@article {13155, title = {Obesity Stigma: Causes, Consequences, and Potential Solutions.}, journal = {Curr Obes Rep}, volume = {12}, year = {2023}, month = {2023 Mar}, pages = {10-23}, abstract = {

PURPOSE OF REVIEW: This review aims to examine (i) the aetiology of obesity; (ii) how and why a perception of personal responsibility for obesity so dominantly frames this condition and how this mindset leads to stigma; (iii) the consequences of obesity stigma for people living with obesity, and for the public support for interventions to prevent and manage this condition; and (iv) potential strategies to diminish our focus on personal responsibility for the development of obesity, to enable a reduction of obesity stigma, and to move towards effective interventions to prevent and manage obesity within the population.

RECENT FINDINGS: We summarise literature which shows that obesity stems from a complex interplay of genetic and environment factors most of which are outside an individual{\textquoteright}s control. Despite this, evidence of obesity stigmatisation remains abundant throughout areas of media, entertainment, social media and the internet, advertising, news outlets, and the political and public health landscape. This has damaging consequences including psychological, physical, and socioeconomic harm. Obesity stigma does not prevent obesity. A combined, concerted, and sustained effort from multiple stakeholders and key decision-makers within society is required to dispel myths around personal responsibility for body weight, and to foster more empathy for people living in larger bodies. This also sets the scene for more effective policies and interventions, targeting the social and environmental drivers of health, to ultimately improve population health.

}, keywords = {Body Weight, Humans, Obesity, Social Behavior, Social Stigma, Stereotyping}, issn = {2162-4968}, doi = {10.1007/s13679-023-00495-3}, author = {Westbury, Susannah and Oyebode, Oyinlola and van Rens, Thijs and Barber, Thomas M} } @article {12324, title = {Out-of-pocket costs attributable to dementia: A longitudinal analysis.}, journal = {Journal of the American Geriatrics Society}, volume = {70}, year = {2022}, pages = {1538-1545}, abstract = {

BACKGROUND: Alzheimer{\textquoteright}s disease and related dementias (ADRD) affect 5.7 million Americans, and are expensive despite the lack of a cure or even treatments effective in managing the disease. The literature thus far has tended to focus on the costs to Medicare, even though one of the main characteristics of ADRD (the loss of independence and ability to care for oneself) incurs costs not covered by Medicare.

METHODS: In this paper, we use survey data for 2002-2016 from the Health and Retirement Study to estimate the out-of-pocket costs of ADRD for the patient and their family through the first 8 years after the onset of symptoms, as defined by a standardized 27-point scale of cognitive ability. A two-part model developed by Basu and Manning (2010) allows us to separate the costs attributable to ADRD into two components, one driven by differences in longevity and one driven by differences in utilization.

RESULTS: We identified a cohort of 3619 incident dementia cases, 38.9\% were male, and 66.9\% were non-Hispanic White. Dementia onset was 77.7 years of age, on average. OOP costs attributable to dementia are $8751 over the first 8 years after the onset. These incremental costs are driven by nursing home expenditures, which are largely uninsured in the US. OOP spending is highest for whites and women.

CONCLUSION: The financial burden of ADRD is significant, and largely attributable to the lack of wide-spread long-term care insurance.

}, keywords = {Dementia, Long-term services and supports, out-of-pocket costs}, issn = {1532-5415}, doi = {10.1111/jgs.17746}, author = {Oney, Melissa and White, Lindsay and Norma B Coe} } @article {11285, title = {Out-of-Pocket Costs Attributable to Dementia: A Longitudinal Analysis}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {475-476}, abstract = {Alzheimer{\textquoteright}s disease and related dementias (ADRD) affects 5.5 million Americans, and is expensive despite the lack of a cure or even treatments effective in managing the disease. The literature thus far has tended to focus on the costs to Medicare, despite the fact that one of the main characteristics of ADRD (the loss of independence and ability to care for oneself) incurs costs not covered by Medicare. In this paper, we use survey data for 2002-2014 from the Health and Retirement Study to estimate the out-of-pocket costs of ADRD for the patient and their family through the first 8 years after onset of symptoms, as defined by a standardized 27-point scale of cognitive ability. A two-part model developed by Basu and Manning (2010) allows us to separate the costs attributable to ADRD into two components, one driven by differences in longevity and one driven by differences in utilization. We consider total out-of-pocket expenditures, as well as out-of-pocket expenditures by category (i.e. hospital, nursing home, doctor, prescription drug, and other). Our results suggest that the out-of-pocket costs of ADRD are quite substantial over the first 8 years after onset. We also find that out-of-pocket spending is decreasing over the first 8 years, similar to the trend seen in Medicare expenditures. The results of this study highlight the financial burden of ADRD, particularly for the population paying out-of-pocket for care.}, keywords = {Alzheimer disease, Dementia, Out-of-pocket medical expenses}, isbn = {2399-5300}, doi = {10.1093/geroni/igaa057.1539}, author = {Oney, Melissa and White, Lindsay and Norma B Coe} } @article {10875, title = {One-Year Mortality After Dialysis Initiation Among Older Adults.}, journal = {JAMA Intern Med}, volume = {179}, year = {2019}, month = {2019 07 01}, pages = {987-990}, abstract = {This cohort study examines the incidence of mortality 1 year after the start of hemodialysis in patients 65 years and older.}, keywords = {Aged, Aged, 80 and over, Female, Humans, Male, Renal Dialysis, United States}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2019.0125}, author = {Melissa W Wachterman and O{\textquoteright}Hare, Ann M and Rahman, Omari-Khalid and Karl A Lorenz and Edward R Marcantonio and Alicante, Gabrielle K and Amy Kelley} } @article {8480, title = {Older adults with poor self-rated memory have less depressive symptoms and better memory performance when perceived self-efficacy is high.}, journal = {Int J Geriatr Psychiatry}, volume = {31}, year = {2016}, month = {2016 07}, pages = {783-90}, abstract = {

OBJECTIVE: To investigate whether self-efficacy moderates the association between self-rated memory and depressive symptoms in a large sample of older adults. The influence of self-efficacy and depressive symptoms on memory performance was also examined in a subsample of individuals who reported poor memory.

METHODS: Non-demented participants (n = 3766) were selected from the 2012 wave of the Health and Retirement Study. Depressive symptomatology was assessed with the 8-item Center for Epidemiologic Studies Depression Scale. A modified version of the Midlife Developmental Inventory Questionnaire was used as the measure of self-efficacy. Participants were asked to rate their memory presently on a five-point scale from Excellent (1) to Poor (5). Immediate memory and delayed memory (after a 5-min interval) were measured by the number of correct words recalled from a 10-item word list.

RESULTS: Multiple regression analyses revealed that negative ratings of memory were significantly associated with greater levels of depressive symptoms, with this effect being greatest in those with low levels of self-efficacy. Additionally, greater self-efficacy was associated with optimal objective memory performances but only when depressive symptoms were low in individuals who reported poor memory function (n = 1196).

CONCLUSION: Self-efficacy moderates the relationship between self-rated memory function and depressive symptoms. Higher self-efficacy may buffer against the impact of subjective memory difficulty on one{\textquoteright}s mood and thereby mitigating the effect of depressive symptoms on memory. Interventions should focus on increasing perceived self-efficacy in older adults reporting poor memory function to potentially minimize memory impairment.

}, keywords = {Aged, Aged, 80 and over, depression, Female, Humans, Male, Memory, Middle Aged, Regression Analysis, Self Efficacy, Surveys and Questionnaires}, issn = {1099-1166}, doi = {10.1002/gps.4392}, url = {http://www.ncbi.nlm.nih.gov/pubmed/26679474}, author = {O{\textquoteright}Shea, Deirdre M and Vonetta M Dotson and Fieo, Robert A and Tsapanou, Angeliki and Laura B Zahodne and Stern, Yaakov} } @article {8053, title = {Obesity and 1-year outcomes in older Americans with severe sepsis.}, journal = {Crit Care Med}, volume = {42}, year = {2014}, note = {Export Date: 21 April 2014 Source: Scopus Article in Press}, month = {2014 Aug}, pages = {1766-74}, publisher = {42}, abstract = {

OBJECTIVES: Although critical care physicians view obesity as an independent poor prognostic marker, growing evidence suggests that obesity is, instead, associated with improved mortality following ICU admission. However, this prior empirical work may be biased by preferential admission of obese patients to ICUs, and little is known about other patient-centered outcomes following critical illness. We sought to determine whether 1-year mortality, healthcare utilization, and functional outcomes following a severe sepsis hospitalization differ by body mass index.

DESIGN: Observational cohort study.

SETTING: U.S. hospitals.

PATIENTS: We analyzed 1,404 severe sepsis hospitalizations (1999-2005) among Medicare beneficiaries enrolled in the nationally representative Health and Retirement Study, of which 597 (42.5\%) were normal weight, 473 (33.7\%) were overweight, and 334 (23.8\%) were obese or severely obese, as assessed at their survey prior to acute illness. Underweight patients were excluded a priori.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Using Medicare claims, we identified severe sepsis hospitalizations and measured inpatient healthcare facility use and calculated total and itemized Medicare spending in the year following hospital discharge. Using the National Death Index, we determined mortality. We ascertained pre- and postmorbid functional status from survey data. Patients with greater body mass indexes experienced lower 1-year mortality compared with nonobese patients, and there was a dose-response relationship such that obese (odds ratio = 0.59; 95\% CI, 0.39-0.88) and severely obese patients (odds ratio = 0.46; 95\% CI, 0.26-0.80) had the lowest mortality. Total days in a healthcare facility and Medicare expenditures were greater for obese patients (p < 0.01 for both comparisons), but average daily utilization (p = 0.44) and Medicare spending were similar (p = 0.65) among normal, overweight, and obese survivors. Total function limitations following severe sepsis did not differ by body mass index category (p = 0.64).

CONCLUSIONS: Obesity is associated with improved mortality among severe sepsis patients. Due to longer survival, obese sepsis survivors use more healthcare and result in higher Medicare spending in the year following hospitalization. Median daily healthcare utilization was similar across body mass index categories.

}, keywords = {Aged, Aged, 80 and over, Body Mass Index, Cohort Studies, Comorbidity, Critical Illness, Delivery of Health Care, Female, Health Expenditures, Hospitalization, Humans, Male, Medicare, Middle Aged, Obesity, Sepsis, Survival Rate, Survivors, United States}, issn = {1530-0293}, doi = {10.1097/CCM.0000000000000336}, author = {Hallie C Prescott and Virginia W Chang and James M. O{\textquoteright}Brien Jr and Kenneth M. Langa and Theodore J Iwashyna} } @article {7705, title = {Obesity, Depression, and Employment Related Outcomes Among Workers Near Retirement}, journal = {Ageing International}, volume = {37}, year = {2012}, pages = {238-253}, publisher = {37}, abstract = {Obese individuals with comorbid depression face greater risks of atrophied health status alongside the associated adverse consequences, such as limitations of daily living and/or work related activities. This study uses the U.S. Health and Retirement Study database to investigate the likelihood of early retirement decisions (before age 62) of older working-age adults (ages 50 to 62). We find that obese subjects with comorbid depression are significantly more likely to reduce work-hours and seek early retirement. Survival models confirm the negative association between obesity with comorbid depression and the duration to early retirement. The bidirectional association between obesity and depression suggest that more carefully designed public policy interventions are necessary for improving the labor market attachments of the older working-age adults that are obese and clinically depressed. PUBLICATION ABSTRACT}, keywords = {Health Conditions and Status, Methodology, Public Policy, Retirement Planning and Satisfaction}, doi = {10.1007/s12126-010-9107-7}, author = {Mustafa C. Karakus and Okunade, A.} } @article {8939, title = {Older adults who persistently present to the emergency department with severe, non-severe, and indeterminate episode patterns.}, journal = {BMC Geriatrrics}, volume = {11}, year = {2011}, pages = {65}, abstract = {

BACKGROUND: It is well known that older adults figure prominently in the use of emergency departments (ED) across the United States. Previous research has differentiated ED visits by levels of clinical severity and found health status and other individual characteristics distinguished severe from non-severe visits. In this research, we classified older adults into population groups that persistently present with severe, non-severe, or indeterminate patterns of ED episodes. We then contrasted the three groups using a comprehensive set of covariates.

METHODS: Using a unique dataset linking individual characteristics with Medicare claims for calendar years 1991-2007, we identified patterns of ED use among the large, nationally representative AHEAD sample consisting of 5,510 older adults. We then classified one group of older adults who persistently presented to the ED with clinically severe episodes and another group who persistently presented to the ED with non-severe episodes. These two groups were contrasted using logistic regression, and then contrasted against a third group with a persistent pattern of ED episodes with indeterminate levels of severity using multinomial logistic regression. Variable selection was based on Andersen{\textquoteright}s behavioral model of health services use and featured clinical status, demographic and socioeconomic characteristics, health behaviors, health service use patterns, local health care supply, and other contextual effects.

RESULTS: We identified 948 individuals (17.2\% of the entire sample) who presented a pattern in which their ED episodes were typically defined as severe and 1,076 individuals (19.5\%) who typically presented with non-severe episodes. Individuals who persistently presented to the ED with severe episodes were more likely to be older (AOR 1.52), men (AOR 1.28), current smokers (AOR 1.60), experience diabetes (AOR (AOR 1.80), heart disease (AOR 1.70), hypertension (AOR 1.32) and have a greater amount of morbidity (AOR 1.48) than those who persistently presented to the ED with non-severe episodes. When contrasted with 1,177 individuals with a persistent pattern of indeterminate severity ED use, persons with severe patterns were older (AOR 1.36), more likely to be obese (AOR 1.36), and experience heart disease (AOR 1.49) and hypertension (AOR 1.36) while persons with non-severe patterns were less likely to smoke (AOR 0.63) and have diabetes (AOR 0.67) or lung disease (AOR 0.58).

CONCLUSIONS: We distinguished three large, readily identifiable groups of older adults which figure prominently in the use of EDs across the United States. Our results suggest that one group affects the general capacity of the ED to provide care as they persistently present with severe episodes requiring urgent staff attention and greater resource allocation. Another group persistently presents with non-severe episodes and creates a considerable share of the excess demand for ED care. Future research should determine how chronic disease management programs and varied co-payment obligations might impact the use of the ED by these two large and distinct groups of older adults with consistent ED use patterns.

}, keywords = {Emergency services, Health Shocks, Medicare/Medicaid/Health Insurance, Older Adults}, issn = {1471-2318}, doi = {10.1186/1471-2318-11-65}, author = {Kaskie, Brian and Maksym Obrizan and Michael P Jones and Suzanne E Bentler and Paula A Weigel and Jason Hockenberry and Robert B Wallace and Robert L. Ohsfeldt and Gary E Rosenthal and Frederic D Wolinsky} } @inbook {5182, title = {Option Value Estimation with HRS Data}, booktitle = {Labor Markets and Firm Benefit Policies in Japan and the United States}, year = {2003}, note = {RDA 1997-011 ProCite field 8 : eds.}, pages = {205-228}, publisher = {University of Chicago Press}, organization = {University of Chicago Press}, address = {Chicago}, abstract = {We estimate the effect of financial incentives to delay retirement on the probability of retirement in the Health and Retirement Study. We find statistically significant effects of both pension wealth and pension incentives on the probability of retirement. The effects are more robust when retirement is defined only as a job separation rather than a complete transition out of the labor force. We also investigate possible interactions between the effects of health, wealth, and health insurance on retirement.}, keywords = {Public Policy, Retirement Planning and Satisfaction}, isbn = {0-226-62094-8}, url = {https://www.nber.org/chapters/c10308}, author = {Andrew A. Samwick and David A Wise}, editor = {Seiritsu Ogura and Toshiaki Tachibanaki and David A Wise} }