared to be a particularly salient mediator. Individuals who experience childhood disability may accumulate more physical impairment over the life course, thus experiencing worse mental health such as greater depressive symptoms in late midlife.

}, keywords = {Child, depression, Female, Health Status, Humans, Male, Middle Aged, Risk Factors, Surveys and Questionnaires, Time Factors, United States}, issn = {1552-7573}, doi = {10.1177/0164027514522276}, url = {http://roa.sagepub.com/content/early/2014/02/23/0164027514522276.abstract}, author = {Kenzie Latham} } @article {8332, title = {Longitudinal patient-oriented outcomes in neuropathy: Importance of early detection and falls.}, journal = {Neurology}, volume = {85}, year = {2015}, month = {2015 Jul 07}, pages = {71-9}, publisher = {85}, abstract = {

OBJECTIVE: To evaluate longitudinal patient-oriented outcomes in peripheral neuropathy over a 14-year time period including time before and after diagnosis.

METHODS: The 1996-2007 Health and Retirement Study (HRS)-Medicare Claims linked database identified incident peripheral neuropathy cases (ICD-9 codes) in patients >=65 years. Using detailed demographic information from the HRS and Medicare claims, a propensity score method identified a matched control group without neuropathy. Patient-oriented outcomes, with an emphasis on self-reported falls, pain, and self-rated health (HRS interview), were determined before and after neuropathy diagnosis. Generalized estimating equations were used to assess differences in longitudinal outcomes between cases and controls.

RESULTS: We identified 953 peripheral neuropathy cases and 953 propensity-matched controls. The mean (SD) age was 77.4 (6.7) years for cases, 76.9 (6.6) years for controls, and 42.1\% had diabetes. Differences were detected in falls 3.0 years before neuropathy diagnosis (case vs control; 32\% vs 25\%, p = 0.008), 5.0 years for pain (36\% vs 27\%, p = 0.002), and 5.0 years for good to excellent self-rated health (61\% vs 74\%, p < 0.0001). Over time, the proportion of fallers increased more rapidly in neuropathy cases compared to controls (p = 0.002), but no differences in pain (p = 0.08) or self-rated health (p = 0.9) were observed.

CONCLUSIONS: In older persons, differences in falls, pain, and self-rated health can be detected 3-5 years prior to peripheral neuropathy diagnosis, but only falls deteriorates more rapidly over time in neuropathy cases compared to controls. Interventions to improve early peripheral neuropathy detection are needed, and future clinical trials should incorporate falls as a key patient-oriented outcome.

}, keywords = {Accidental Falls, Aged, Aged, 80 and over, Early Diagnosis, Female, Humans, International Classification of Diseases, Longitudinal Studies, Male, Medicare, Patient-Centered Care, Peripheral Nervous System Diseases, Treatment Outcome, United States}, issn = {1526-632X}, doi = {10.1212/WNL.0000000000001714}, author = {Brian C. Callaghan and Kevin Kerber and Kenneth M. Langa and Banerjee, Mousumi and Rodgers, Ann and Ryan J McCammon and James F. Burke and Eva L Feldman} } @article {8069, title = {Lee and Schwarz Respond to Kawada, Question Context, Ethnic Difference, and Self-Rated Health}, journal = {American Journal of Public Health}, volume = {104}, year = {2014}, pages = {e3-e4}, publisher = {104}, abstract = {We agree with Kawada that the ideal data set for our study would include a confounder-free experiment that asks the self-rated health (SRH) question in different contexts (or order) and follows study subjects over time to assess subsequent morbidity and mortality. This data set does not exist. As an approximation with minimal methodological non-comparability, we used the National Health Interview Survey linked with the National Death Index and the Health and Retirement Study (HRS) to examine SRH context effects on health outcome predictions.}, keywords = {Health Conditions and Status, Healthcare}, doi = {10.2105/AJPH.2013.301712}, url = {http://dx.doi.org/10.2105/AJPH.2013.301712}, author = {Lee, Sunghee and Schwarz, Norbert} } @article {8008, title = {Leveraging the health and retirement study to advance palliative care research.}, journal = {J Palliat Med}, volume = {17}, year = {2014}, month = {2014 May}, pages = {506-11}, publisher = {17}, abstract = {

BACKGROUND: The critical need to expand and develop the palliative care evidence base was recently highlighted by the Journal of Palliative Medicine{\textquoteright}s series of articles describing the Research Priorities in Geriatric Palliative Care. The Health and Retirement Study (HRS) is uniquely positioned to address many priority areas of palliative care research. This nationally representative, ongoing, longitudinal study collects detailed survey data every 2 years, including demographics, health and functional characteristics, information on family and caregivers, and personal finances, and also conducts a proxy interview after each subject{\textquoteright}s death. The HRS can also be linked with Medicare claims data and many other data sources, e.g., U.S. Census, Dartmouth Atlas of Health Care.

SETTING: While the HRS offers innumerable research opportunities, these data are complex and limitations do exist. Therefore, we assembled an interdisciplinary group of investigators using the HRS for palliative care research to identify the key palliative care research gaps that may be amenable to study within the HRS and the strengths and weaknesses of the HRS for each of these topic areas.

CONCLUSION: In this article we present the work of this group as a potential roadmap for investigators contemplating the use of HRS data for palliative care research.

}, keywords = {Aged, Caregivers, Evidence-Based Practice, Health Services Research, Health Surveys, Humans, Longitudinal Studies, Needs Assessment, Pain Management, Palliative care, Quality of Life, Retirement, Sociological Factors, United States}, issn = {1557-7740}, doi = {10.1089/jpm.2013.0648}, author = {Amy Kelley and Kenneth M. Langa and John G. Cagle and Katherine A Ornstein and Maria J Silveira and Lauren Hersch Nicholas and Kenneth E Covinsky and Christine S Ritchie} } @article {5849, title = {The Long-Term Effect of Health Insurance on Near-Elderly Health and Mortality}, year = {2014}, institution = {Evanston, IL, Northwestern University Law Schoo}, abstract = {We use the best available longitudinal dataset, the Health and Retirement Survey, and a battery of causal inference methods to provide both central estimates and bounds on the effect of health insurance on health and mortality among the near elderly (initial age 50-61) over an 18-year period. Those uninsured in 1992 consume fewer healthcare services, but are not less healthy and, in our central estimates, do not die sooner than their insured counterparts. We discuss why a zero average effect of uninsurance on mortality and health is plausible, some selection effects that might explain our full results, and methodological concerns with prior studies.}, keywords = {Health Conditions and Status, Healthcare, Medicare/Medicaid/Health Insurance, Methodology}, author = {Black, Bernard and Jos{\'e}-Antonio Esp{\'\i}n-S{\'a}nchez and Eric French and Litvak, Kate} } @article {7913, title = {Latent heterogeneity in long-term trajectories of body mass index in older adults.}, journal = {J Aging Health}, volume = {25}, year = {2013}, month = {2013 Mar}, pages = {342-63}, publisher = {25}, abstract = {

OBJECTIVE: To evaluate latent heterogeneity in long-term trajectories of body weight in older adults.

METHODS: We analyzed 14-year longitudinal data on 10,314 older adults from the Health and Retirement Study. Semiparametric mixture models identified latent subgroups of similar trajectories of body mass index (BMI).

RESULTS: Five distinct trajectory subgroups emerged: normal starting-BMI with accelerated increase over time (trajectory $\#$1), overweight and increasing (trajectory $\#$2), borderline-obese and increasing (trajectory $\#$3), obese and increasing (trajectory $\#$4), and morbidly obese with decelerating gain (trajectory $\#$5). Blacks and Hispanics had greater risk of membership in ascending high-BMI trajectory groups. Females had approximately half the risk of following overweight and obese increasing BMI trajectories compared with males.

DISCUSSION: Distinct latent subgroups of BMI trajectories and significant racial/ethnic and gender trajectory heterogeneity exist in the older adult population. The propensity of men and minorities to experience high-risk BMI trajectories may exacerbate existing disparities in morbidity/ mortality in older age.

}, keywords = {Aging, Black or African American, Body Mass Index, Female, Hispanic or Latino, Humans, Longitudinal Studies, Male, Middle Aged, Obesity, Obesity, Morbid, Overweight, Risk Factors, Sex Distribution, United States}, issn = {1552-6887}, doi = {10.1177/0898264312468593}, author = {Anda Botoseneanu and Jersey Liang} } @article {7955, title = {Longer lived parents: protective associations with cancer incidence and overall mortality.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {68}, year = {2013}, note = {Times Cited: 0}, month = {2013 Nov}, pages = {1409-18}, publisher = {68}, abstract = {

BACKGROUND: Children of centenarians have lower cardiovascular disease prevalence and live longer. We aimed to estimate associations between the full range of parental attained ages and health status in a middle-aged U.S. representative sample.

METHODS: Using Health and Retirement Study data, models estimated disease incidence and mortality hazards for respondents aged 51-61 years at baseline, followed up for 18 years. Full adjustment included sex, race, smoking, wealth, education, body mass index, and childhood socioeconomic status. Mother{\textquoteright}s and father{\textquoteright}s attained age distributions were used to define short-, intermediate-, and long-lived groups, yielding a ranked parental longevity score (n = 6,055, excluding short-long discordance). Linear models (n = 8,340) tested mother{\textquoteright}s or father{\textquoteright}s attained ages, adjusted for each other.

RESULTS: With increasing mother{\textquoteright}s or father{\textquoteright}s survival (>65 years), all-cause mortality declined 19\% (hazard ratio [HR] = 0.81, 95\% CI: 0.76-0.86, p < .001) and 14\% per decade (HR = 0.87, 95\% CI: 0.81-0.92, p < .001). Estimates changed only modestly when fully adjusted. Parent-in-law survival was not associated with mortality (n = 1,809, HR = 1.00, 95\% CI: 0.90-1.12, p = .98). Offspring with one or two long-lived parents had lower cancer incidence (938 cases, HR per parental longevity score = 0.76, 95\% CI: 0.61-0.94, p = .01) versus two intermediate parents. Similar HRs for diabetes (HR = 0.89, 95\% CI: 0.84-0.96, p = .001), heart disease (HR = 0.88, 95\% CI: 0.82-0.93, p < .001), and stroke (HR = 0.86, 95\% CI: 0.78-0.95, p = .002) were significant, but there was no trend for arthritis.

CONCLUSIONS: The results provide the first robust evidence that increasing parental attained age is associated with lower cancer incidence in offspring. Health advantages of having centenarian parents extend to a wider range of parental longevity and may provide a quantitative trait of slower aging.

}, keywords = {Aged, Aged, 80 and over, Female, Humans, Incidence, Longevity, Male, Middle Aged, Mortality, Neoplasms, Parents}, issn = {1758-535X}, doi = {10.1093/gerona/glt061}, author = {Ambarish Dutta and Henley, William and Robine, Jean-Marie and Kenneth M. Langa and Robert B Wallace and David Melzer} } @article {7692, title = {Loneliness, health, and mortality in old age: a national longitudinal study.}, journal = {Soc Sci Med}, volume = {74}, year = {2012}, month = {2012 Mar}, pages = {907-14}, publisher = {74}, abstract = {

This study examined the relationship between loneliness, health, and mortality using a U.S. nationally representative sample of 2101 adults aged 50 years and over from the 2002 to 2008 waves of the Health and Retirement Study. We estimated the effect of loneliness at one point on mortality over the subsequent six years, and investigated social relationships, health behaviors, and health outcomes as potential mechanisms through which loneliness affects mortality risk among older Americans. We operationalized health outcomes as depressive symptoms, self-rated health, and functional limitations, and we conceptualized the relationships between loneliness and each health outcome as reciprocal and dynamic. We found that feelings of loneliness were associated with increased mortality risk over a 6-year period, and that this effect was not explained by social relationships or health behaviors but was modestly explained by health outcomes. In cross-lagged panel models that tested the reciprocal prospective effects of loneliness and health, loneliness both affected and was affected by depressive symptoms and functional limitations over time, and had marginal effects on later self-rated health. These population-based data contribute to a growing literature indicating that loneliness is a risk factor for morbidity and mortality and point to potential mechanisms through which this process works.

}, keywords = {Aged, Aged, 80 and over, Aging, Cohort Studies, depression, Female, Health Behavior, Health Status, Humans, Interpersonal Relations, Loneliness, Longitudinal Studies, Male, Middle Aged, Mortality, Social Support, Socioeconomic factors, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2011.11.028}, url = {http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2601961601andFmt=7andclientId=17822andRQT=309andVName=PQD}, author = {Ye Luo and Louise C Hawkley and Linda J. Waite and John T. Cacioppo} } @article {7694, title = {A Longitudinal Study of Social Status, Perceived Discrimination, and Physical and Emotional Health Among Older Adults}, journal = {Research on Aging}, volume = {34}, year = {2012}, pages = {275}, publisher = {34}, abstract = {This study examines the relationships between social status, perceived discrimination, and physical and emotional health using a nationally representative sample of 6,377 older adults from the 2006 and 2008 waves of the Health and Retirement Study. About 63 of older adults reported at least one type of everyday discrimination and 31 reported at least one major discriminatory event during lifetime. Blacks, those separated, divorced, or widowed, and those with lower household assets have higher levels of perceived discrimination than Whites, the married or partnered, and those with more assets. Perceived discrimination is negatively associated with changes in health over 2 years, and everyday discrimination has stronger effects than major discriminatory events, especially on emotional health. The effects of perceived everyday discrimination on changes in depressive symptoms and self-rated health are independent of general stress. Efforts to reduce discrimination, including perceptions of discrimination, can be beneficial for health in old age. PUBLICATION ABSTRACT}, keywords = {Demographics, Employment and Labor Force, Health Conditions and Status, Women and Minorities}, url = {http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2621993131andFmt=7andclientId=17822andRQT=309andVName=PQD}, author = {Ye Luo and Jun Xu and Granberg, E. and Wentworth, W.} } @article {7650, title = {Lifecourse socioeconomic circumstances and multimorbidity among older adults.}, journal = {BMC Public Health}, volume = {11}, year = {2011}, note = {Tucker-Seeley, Reginald D Li, Yi Sorensen, Glorian Subramanian, S V England BMC public health BMC Public Health. 2011 May 14;11:313.}, month = {2011 May 14}, pages = {313}, publisher = {11}, abstract = {

BACKGROUND: Many older adults manage multiple chronic conditions (i.e. multimorbidity); and many of these chronic conditions share common risk factors such as low socioeconomic status (SES) in adulthood and low SES across the lifecourse. To better capture socioeconomic condition in childhood, recent research in lifecourse epidemiology has broadened the notion of SES to include the experience of specific hardships. In this study we investigate the association among childhood financial hardship, lifetime earnings, and multimorbidity.

METHODS: Cross-sectional analysis of 7,305 participants age 50 and older from the 2004 Health and Retirement Study (HRS) who also gave permission for their HRS records to be linked to their Social Security Records in the United States. Zero-inflated Poisson regression models were used to simultaneously model the likelihood of the absence of morbidity and the expected number of chronic conditions.

RESULTS: Childhood financial hardship and lifetime earnings were not associated with the absence of morbidity. However, childhood financial hardship was associated with an 8\% higher number of chronic conditions; and, an increase in lifetime earnings, operationalized as average annual earnings during young and middle adulthood, was associated with a 5\% lower number of chronic conditions reported. We also found a significant interaction between childhood financial hardship and lifetime earnings on multimorbidity.

CONCLUSIONS: This study shows that childhood financial hardship and lifetime earnings are associated with multimorbidity, but not associated with the absence of morbidity. Lifetime earnings modified the association between childhood financial hardship and multimorbidity suggesting that this association is differentially influential depending on earnings across young and middle adulthood. Further research is needed to elucidate lifecourse socioeconomic pathways associated with the absence of morbidity and the presence of multimorbidity among older adults.

}, keywords = {Aged, Chronic disease, Comorbidity, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Social Class, United States}, issn = {1471-2458}, doi = {10.1186/1471-2458-11-313}, author = {Reginald D. Tucker-Seeley and Li, Yi and Sorensen, Glorian and Subramanian, S V} } @mastersthesis {6415, title = {A life-cycle analysis of retirement savings and portfolio choices: Optimal asset allocation and location with taxable and tax-deferred investment}, volume = {Ph.D.}, year = {2010}, school = {State University of New York at Stony Brook}, address = {Stony Brook, NY}, abstract = {In this study, I analyze theoretically and empirically the optimal saving and investment decisions of the households in Defined Contribution (DC) pension accounts, and show that the pension characteristics play important roles in explaining the households{\textquoteright} behavior. The first essay attempts to explain the observed asset allocation and location decisions for households making taxable and tax-deferred investment. I incorporate employer matching policies and other pension account characteristics into a life-cycle model of optimal intertemporal consumption and portfolio choice, which includes a taxable saving account and a tax-deferred retirement saving account. The model is estimated using data from the Surveys of Consumer Finances (1992 to 2007), and the structural parameters are recovered by the Method of Simulated Moments. After modeling the features of U.S. pension system, the predicted policy rules are able to explain the observed portfolio patterns of American households, who are more likely to hold equities in the tax-deferred pension account. The estimates and results show that employer matching policy induces higher proportion of total wealth held in the pension account, so investors tend to reduce equity holdings in the taxable account for precautionary saving purpose and boost equity investments in the tax-deferred account to maintain an optimal portfolio mix. I find that a 10 percentage point increase in the estimated employer matching rate makes investors reduce the average equity proportion in the taxable account by 22 percentage point and boost those holdings in the pension account by 10 percentage point. In contrast, since the employer stock match exposes the households to a riskier situation in the pension account than the cash match, it causes households voluntarily to hold less equity in that account, resulting in an average decrease of 4 percentage point in the equity ownership and 3 percentage point in the conditional equity proportion. Moreover, the policy experiment reveals that a deletion of Social Security taxes and payments makes the pension account the only source of retirement income, so households tend to put a higher proportion of savings in the tax-deferred account, and they are likely to invest conservatively and hold about 25 percent more of pension wealth in relatively safe assets. The second essay is about company stock investment in 401(k) plans. Previous studies on the determinants of company stock holdings focus on the past stock market performance of company stock, but ignore the characteristics of the retirement plans and individuals. In this study, using the data from Survey of Consumer Finances (SCF), I provide an empirical analysis of the factors that affect company stock holdings in 401(k) plans, by analyzing a broad list of company features, individual characteristics, and financial wealth information. My preferred estimates suggest that, different from general stocks which are sensitive to risk preference and total wealth, the decision of whether to hold company stock is more likely to be affected by the employer{\textquoteright}s characteristics and the availability of other investment opportunities. Individuals who work in larger companies and receive more employer matches in the retirement account are more likely to hold company stock in the retirement account, and they are less likely to hold company stocks when the wealth outside the pension account is large and they have other retirement accounts. In addition, I find that the company stock share in 401(k) account is decreasing with pension wealth and total net wealth, which indicates that less wealthy individuals are those who are more exposed to company stock risk. The third essay analyzes the impact of investment choice on savings in defined contribution pensions. The striking growth defined contribution (DC) pensions have vastly expanded the number of individuals with some discretion regarding their retirement savings. One of the factors that may affect saving decisions is investment choice: namely the ability of the participant to direct the investment of the assets in the pension account. In most studies, people who report that they have control over assets allocation in pension plans do not distinguish the assets between the participant contribution and the employer contribution, but it is common for the employer{\textquoteright}s contribution to be constrained-often to company stock. In this study, I use the Health and Retirement Study (HRS) to estimate the impacts of unconstrained and constrained investment choices on participant saving levels in DC Pensions. The estimates and results indicate that participants with investment choice contribute over 3 percentage points more of their earnings into the defined contribution plan than people without choice, and people constrained in their investment contribute about 3 percentage points less in their retirement saving account. In addition, I find that male and lower income participants tend to contribute more in a self-directed saving account.}, keywords = {Consumption and Savings, Event History/Life Cycle, Methodology, Net Worth and Assets, Pensions, Retirement Planning and Satisfaction}, url = {https://crr.bc.edu/about-us/grants/a-life-cycle-analysis-of-retirement-savings-and-portfolio-choices-optimal-asset-allocation-and-location-with-taxable-and-tax-deferred-investment/}, author = {Li, Zhe} } @article {7528, title = {Long-term cognitive impairment and functional disability among survivors of severe sepsis.}, journal = {JAMA}, volume = {304}, year = {2010}, month = {2010 Oct 27}, pages = {1787-94}, publisher = {304}, abstract = {

CONTEXT: Cognitive impairment and functional disability are major determinants of caregiving needs and societal health care costs. Although the incidence of severe sepsis is high and increasing, the magnitude of patients{\textquoteright} long-term cognitive and functional limitations after sepsis is unknown.

OBJECTIVE: To determine the change in cognitive impairment and physical functioning among patients who survive severe sepsis, controlling for their presepsis functioning.

DESIGN, SETTING, AND PATIENTS: A prospective cohort involving 1194 patients with 1520 hospitalizations for severe sepsis drawn from the Health and Retirement Study, a nationally representative survey of US residents (1998-2006). A total of 9223 respondents had a baseline cognitive and functional assessment and had linked Medicare claims; 516 survived severe sepsis and 4517 survived a nonsepsis hospitalization to at least 1 follow-up survey and are included in the analysis.

MAIN OUTCOME MEASURES: Personal interviews were conducted with respondents or proxies using validated surveys to assess the presence of cognitive impairment and to determine the number of activities of daily living (ADLs) and instrumental ADLs (IADLs) for which patients needed assistance.

RESULTS: Survivors{\textquoteright} mean age at hospitalization was 76.9 years. The prevalence of moderate to severe cognitive impairment increased 10.6 percentage points among patients who survived severe sepsis, an odds ratio (OR) of 3.34 (95\% confidence interval [CI], 1.53-7.25) in multivariable regression. Likewise, a high rate of new functional limitations was seen following sepsis: in those with no limits before sepsis, a mean 1.57 new limitations (95\% CI, 0.99-2.15); and for those with mild to moderate limitations before sepsis, a mean of 1.50 new limitations (95\% CI, 0.87-2.12). In contrast, nonsepsis general hospitalizations were associated with no change in moderate to severe cognitive impairment (OR, 1.15; 95\% CI, 0.80-1.67; P for difference vs sepsis = .01) and with the development of fewer new limitations (mean among those with no limits before hospitalization, 0.48; 95\% CI, 0.39-0.57; P for difference vs sepsis <.001 and mean among those with mild to moderate limits, 0.43; 95\% CI, 0.23-0.63; P for difference = .001). The declines in cognitive and physical function persisted for at least 8 years.

CONCLUSIONS: Severe sepsis in this older population was independently associated with substantial and persistent new cognitive impairment and functional disability among survivors. The magnitude of these new deficits was large, likely resulting in a pivotal downturn in patients{\textquoteright} ability to live independently.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Case-Control Studies, Cognition Disorders, Disabled Persons, Female, Health Status, Hospitalization, Humans, Male, Prospective Studies, Sepsis, Severity of Illness Index, Survivors, United States}, issn = {1538-3598}, doi = {10.1001/jama.2010.1553}, url = {http://jama.ama-assn.org/content/304/16/1787.abstract}, author = {Theodore J Iwashyna and E Wesley Ely and Dylan M Smith and Kenneth M. Langa} } @mastersthesis {6409, title = {Labor Market Outcomes of Obesity among the Near-Elderly}, year = {2009}, month = {2009}, school = {Wayne State University}, address = {United States, Michigan}, abstract = {The objective of this study is to examine the effect of obesity labor market outcomes among the near-elderly population in the U.S.. Previous studies on the labor market outcomes of obesity mostly focused on younger population and may not fully capture the adverse effects of obesity that are developed after middle-age. This study contributes to the existing literature by focusing on the specific near-elderly population. Several aspects of labor market outcomes are examined, in particular, retirement, wage and work absenteeism. This study employed the panel data of 1992 through 2004 surveys from Health and Retirement Study, a Nationally representative survey. Study sample includes over twenty thousands working males and females between age 51 and 64. I measure obesity using Body Mass Index based on self-reported weight. Logistic model is used to estimate the effect of being obese at baseline on the probability of retirement before age 64, controlling for a set of socioeconomic factors, health variables and job-related characteristics. OLS models is used to estimate the impact of obesity on hourly wage. For absenteeism, I first use logistic model to estimate the impact of obesity on the probability of missing any day due to illness among the entire working sample. Then using the sub-sample of workers who did miss any day from work, I estimate OLS models of the number of days missed due to illness. Recognizing the potential endogeneity of obesity, I applied Hausman{\textquoteright}s endogeneity test and Instrumental Variable approach. Two Stage Residual Inclusion models were estimated for each outcome variable to compare with the models that didn{\textquoteright}t adjust for endogeneity. Models are estimated for separately by gender. Estimation results suggest that obese male and female workers receive significantly lower hourly wage and lower annual earnings than their non-obese peers. Obese male and female workers are also more likely to miss some work days due to illness. In particularly, obese female workers take off a greater number of sick days than their non-obese counterparts. Although the direct effect of obesity on retirement is not significant, I observe some indirect effect of obesity on retirement through poor health status. In conclusion, obesity affects the labor market outcomes of near-elderly workers in several aspects: Obese near-elderly workers are paid less, take more sick days, and more likely to retire early due to bad health. This study can inform policy makers of the indirect cost that obesity posed on employers and individuals in terms of reduced productivity and labor participation.}, keywords = {Demographics, Employment and Labor Force, Health Conditions and Status}, author = {Li, Kemeng} } @article {NBERw14540, title = {Labor Supply Responses to Marginal Social Security Benefits: Evidence from Discontinuities}, number = {14540}, year = {2008}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {A key question for Social Security reform is whether workers currently perceive the link on the margin between the Social Security taxes they pay and the Social Security benefits they will receive. We estimate the effects of the marginal Social Security benefits that accrue with additional earnings on three measures of labor supply: retirement, hours, and labor earnings. We develop a new approach to identifying these incentive effects by exploiting five provisions in the Social Security benefit rules that generate discontinuities in marginal benefits or non-linearities in marginal benefits that converge to discontinuities as uncertainty about the future is resolved. We find clear evidence that individuals approaching retirement (age 52 and older) respond to the Social Security tax-benefit link on the extensive margin of their labor supply decisions: we estimate that a 10 percent increase in the net-of-tax share reduces the two-year retirement hazard by a statistically significant 2.1 percentage points from a base rate of 15 percent. The evidence with regards to labor supply responses on the intensive margin is more mixed: we estimate that the elasticity of hours with respect to the net-of-tax share is 0.41 and statistically significant, but we do not find a statistically significant earnings elasticity.}, keywords = {Labor, Labor Supply, Social Security}, doi = {10.3386/w14540}, author = {Jeffrey B Liebman and Erzo F. P. Luttmer and Seif, David G} } @article {7195, title = {A Longitudinal Analysis of the Impact of Health Shocks on the Wealth of Elders}, journal = {Journal of Population Economics}, volume = {21}, year = {2008}, pages = {217-230}, publisher = {21}, abstract = {We investigate the impact of health shocks on wealth, using all four waves of the Health and Retirement Study, and estimate not only the short-term effect but also the long-term effect of health shocks on wealth of the elderly. We find that new health events lower wealth in elders during the period in which such health shocks occur, but the impact tends to disappear over time. We also find that health shocks result in greater wealth depletion when they occur later in life. Together with existing health problems, the overall impact of health problems on wealth increases over time.}, keywords = {Demographics, Health Conditions and Status, Net Worth and Assets}, doi = {https://doi.org/10.1007/s00148-007-0156-5}, author = {Jinkook Lee and Hyungsoo Kim} } @article {5693, title = {Life-Cycle Models: Lifetime Earnings and the Timing of Retirement}, number = {WP 2007-165}, year = {2007}, institution = {Michigan Retirement and Disability Research Center, University of Michigan}, address = {Ann Arbor, MI}, abstract = {After dropping for a century, the average retirement age for U.S. males seems to have leveled off in recent decades. An important question is whether as future improvements in technology cause wages to rise, desired retirement ages will resume their downward trend, or not. This paper attempts to use HRS panel data to test how relatively high (or low) earnings affect male retirement ages. Our goal is to use cross sectional earning differences to help anticipate likely time series developments in coming decades. Our preliminary regression results show that higher earnings do lead to somewhat earlier retirement. Unless additional analysis changes the parameter estimates, the implication is that the downward trend in male retirement ages will ultimately return.}, keywords = {Employment and Labor Force, Retirement Planning and Satisfaction}, url = {https://deepblue.lib.umich.edu/handle/2027.42/57312}, author = {John Laitner and Daniel S. Silverman} } @article {11442, title = {The Link between Individual Expectations and Savings: Do Nursing Home Expectations Matter?}, number = {2006-5}, year = {2006}, institution = {University of Aarhus}, address = {Aarhus, Denmark}, abstract = {Preparing for the end of life, especially for the prospect of needing long-term are, is an important issue facing older Americans. Those who reach age 65 have a 40\% chance of going into a nursing home in their remaining lifetime, and about 10\% of those who do will stay there for at least five years. The costs of a stay are high with on average US$70,000 annually for a private room. Long-term stays in nursing homes are, therefore, not likely, but very expensive. In this paper, we examine individual expectations about future nursing home entry and study the relationship between these expectations and savings behavior, using data from the Health and Retirement Study. We find a clear relation between subjective expectations and probability of future nursing home entry, and a positive effect of these expectations on savings behavior. Surprisingly, we find no difference of this effect by wealth group, so it seems that Medicaid eligibility in the context of nursing home entry plays no factor in the decision to save.}, keywords = {Expectations, nursing home, Savings}, doi = {http://dx.doi.org/10.2139/ssrn.1147034}, author = {Kristin J. Kleinjans and Jinkook Lee} } @article {6949, title = {Long-Term Care Insurance Policy Dropping in the U.S. from 1996 to 2000: Evidence and Implications for Long-Term Care Financing}, journal = {The Geneva Papers on Risk and Insurance}, volume = {29}, year = {2004}, pages = {640-651}, publisher = {29}, abstract = {While the market for private long-term care insurance in the U.S. has grown dramatically, consumer advocates have argued for increased regulatory attention and for broadened consumer education programs concerning long-term care insurance. We analyse Health and Retirement Survey data from 1996, 1998, and 2000 using a zero-inflated negative binomial regression model of the counts of consecutive periods of long-term care insurance coverage. We find that while a significant proportion of Americans over the age of 50 purchase long-term care insurance, many of these purchasers drop their coverage within a five-year period. This finding raises questions for long-term care insurance researchers and it contains implications for market regulators, public policy makers interested in financing long-term care, as well as for insurance companies and consumer advocates.}, keywords = {Medicare/Medicaid/Health Insurance}, doi = {https://doi.org/10.1111/j.1468-0440.2004.00307.x}, author = {McNamara, Paul E. and Lee, Nayoung} } @article {5502, title = {Liquidity Constraints, Wealth Accumulation and Entrepreneurship}, year = {2002}, institution = {Chicago Business School}, abstract = {There exist many government programs in the U.S. aimed to foster entrepreneurship and, in particular, to relax credit restrictions new entrepreneurs may face. However, many leading empirical works have found that there exists a positive correlation between wealth and starting a business and argued that binding liquidity constraints prevent many household from becoming business owners. In this paper, we examine closely the relationship between weath accumulation and entrepreneurship. We argue that, if liquidity constraints are binding, the incremental effect of a dollar of wealth on the probability to start a business should decrease as welath increases. Using data from several surveys, we can reject the hypothesis that liquidity constraints are the cause of the observed wealth-business start-up correlation. We find that only a small group of extremely wealthy households (top 3 of the wealth distribution) drives the correlation between wealth and becoming a business owner. Additionally, we find that there is no correlation between initial wealth (and wealth changes) and the propensity to become a business owner among businesses that require high starting capital and among groups that are ex-ante more likely to be liquidity constrained, such as young, black, or female households. Furthermore, when using a more appropriate measure of liquidity and accessibility of funds, such as receiving insurance settlements or capital gains on home equity, we find that the positive correlation between wealth and starting a business vanishes. Finally, we examine the importance of family wealth in affecting the child{\textquoteright}s propensity to start a business as well as business survival. We again show that it is mainly those families at the very top of the wealth distribution that are responsible for driving the positive relationship between wealth and business start-up and wealth and business survival. Taken together, our evidence casts severe doubts that the mechanism at play in explaining the positive relationship between wealth and business start-up had much to do with the existence of liquidity constraints.}, keywords = {Employment and Labor Force, Net Worth and Assets}, doi = {10.1086/381478}, author = {Hurst, Erik and Annamaria Lusardi} } @article {6834, title = {Low Cognitive Performance, Comorbid Disease, and Task Specific Disability: Findings from a nationally representative survey}, journal = {The Journals of Gerontology: Medical Sciences}, volume = {57A}, year = {2002}, pages = {M523-M531}, publisher = {57A}, abstract = {Background. This research evaluated the association of low cognitive performance with both chronic diseases and conditions, and with difficulties in a broad array of task-specific functioning and disability measures in older adults living in the community. Methods. Data were from the first wave of the Assets and Health Dynamics Among the Oldest-Old Study, a national panel survey of individuals age 70 and older (n 6600 age-eligible self-respondents). Low cognitive performance (LCP) was defined as scores in the lowest (poorest performing) 25th percentile of a cognitive performance scale. The associations of LCP with prevalent chronic diseases and conditions and with limitations in 14 tasks (strength and mobility, instrumental activities of daily living, and activities of daily living) were evaluated. Associations of LCP and task limitations were adjusted for potential modifiers and confounders, including demographic characteristics (age, gender, race), educational attainment, chronic diseases, depressive symptoms, and sensory impairments. Data were weighted to account for complex sample design and nonresponse. Results. More than one third of people with LCP had three or more coexisting diseases and conditions. The unadjusted associations of LCP with task functioning were attenuated after covariate adjustment, but even after adjustment, LCP remained significantly and independently associated with functioning problems in 9 of 14 tasks (borderline with four more), including mobility tasks. Conclusions. Low cognitive performance, regardless of its relationship to clinical dementia, coexists with multiple chronic diseases and conditions. It is independently associated with a broad array of functioning difficulties, even after controlling for demographic characteristics, educational attainment, and chronic conditions. Chronic diseases and conditions, however, attenuate the relationship between LCP and some task difficulties. LCP should be considered an important comorbid condition associated with both chronic diseases and disability that substantially increases the health burden of many older adults who are poorly equipped to handle it.}, keywords = {Disabilities, Health Conditions and Status}, doi = {10.1093/gerona/57.8.M523}, author = {Caroline S Blaum and Mary Beth Ofstedal and Jersey Liang} } @article {6777, title = {Longitudinal Changes in Net Worth by Household Income and Demographic Characteristics for the first three waves of HRS Data}, journal = {Financial Services Review}, volume = {10}, year = {2001}, pages = {55-73}, publisher = {10}, abstract = {The purpose of this study is to provide an initial examination of the first three waves of HRS in terms of non-housing net worth by gender, education, race, religion, income, and age. The longitudinal data that is available for a sample of those who are nearing retirement or in retirmenet allows a picture of their financial condition to be drawn. Statistical analysis indicates that there is a difference in non-housing net worth by demographic characteristics and material status for each wave of data.}, keywords = {Adult children, Income, Methodology, Net Worth and Assets}, doi = {10.1016/S1057-0810(02)00100-2}, author = {Karen E. Lahey and Kim, Doseong} } @article {6589, title = {Life-Cycle Aspects of Poverty Among Older Women}, journal = {Social Security Bulletin}, volume = {60}, year = {1997}, publisher = {60}, keywords = {Net Worth and Assets, Women and Minorities}, url = {https://www.ssa.gov/policy/docs/ssb/v60n2/v60n2p17.pdf}, author = {Choudhury, Sharmila and Leonesio, Michael V.} }