@article {12406, title = {Racial and Ethnic Differences in Informal and Formal Advance Care Planning Among U.S. Older Adults.}, journal = {Journal of Aging and Health}, year = {Forthcoming}, abstract = {

OBJECTIVE: To examine advance care planning (ACP) trends among an increasingly diverse aging population, we compared informal and formal ACP use by race/ethnicity among U.S. older adults (<=65~years).

METHODS: We used Health and Retirement Study data (2012-2018) to assess relationships between race/ethnicity and ACP type (i.e., no ACP, informal ACP only, formal ACP only, or both ACP types). We reported adjusted risk ratios with 95\% confidence intervals.

RESULTS: Non-Hispanic Black and Hispanic respondents were 1.77 (1.60, 1.96) and 1.76 (1.55, 1.99) times as likely, respectively, to report no ACP compared to non-Hispanic White respondents. Non-Hispanic Black and Hispanic respondents were 0.74 (0.71, 0.78) and 0.74 (0.69, 0.80) times as likely, respectively, to report using both ACP types as non-Hispanic White respondents.

DISCUSSION: Racial/ethnic differences in ACP persist after controlling for a variety of barriers to and facilitators of ACP which may contribute to disparities in end-of-life care.

}, keywords = {Advance care planning, Advance directives, end of life, Healthcare Disparities, race and ethnicity}, issn = {1552-6887}, doi = {10.1177/08982643221104926}, author = {Lenko, Rachel and Voepel-Lewis, Terri and Robinson-Lane, Sheria G and Silveira, Maria J and Hoffman, Geoffrey J} } @article {doi:10.1080/15427609.2024.2330284, title = {RELATIONSHIP AND SINGLEHOOD TRAJECTORIES DURING THE TRANSITION TO OLDER ADULTHOOD OVER THE PAST 40 YEARS}, journal = {Research in Human Development}, year = {2024}, pages = {1{\textendash}22}, abstract = {Using data from the Health and Retirement Study spanning four decades of historical time (i.e., birth cohorts ranging from 1921{\textendash}1964), we documented heterogeneity in relationship and singlehood trajectories across the transition into older adulthood (ages 55{\textendash}70) and its covariates (cohort, sex, race/ethnicity, educational attainment). Nine relationship trajectory classes were identified based on current marital/relationship status. Most classes entailed no transitions. Class membership varied across historical time, sex, race/ethnicity, and educational attainment. Recent cohorts were more likely to be spending their beginning golden years single, and this was especially pronounced for women, those racialized as Black, and those with less education.}, keywords = {Adulthood, Heterogeneity, Marital Status, relationship, Singlehood}, doi = {10.1080/15427609.2024.2330284}, author = {Amy Rauer, Justin Jager and Mike Vuolo} } @article {12479, title = {Race-Discordant School Attendance and Cognitive Function in Later Life.}, journal = {Research on Aging}, year = {2023}, abstract = {

Early schooling plays an important role in shaping cognitive development. This study explored benefits of cognitive functioning in later life related to attending diverse schools in early life. Specifically, we explored the effects of having attended schools composed primarily of different race peers-race discordant schools (RDS)-among Black and White older adults. Using retrospective and prospective data from the Health and Retirement Study, we examined the association between RDS exposure and two measures of cognitive function (working memory, episodic memory) at age 55 and at age 70. We found that RDS exposed Blacks experienced significant benefits in cognitive function at age 55 and at age 70. In general, RDS exposed Whites did not experience cognitive benefits or deficits. Results suggest that exposure to more racially diverse school environments provides potentially beneficial effects for cognitive function, particularly in later phases of the life course.

}, keywords = {Cognitive health, Racial/Ethnic Groups, school segregation}, issn = {1552-7573}, doi = {10.1177/01640275221103791}, author = {Carr, Dawn C and Reynolds, John} } @article {13248, title = {Racial and Ethnic Disparities in Health Care Use and Access Associated With Loss of Medicaid Supplemental Insurance Eligibility Above the Federal Poverty Level.}, journal = {JAMA Intern Med}, volume = {183}, year = {2023}, pages = {534-543}, abstract = {

IMPORTANCE: Medicaid supplemental insurance covers most cost sharing in Medicare. Among low-income Medicare beneficiaries, the loss of Medicaid eligibility above this program{\textquoteright}s income eligibility threshold (100\% of federal poverty level [FPL]) may exacerbate racial and ethnic disparities in Medicare beneficiaries{\textquoteright} ability to afford care.

OBJECTIVE: To examine whether exceeding the income threshold for Medicaid, which results in an abrupt loss of Medicaid eligibility, is associated with greater racial and ethnic disparities in access to and use of care.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a regression discontinuity design to assess differences in access to and use of care associated with exceeding the income threshold for Medicaid eligibility. We analyzed Medicare beneficiaries with incomes 0\% to 200\% of FPL from the 2008 to 2018 biennial waves of the Health and Retirement Study linked to Medicare administrative data. To identify racial and ethnic disparities associated with the loss of Medicaid eligibility, we compared discontinuities in outcomes among Black and Hispanic beneficiaries (n = 2885) and White beneficiaries (n = 5259). Analyses were conducted between January 1, 2022, and October 1, 2022.

MAIN OUTCOME MEASURES: Patient-reported difficulty accessing care due to cost and outpatient service use, medication fills, and hospitalizations measured from Medicare administrative data.

RESULTS: This cross-sectional study included 8144 participants (38 805 person-years), who when weighted represented 151 282 957 person-years in the community-dwelling population of Medicare beneficiaries aged 50 years and older and incomes less than 200\% FPL. In the weighted sample, the mean (SD) age was 75.4 (9.4) years, 66.1\% of beneficiaries were women, 14.8\% were non-Hispanic Black, 13.6\% were Hispanic, and 71.6\% were White. Findings suggest that exceeding the Medicaid eligibility threshold was associated with a 43.8 percentage point (pp) (95\% CI, 37.8-49.8) lower probability of Medicaid enrollment among Black and Hispanic Medicare beneficiaries and a 31.0 pp (95\% CI, 25.4-36.6) lower probability of Medicaid enrollment among White beneficiaries. Among Black and Hispanic beneficiaries, exceeding the threshold was associated with increased cost-related barriers to care (discontinuity: 5.7 pp; 95\% CI, 2.0-9.4), lower outpatient use (-6.3 services per person-year; 95\% CI, -10.4 to -2.2), and fewer medication fills (-6.9 fills per person-year; 95\% CI, -11.4 to -2.5), but it was not associated with a statistically significant discontinuity in hospitalizations. Discontinuities in these outcomes were smaller or nonsignificant among White beneficiaries. Consequently, exceeding the threshold was associated with widened disparities, including greater reductions in outpatient service use (disparity: -6.2 services per person-year; 95\% CI, -11.7 to -0.6; P = .03) and medication fills (disparity: -7.2 fills per person-year; 95\% CI, -13.4 to -1.0; P = .02) among Black and Hispanic vs White beneficiaries.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that loss of eligibility for Medicaid supplemental insurance above the federal poverty level, which increases cost sharing in Medicare, was associated with increased racial and ethnic health care disparities among low-income Medicare beneficiaries. Expanding eligibility for Medicaid supplemental insurance may narrow these disparities.

}, keywords = {Aged, Cross-Sectional Studies, Female, Healthcare Disparities, Humans, Male, Medicaid, Medicare, Middle Aged, Poverty, United States}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2023.0512}, author = {Roberts, Eric T and Kwon, Youngmin and Hames, Alexandra G and McWilliams, J Michael and Ayanian, John Z and Tipirneni, Renuka} } @article {12650, title = {Receptive and participatory arts engagement and healthy aging: Longitudinal evidence from the Health and Retirement Study}, journal = {Social Science \& Medicine}, volume = {334}, year = {2023}, pages = {116198}, abstract = {Background: There is increasing interest in the potential benefits of referring older adults to engage in community-based arts activities to enhance health. The arts have been found to have wide-ranging benefits for older adults including being associated with an increased lifespan. However, it remains unclear whether they are additionally associated with an increase in the portion of people{\textquoteright}s lives for which they remain healthy ({\textquoteright}healthspan{\textquoteright}). Methods: We included 1,269 older adults who completed the 2014 Arts and Culture Supplement of the Health and Retirement Study and were alive in 2016 and 2018. We measured the number of participatory arts activities engaged in (e.g., reading, crafts, dancing) and the frequency of receptive arts engagement (e.g., going to a gallery or performance) in the past year. Healthy aging was a binary outcome, conceptualized using a previously validated definition of no major chronic diseases, no cognitive impairment, good physical functioning, and good mental health. Logistic regression models tested whether receptive and participatory arts engagement were associated with healthy aging two and four years later. Results: After adjusting for demographic and socioeconomic covariates, doing receptive arts activities once a month or more was associated with 84\% higher odds of healthy aging two years later compared to never engaging (adjusted OR [AOR]=1.84, 95\% CI=1.06-3.19). There was some weak evidence that this association was maintained four years later (AOR=1.68, 95\% CI=0.97-2.90). Although doing one participatory arts activity was associated with 53\% lower odds of healthy aging four years later compared to no participation (AOR=0.47, 95\% CI=0.26-0.87), this association was not present at two years or for higher levels of participatory arts engagement. Conclusions: Expanding on previous studies, which have suggested that receptive arts engagement is related to prolonged longevity, our findings suggest that receptive arts engagement may also be associated with better overall health and function in those who survive. Those with poorer health may have been engaging in participatory arts because they were unable to attend receptive arts or broader leisure activities (indicating reverse causality), or receptive arts activities may contain specifically beneficial active ingredients for healthy aging. These possibilities present promising avenues for future research.}, keywords = {Chronic disease, Cognition, cognitive impairment, Cultural engagement, Mental Health, physical functioning}, doi = {10.1016/j.socscimed.2023.116198}, author = {Rena, Melinda and Fancourt, Daisy and Bu, Feifei and Paul, Elise and Sonke, Jill K and Bone, Jessica K} } @article {13521, title = {Receptive and participatory arts engagement and subsequent healthy aging: Evidence from the Health and Retirement Study.}, journal = {Soc Sci Med}, volume = {334}, year = {2023}, pages = {116198}, abstract = {

RATIONALE: Arts engagement is associated with prolonged longevity, but it remains unclear whether it is also associated with increases in the portion of people{\textquoteright}s lives for which they remain healthy. We investigated whether receptive and participatory arts engagement were associated with healthy aging two and four years later.

METHOD: We included 1269 older adults from the Health and Retirement Study (HRS), a longitudinal study of individuals aged 50 and above in the United States. Participants who completed the HRS 2014 Culture and the Arts Module and who were alive in 2016 and 2018 were eligible. We measured the number of participatory arts activities engaged in (e.g., crafts, dancing) and frequency of receptive arts engagement (e.g., going to a gallery or performance) in the past year. Healthy aging was a binary outcome, conceptualized as no major chronic diseases, no cognitive impairment, good physical functioning, and good mental health.

RESULTS: In logistic regression models, doing receptive arts once a month or more was associated with higher odds of healthy aging four years later compared to never engaging (odds ratio [OR]~=~1.80, 95\% CI~=~1.10, 2.96). However, this evidence was attenuated after adjusting for demographic and socioeconomic covariates (adjusted OR~=~1.44, 95\% CI~=~0.84, 2.46). The number of participatory arts activities engaged in was not associated with healthy aging two or four years later. In sensitivity analyses, there was some evidence that receptive engagement was associated specifically with higher odds of good physical functioning four years later.

CONCLUSIONS: The lack of consistent associations between receptive and participatory arts engagement and healthy aging was unexpected given previous evidence for links between arts engagement and each of the four domains of healthy aging. Our findings highlight key methodological issues that should be explored in further research with larger nationally representative samples, longer follow-ups, and more detailed measures of arts engagement.

}, keywords = {Chronic disease; Cognition; Cultural engagement; Mental health; Physical functioning}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2023.116198}, author = {Rena, Melinda and Fancourt, Daisy and Bu, Feifei and Paul, Elise and Sonke, Jill K and Bone, Jessica K} } @article {13534, title = {The relationship between physical activity, cognitive function and health care use: A mediation analysis.}, journal = {Social Science \& Medicine (1983)}, volume = {335}, year = {2023}, pages = {116202}, abstract = {

Physical activity is known to provide substantial health benefits and subsequently reduce health care use among older people, but little is known about how much of this effect is due to improved cognitive function as opposed to physical improvements in health. We study the direct and indirect effect of physical activity on health care use using the word recall task as a measure of cognitive function in a mediation framework. We use data from eight waves of the US Health and Retirement Study (HRS) (2004 - 2018) of people aged 65 and older and exploit genetic variations between individuals as an instrumental variable (IV) for cognitive function, a local health care supply measure as IV for health care use, and neighbourhood physical activity as IV for individual physical activity in our simultaneous three-equation model. We find small but negative direct and indirect effects of physical activity through improved cognitive function on the probability to see a GP and being admitted to a hospital, as well as the number of GP visits and the hospital length of stay. Improved cognitive function explains between 5\% to 17\% of the total effect of physical activity on the reduction in health care use.

}, keywords = {cognitive function, Health care use, HRS, mediation analysis, Physical activity}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2023.116202}, author = {Lenzen, Sabrina and Gannon, Brenda and Rose, Christiern and Norton, Edward C} } @article {13328, title = {Representativeness of samples enrolled in Alzheimer{\textquoteright}s disease research centers.}, journal = {Alzheimers Dement (Amst)}, volume = {15}, year = {2023}, pages = {e12450}, abstract = {

UNLABELLED: To generalize findings on the mechanisms and prognosis in Alzheimer{\textquoteright}s disease and related dementias (ADRD), it is critical for ADRD research to be representative of the population. Sociodemographic and health characteristics across ethnoracial groups included in the National Alzheimer{\textquoteright}s Coordinating Center sample (NACC) were compared to the nationally representative Health and Retirement Study (HRS). Baseline NACC data (~=~36,639) and the weighted 2010 HRS wave (~=~52,071,840) were included. We assessed covariate balance by calculating standardized mean differences across harmonized covariates (i.e., sociodemographic, health). NACC participants were older, more educated, with worse subjective memory and hearing, but endorsed fewer depressive symptoms compared to HRS participants. While all racial and ethnic groups in NACC differed from HRS participants in the same way overall, these differences were further amplified between racial and ethnic groups. NACC participants do not represent the U.S. population in key demographic and health factors, which differed by race and ethnicity.

HIGHLIGHTS: We examined selection factors included in NACC studies compared to a nationally representative sample.Selection factors included demographic and health factors and self-reported memory concerns.Results suggest that NACC participants are not representative of the U.S. population.Importantly, selection factors differed across racial and ethnic groups.Findings are suggestive of selection bias within NACC studies.

}, issn = {2352-8729}, doi = {10.1002/dad2.12450}, author = {Arce Renter{\'\i}a, Miguel and Mobley, Taylor M and Evangelista, Nicole D and Medina, Luis D and Deters, Kacie D and Fox-Fuller, Joshua T and Minto, Lex R and Avila-Rieger, Justina and Bettcher, Brianne M} } @article {13203, title = {Risk of Large Medical Expenditures at Older Ages and Their Impact on Economic Well-being}, year = {2023}, institution = {University of Michigan Retirement and Disability Research Center}, address = {Ann Arbor, Michigan}, abstract = {We study out-of-pocket (OOP) medical expenditure risk of the U.S. population ages 55 and older using data from the Health and Retirement Study and its supplemental survey on household spending. We document trends in individual-level OOP spending from 1998 to 2018, both at the median and 95th percentile, showing a large increase until 2004, followed by rapid declines, so that 2018 OOP was less than 1998 OOP spending. We show how these changes impacted the budget share of OOP as a fraction of total household spending and analyze how households adjust the composition of their spending as OOP expenses vary. Because the distribution of OOP expenses is skewed, households face a non-negligible risk of incurring a large expense. We examined the extent to which OOP medical expenditures contribute to economic hardship among older households, as measured by food insecurity and skipping medications because of cost. We found a weak relationship with respect to food insecurity, suggesting that government programs, like Medicaid, help protect against OOP risk leading to such as an extreme form of hardship. However, we obtained statistically significant and economically meaningful effects with respect to medication insecurity: An increase from the 10th to the 90th percentile in OOP spending would increase the probability of medication insecurity by about 15 percentage points. When asked about their perceived OOP risk, individuals tend to substantially overestimate the chances of large OOP spending, although less so at advanced ages; prior experience with OOP expenses seems to lead to more accurate expectations.}, keywords = {economic well-being, medical expenditures, Older ages}, url = {https://mrdrc.isr.umich.edu/publications/papers/pdf/wp457.pdf}, author = {Susann Rohwedder and P{\'e}ter Hudomiet and Michael D Hurd} } @article {13709, title = {The Role of Different Weakness Cut-Points for Future Cognitive Impairment in Older Americans.}, journal = {Journal of the American Directors Association}, volume = {24}, year = {2023}, pages = {1936-1941.e2}, abstract = {

OBJECTIVES: New absolute and normalized handgrip strength (HGS) cut-points may not yield similar predictive value for cognitive performance. We sought to determine the associations of (1) each absolute and normalized weakness cut-point, and (2) compounding weakness on future cognitive impairment in older Americans.

DESIGN: Longitudinal panel.

SETTING AND PARTICIPANTS: The analytic sample included 11,116 participants aged >=65 years from the 2006 to 2018 waves of the Health and Retirement Study. Participants from the Health and Retirement Study completed detailed interviews that included physical measures and core interviews.

METHODS: The modified Telephone Interview of Cognitive Status assessed cognitive function and persons scoring <11 were classified as having a cognitive impairment. A handgrip dynamometer measured HGS. Men were considered weak if their HGS was <35.5 kg (absolute), <0.45~kg/kg (body mass normalized), or <1.05~kg (body mass index normalized), whereas women were classified as weak if their HGS was <20.0 kg, <0.337~kg/kg, or <0.79~kg. Compounding weakness included those below 1, 2, or all 3 cut-points. Generalized estimating equations quantified the associations.

RESULTS: Persons considered weak under the absolute cut-point had 1.62 (95\% CI 1.34-1.96) greater odds for future cognitive impairment, but no significant associations were observed for those classified as weak under the body mass [odds ratio (OR) 1.12, CI 0.91-1.36] and body mass index normalized (OR 1.17, CI 0.95-1.43) cut-points. Older Americans below all 3 weakness cut-points had 1.47 (CI 1.15-1.88) greater odds for future cognitive impairment, but no significant associations were found for persons classified as weak under 1 (OR 1.08, CI 0.83-1.42) or 2 (OR 1.19, CI 0.91-1.55) cut-points.

CONCLUSIONS AND IMPLICATIONS: Our findings suggest that each weakness cut-point has differential prognostic value for future cognitive impairment, and aggregating weakness cut-points may improve their predictive utility. Consideration should be given to how weakness categories are uniquely linked to cognitive function.

}, keywords = {Aged, Body Mass Index, Cognition, Cognitive Dysfunction, Female, Geriatric Assessment, Hand Strength, Humans, Male}, issn = {1538-9375}, doi = {10.1016/j.jamda.2023.07.021}, author = {McGrath, Ryan and Tomkinson, Grant R and Hamm, Jeremy M and Juhl, Kirsten and Knoll, Kelly and Parker, Kelly and Smith, Ashleigh E and Rhee, Yeong} } @article {resor_cooke_katz_2021, title = {The role of social communication technologies in cognition and affect in older adults}, journal = {Ageing \& Society}, volume = {43}, year = {2023}, pages = {24 - 52}, abstract = {Affect and cognition have both been associated with communication across one{\textquoteright}s social network during ageing. Thus, it is important to consider how communication varies by different aspects of one{\textquoteright}s social network, and by communication mode, including phone, email and social media. This study aimed to investigate the relationship between technology-mediated communication, depression and an executive function-related fluid-reasoning measure among older adults. Data were drawn from the Health and Retirement dataset{\textquoteright}s 2016 wave. Hierarchical regression analyses were conducted to examine the link between communication modes (phone, email and social media) with children, family and friends with a fluid-reasoning cognition measure and Center for Epidemiologic Studies Depression Scale, controlling for demographic covariates, among 3,798 older American adults. Phone and email communication, but not social media, were significantly related to depression and cognition. The model fit was considerably stronger for the analyses with cognition than depression. Curvilinear associations were found for communication via phone and email with cognition, suggesting moderate amounts of communication by phone and email across social groups were most closely linked with higher scores on fluid reasoning. For depression, curvilinear relationships were found for talking on the phone with family and friends, and emailing for children and family, indicating that moderate communication levels revealed the lowest depression levels. Implications for how older adults{\textquoteright} social support may contribute to depression and cognition status are discussed.}, keywords = {Cognition, Communication, depression, technologies}, doi = {10.1017/S0144686X21000386}, author = {Resor, Jessica and Cooke, Steph and Katz, Benjamin} } @article {12402, title = {Race, Childhood Socioeconomic Status, and Region of Childhood Residence as Intersectional Life-Course Predictors of Cognitive Aging in the United States }, journal = {Innovation in Aging}, volume = {6}, year = {2022}, pages = {igac020}, abstract = {Background and Objectives Race, childhood socioeconomic status (cSES), and region of childhood residence are each associated with later-life cognition, but no studies have examined how the confluence of these factors influences later-life cognitive performance. Guided by intersectionality theory, we examined individuals{\textquoteright} social positionality across these dimensions as a predictor of cognitive performance in later life among non-Hispanic White (NHW) and non-Hispanic Black (NHB) older adults. Research Design and Methods We used data from the 2010{\textendash}2016 waves of the Health and Retirement Study with participants aged 65 and older in 2010. We employed growth curve modeling to estimate associations among race, cSES, and region of childhood residence, as well as their interactions, and cognitive performance at baseline and over time. Results Identifying as NHB, residing in the South, and having lower cSES each were associated with poorer later-life cognition at baseline. Childhood residence in the South was an especially strong risk factor for poorer cognition among NHBs. Among NHWs, higher cSES was associated with better baseline cognitive performance, especially among those from the South. NHBs from the South demonstrated a small advantage of higher cSES, but regardless of cSES, NHBs from the South had lower levels of baseline cognitive scores compared to all other subgroups. We observed steeper declines in cognitive performance over the 6-year study period among participants who lived in the South as children. Discussion and Implications Our findings suggest that intersectional social positions across race, cSES, and region of childhood residence primarily influence baseline cognition in later life. Results implicate the importance of attention to multiple life-course social positions in the context of racism within social policies and other initiatives to promote equity in later-life brain health.}, keywords = {Black adults, Brain health, childhood conditions, Racial Disparities}, doi = {10.1093/geroni/igac020}, author = {Reynolds, Addam and Greenfield, Emily A and Moorman, Sara M and Reyes, Laurent} } @article {12997, title = {RACIAL AND ETHNIC VARIATIONS IN DEMENTIA DIAGNOSIS, SURVIVAL, AND END-OF-LIFE CARE QUALITY}, journal = {Innovation in Aging}, volume = {6}, year = {2022}, pages = {353}, abstract = {In the United States most adults have a preference to die at home and is an indicator of good end-of-life care. In the context of dementia, family members and caregivers are decision makers and part of good and equitable care involves understanding cultural variation in attitudes and social norms related to dementia, death and dying, and the meaning of a good death. This symposium explores racial and ethnic variation in lifetime dementia diagnosis and end-of-life care quality indicators. The first presentation examines racial, ethnic, and geographic variation in the rarely discussed lifetime prevalence of dementia and survival time from dementia diagnosis to death using national Medicare data. The second presentation describes the relationship between end-of-life care planning and satisfaction with end-of-life care using data from the Health and Retirement Study. The third presentation describes variation in place of death, a key indicator of end-of-life care quality, by dementia diagnosis and race/ethnicity using national Medicare data. The fourth presentation examines variation in hospice use, another indicator of end-of-life-care quality, and place of death by dementia diagnosis, race, and ethnicity using national Medicare data. The symposium concludes with a presentation examining the relationship between place of death and satisfaction with care received using data from the Health and Retirement Study. The Institute for Healthcare Improvement{\textquoteright}s Triple Aim (improving the experience of care, improving the health of populations, and reducing per capita costs of health care) serves as a lens for discussing policy and practice implications of the major findings from each presentation.}, keywords = {dementia diagnosis, End of life care, Race/ethnicity}, doi = {10.1093/geroni/igac059.1396}, author = {Jarrin, Olga and Rahemi, Zahra and Gusmano, Michael} } @article {11751, title = {Racial-ethnic disparities in pain intensity and interference among middle-aged and older U.S. adults.}, journal = {The Journals of Gerontology: Series A }, volume = {77}, year = {2022}, pages = {e74-e81}, abstract = {

BACKGROUND: This study aims to better understand differing pain experiences across U.S. racial/ethnic subgroups by estimating racial-ethnic disparities in both pain intensity and domain-specific pain-related interference. To address this issue, we use a nationally-representative sample of non-Hispanic White, non-Hispanic Black, and Hispanic adults ages 50+ who report recently experiencing pain.

METHODS: Using data from the 2010 wave of the Health and Retirement Study (HRS; N=684), we conducted a series of multivariate analyses to assess possible racial/ethnic disparities in pain intensity and seven domains of pain interference, controlling for relevant sociodemographic variables and other health problems.

RESULTS: Black and Hispanic participants reported higher pain intensity than White participants after controlling for socioeconomic status (SES) and other health conditions. Both Black and Hispanic individuals reported more domain-specific pain interference in bivariate analyses. In multivariate analyses, Black (vs. White) participants reported significantly higher levels of pain interference with family-home responsibilities, occupation, sexual behavior, and daily self-care. We did not find significant Hispanic-White differences in the seven pain interference domains, nor did we find Black-White differences in three domains (recreation, social activities, and essential activities).

CONCLUSIONS: Our findings highlight the need for using multi-dimensional measures of pain when assessing for possible pain disparities with respect to race/ethnicity. Future studies on pain interventions should consider contextualizing the pain experience across different racial subgroups to help pain patients with diverse needs, with the ultimate goal of reducing racial/ethnic disparities in pain.

}, keywords = {health inequity, Pain interference, Racial Disparities}, issn = {1758-535X}, doi = {10.1093/gerona/glab207}, author = {Yang, Yulin and Reid, M Carrington and Grol-Prokopczyk, Hanna and Pillemer, Karl} } @article {11833, title = {The Relationship between Pain and Psychological Distress during the COVID-19 Pandemic: Is Social Technology Use Protective?}, journal = {Pain Medicine}, volume = {23}, year = {2022}, pages = {280-287}, abstract = {

OBJECTIVES: The COVID-19 pandemic and resulting shelter-in-place orders have profoundly changed the everyday social environment. This study examines the relationship between pain and psychological distress (depression, anxiety, and loneliness) among US adults ages 54+ during the pandemic. We also test whether use of technology for social purposes moderates the association between pain severity and psychological distress.

METHODS: Using cross-sectional data on 1,014 adults ages 54 + (pain-free, n = 637; mild pain, n = 106; moderate pain, n = 227; and severe pain, n = 64) from the 2020 Health and Retirement Study COVID-19 Project (Early, Version 1.0), we conducted regression analyses to test the association between pain severity and psychological outcomes, and to assess social technology use frequency as a moderator.

RESULTS: Compared to their pain-free peers, participants with mild-to-moderate pain reported more depressive symptoms and greater loneliness; those with severe pain reported higher levels of depression, anxiety, and loneliness. Social technology use was associated with lower levels of depression and loneliness. However, interaction analyses show that social technology use predicted an increase in depression for individuals with pain, but a decrease in depression among pain-free individuals. For anxiety and loneliness, no significant effects of social technology use were observed.

CONCLUSION: Older adults with pain are at high risk of depression, anxiety, and loneliness during the pandemic. Although social technologies have become a common alternative to face-to-face interactions during the COVID-19 crisis, and overall they can provide mental health benefits, our results suggest that social technologies can be detrimental to psychological well-being among people with pain. These findings can inform technology-based interventions aiming to promote well-being among older adults with pain.

}, keywords = {Anxiety, COVID-19, depression, Loneliness, technology use for social purpose}, issn = {1526-4637}, doi = {10.1093/pm/pnab262}, author = {Yang, Yulin and Grol-Prokopczyk, Hanna and Reid, M Carrington and Pillemer, Karl} } @article {ghilarducci_radpour_webb_2022, title = {Retirement plan wealth inequality: measurement and trends}, journal = {Journal of Pension Economics and Finance}, volume = {21}, year = {2022}, pages = {119{\textendash}139}, abstract = {Using Health and Retirement Study data linked to summary plan descriptions and W-2s, this study reports trends in retirement wealth inequality of older employees 1992{\textendash}2010. The study identifies and corrects methodological flaws in past research. Retirement wealth is highly unequally distributed; the top lifetime earnings quintile holds half of all retirement wealth, the bottom quintile, only 1\%. The top earnings quintile fared better in 2010 than in 1992, whereas bottom-quintile earners fared worse. But retirement wealth inequality mainly reflects inequality within earnings quintiles, resulting from inadequate savings, not outsize accumulations. Systemic flaws reduce median retirement wealth by 84\% }, keywords = {Inequality, Retirement wealth}, doi = {10.1017/S1474747220000074}, author = {Ghilarducci, Teresa and Radpour, Siavash and Webb, Anthony} } @article {13092, title = {Retirement Reforms Are Necessary{\textemdash}So Is Strengthening Social Security}, year = {2022}, keywords = {Retirement Reforms, Social Security}, author = {Owen Davis and Siavash Radpour and Eva Conway and Teresa Ghilarducci} } @article {12877, title = {The role of cohabitation on adaptive and innate immune cell profiles in the Health and Retirement Study}, journal = {American Journal of Clinical Pathology}, volume = {158}, year = {2022}, pages = {S2}, abstract = {Immune cells distribution is shaped by numerous factors including environmental factors, age, and genetics. Cohabitation has been associated with similar microbiomes, possibly due to dietary patterns and exposure to similar pathogens but has not been studied in the context of adaptive and innate immune systems previously. We used immunophenotyping data of 2283 households with participants living in the same household and compared it to 2283 randomly generated pairs of participants from the Health and Retirement study. The adaptive immune cells (subsets of T-cells and B-cells), and innate immune cells (monocytes, natural killer cells, and neutrophils) were compressed to two coordinates using multidimensional scaling. The Euclidean distances between participants in the same household were compared to the distances between the random pairs of participants using two sample independent t-tests. The mean distances of the immune coordinate points for adaptive immune cells between participants in the same household were lower than the randomly paired participants (p-value \< 0.0001) and the variability of intra-household distances was lower than the random pairs (IQR: 7.18 vs 8.99). For the innate immune cells, the mean distances between participants in the same household were slightly lower than the randomly paired participants (p-value = 0.03) but the variability of the intra-household distances was higher than the random pairs (IQR: 4.08 vs 3.65). Variability in the adaptive immune system among participants living in the same household were substantially lower indicating the influence of shared environmental conditions in determining the adaptive immune profiles.}, keywords = {adaptive immune cells, Cohabitation, Households}, doi = {10.1093/ajcp/aqac126.002}, author = {Ramasubramanian, Ramya and Meier, Helen and Eileen M. Crimmins and Jessica Faul and Bharat Thyagarajan} } @article {11755, title = {The role of frailty in the association between depression and fall risk among older adults}, journal = {Aging \& Mental Health}, volume = {26}, year = {2022}, pages = {1805-1812}, abstract = {Objectives Although there is a recognized association between depression and greater fall risk among older adults, the mechanisms explaining this association are unclear. This study evaluated the role of frailty, a common geriatric syndrome, in determining greater risk of falls among older adults with depression.Method We used longitudinal data from three biennial waves of the Health and Retirement Study (HRS; 2010?2014). The sample included community-dwelling survey respondents age >= 65 who participated in objective physiological measures. Major Depression (MD) was measured using Composite International Diagnostic Interview for depression short form. Frailty was measured using criteria outlined in the frailty phenotype model. Causal mediation analysis was used to differentiate the direct effect of depression and indirect effect mediated by frailty on falls, fall injuries, and multiple falls.Results Major depression was associated with significantly greater odds of experiencing a fall (OR: 1.91; 95\% CI: 1.31, 2.77), fall injury (OR: 1.86; 95\% CI: 1.17, 2.95), and multiple falls (OR: 2.26; 95\% CI: 1.52, 3.37) over a two-year period. Frailty was a significant mediator of the effects of depression on falls and multiple falls, accounting for approximately 18.9\% and 21.3\% of the total effects, respectively. We found no evidence of depression-frailty interaction. Sensitivity analyses showed that results were robust to unmeasured confounding and alternative operationalizations of depression.Conclusion Frailty explains a significant proportion of increased likelihood of falls among older adults with depression. Treatment and management of frailty symptoms may be an important components of fall prevention among older adults with depression.}, keywords = {Causal mediation analysis, Epidemiology, falls and mobility problems}, isbn = {1360-7863}, doi = {10.1080/13607863.2021.1950616}, author = {Matthew C. Lohman and Briana Mezuk and Amanda J Fairchild and Nicholas V Resciniti and Anwar T Merchant} } @article {11764, title = {The Roles of General and Domain-Specific Perceived Stress in Healthy Aging.}, journal = {The Journals of Gerontology: Series B }, volume = {77}, year = {2022}, pages = {536-549}, abstract = {

OBJECTIVES: Theoretical and empirical evidence suggests the existence of a general perceived stress factor overarching different life domains. The present study investigated the general perceived stress relative to domain-specific perceived stress as predictors of 26 diverse health outcomes, including mental and physical health, health behaviors, cognitive functioning, and physiological indicators of health.

METHOD: A bifactor exploratory structural equational modelling (BiESEM) approach was adopted in two aging samples from the Health and Retirement Study (HRS; N = 8325 in Sample 1, N = 7408 in Sample 2).

RESULTS: Across the two samples, perceived stress was well-represented by a bifactor structure where there was a robust general perceived stress factor representing a general propensity towards stress perception. Meanwhile, after controlling for the general perceived stress factor, specific factors that represent perceived stress in different life domains were still clearly present. Results also suggested age, sex, race, education, personality traits, and past and recent stressor exposure as possible factors underlying individual differences in the general perceived stress factor. The general perceived stress factor was the most robust predictor of the majority of health outcomes, as well as changes in mental health outcomes. The specific factor of perceived neighborhood stress demonstrated incremental predictive effects across different types of health outcomes.

DISCUSSION: The current study provides strong evidence for the existence of a general perceived stress factor that captures variance shared among stress across life domains, and the general perceived stress factor demonstrated substantial prospective predictive effects on diverse health outcomes in older adulthood.

}, keywords = {Aging, Bifactor model, health, Perceived stress}, issn = {1758-5368}, doi = {10.1093/geronb/gbab134}, author = {Luo, Jing and Zhang, Bo and Willroth, Emily C and Daniel K. Mroczek and Brent W Roberts} } @article {11414, title = {Relationships among types of activity engagement and insomnia symptoms among older adults.}, journal = {BMC Geriatrics}, volume = {21}, year = {2021}, pages = {87}, abstract = {

BACKGROUND: An increasing awareness exists that lack of activity engagement is associated with insomnia symptoms. However, the majority of studies have focused on the association between a single type of activity engagement and insomnia symptoms.

METHODS: This is a cross-sectional study using secondary data from the Health and Retirement Study examining the relationships among different types of activity engagement and insomnia symptoms among older adults. The sample for this study included 3321 older adults who responded to survey modules on activity engagement and insomnia symptoms in 2016. Activity engagement was measured using items for three types of activities (i.e., social, cognitive, and physical) validated in this study. Insomnia symptoms were measured using four items (i.e., difficulty of falling asleep, waking up during the night, waking up too early, and feeling rested). Independent t-tests were conducted to identify the differences in insomnia symptoms according to activity engagement level. Regressions were conducted to examine the associations among three types of activity engagement and insomnia symptoms after adjusting for covariates such as demographics, chronic disease, activities of daily living difficulty, cognitive function, sleep disorder, loneliness, and caregiving.

RESULTS: The respondents in the high-level social, cognitive, and physical activity engagement groups were found to show fewer insomnia symptoms. Furthermore, higher social (β = - 0.04, p = 0.040) and cognitive (β = - 0.06, p = 0.007) activity engagements were associated with fewer insomnia symptoms even after adjusting for other types of activity engagement and all covariates.

CONCLUSIONS: This study suggests that older adults with higher social and cognitive activity engagements may be likely to have fewer insomnia symptoms. Based on these results, future research is needed to develop multi-component intervention programs that can encourage older adults to engage in these activities.

}, keywords = {Aged, Exercise, Leisure activities, Sleep}, issn = {1471-2318}, doi = {10.1186/s12877-021-02042-y}, author = {Kim, Da Eun and Roberts, Tonya J and Moon, Chooza} } @article {12622, title = {Is Retirement That Easy? Analyzing the Impact of Financial Rules of Thumb Through the Theory of Planned Behavior.}, journal = {Journal of Personal Finance}, volume = {20}, year = {2021}, pages = {40-56}, abstract = {This study investigates the relationship between sociological characteristics and retiring on time within a sample of 2,129 US individuals over age 50 from the Health and Retirement Study. Sociological factors were operationalized through the theory of planned behavior constructs of attitude, subjective norms, and perceived behavioral control. Results of confirmatory factor analysis (CFA) within a structural equation modeling framework revealed that intention to retire and perceived behavioral control are positively associated with early or on-time retirement. Attitudes and subjective norms, measured by financial rules of thumb, were not related to retirement intent. This study adds to the body of knowledge with a positive association of attitudes and perceived behavioral control on early or on-time retirement while financial rules of thumb alone do not ensure financial success.}, keywords = {attitudes, financial rule of thumb, perceived behavior controls, retirement preparedness}, issn = {15406717}, url = {https://eds.p.ebscohost.com/abstract?site=eds\&scope=site\&jrnl=15406717\&AN=153053325\&h=M89x1V\%2fCfQvlCqYjSd1ndUekwR\%2ffsa218WwKXLDjDemQlm5XCpbh6pTCJ5JdXZ6DLAy7lrgw9DMXcRjDm8HMsQ\%3d\%3d\&crl=c\&resultLocal=ErrCrlNoResults\&resultNs=Ehost\&crlhashurl=login.aspx\%3}, author = {Russell, Matthew and Strong, C Ramel and Krausman, Jody and Lawson, Derek} } @mastersthesis {12148, title = {Role of Custodial Caregiving on Grandmother Well-Being}, year = {2021}, school = {Florida State University }, address = {Tallahassee, FL}, abstract = {The United States Census estimated that there are 2.4 million grandparents in the United States who are the custodial caregivers of a grandchild (US Census Bureau, 2017). The grandparent caregiving role can strain finances, increase the risk of chronic illness, and strain systems of social support (Hayslip et al., 2017). These difficulties place custodial grandparent caregivers at risk for worse outcomes financially, socially, physically and emotionally than their peers (Hayslip et al., 2017). However, custodial care of a grandchild also has the potential to enrich the lives of both the child and custodial grandparent. Many custodial grandparents report finding great fulfillment in their role (Taylor et al., 2018). Quantitative studies have largely focused on the detrimental role of custodial caregiving on grandparent well-being, while recent qualitative work has demonstrated positive implications of the role (Hayslip et al., 2017; Taylor et al., 2018). The research gap in the quantitative study of positive implications for well-being has also been noted in the larger body of family caregiving literature (Marino et al., 2017). Researchers has focused on only one aspect of well-being, negative affect, while ignoring other aspects of well-being such as personal growth and life satisfaction. This study aimed to (1) compare the effects of custodial caregiving on grandparent well-being compared to their peers, (2) understand the role of adaptive traits and resources in moderating these effects, and (3) examine trajectories of grandparent caregiver well-being over time. I used secondary data from the 2010, 2012, and 2014 waves of the Health and Retirement study (HRS). The HRS is a longitudinal study of adults 50 and older that includes multiple measures of psychological well-being that evaluate constructs such as positive affect, life satisfaction and purpose in life. I used cross-sectional data from 2014 to compare well-being of grandparent caregivers and their peers. I included community dwelling female participants who completed the leave behind psychosocial survey. Nursing home residents were excluded from the analysis, and men were excluded to ensure only one case per household. Longitudinal data from 2010, 2012, and 2014 were utilized to compare well-being trajectories of grandmother caregivers based on their time in the role. Grandmothers with complete psychosocial data for at least one wave were included in this analysis. Custodial grandmothers positive affect and life satisfaction were similar to their peers. Custodial caregiving was associated with decreased physical well-being (OR= .58, p<.01), and purpose in life (b=-.19, p<.05), and increased negative affect (b=.14, p<.05). Perceived support buffered the role of caregiving on negative affect, and grandmother caregivers with high levels of perceived support did not experience more negative affect than their peers. The longitudinal analysis did not reveal differences in well-being based on time in the caregiving role. The findings of this study highlight the importance of incorporating positive measures of well-being in the study of custodial caregiving for a more complete understanding of the role of caregiving on well-being. Custodial caregivers{\textquoteright} positive affect and life satisfaction may be an important area of strength and source of resilience that warrants further exploration. Interventions that target social support are likely to improve positive well-being and reduce negative outcomes.}, keywords = {Custodial grandmother, Custodial grandparent, grandchildren caregiving, Grandparents}, url = {https://purl.lib.fsu.edu/diginole/2020_Summer_Fall_Rakes_fsu_0071E_16466}, author = {Rakes, Sarah} } @article {11797, title = {The role of education and income for cognitive functioning in old age: A cross-country comparison.}, journal = {International Journal of Geriatric Psychiatry}, volume = {36}, year = {2021}, pages = {1908-1921}, abstract = {

OBJECTIVES: Previous studies have shown that higher education promotes cognitive health. This effect, however, is embedded in the living conditions of a particular country. Since it is not clear to what extent the country and its specific living standards are necessary preconditions for the observed effect, we investigated whether the impact of education and income on cognitive functioning differs between countries.

METHODS: Analyses were based on harmonized data from the World Health Organization{\textquoteright}s multi-country Study on global AGEing and adult health (WHO SAGE), the Health and Retirement Study (HRS), and the Survey of Health, Ageing and Retirement in Europe (SHARE)) of over 85,000 individuals aged 50 years and older. Analyses were conducted via multivariate regression analyses and structural equation modelling adjusted for age, gender, marital status, health status, and depression.

RESULTS: The effect of education was twice as large as the effect of income on cognitive functioning and indirectly moderated the effect of income on cognitive functioning. The effect sizes varied strongly between countries. The country{\textquoteright}s gross domestic product per capita seems to influence cognitive functioning.

CONCLUSIONS: Our findings indicate that education has a dominant effect on cognitive functioning in people aged 50 years and older, which might even offset the adverse implications of living with low income on cognitive health. Therefore, expanding efforts to achieve universal education are essential to mitigate health disparities due to low income and early life disadvantages, including chances for good cognitive functioning over the life-span. This article is protected by copyright. All rights reserved.

}, keywords = {cognitive functioning, Cognitive Reserve, Cross-country comparison, deprivation, Education, Epidemiology, Income, Life-course, Poverty, SHARE}, issn = {1099-1166}, doi = {10.1002/gps.5613}, author = {Rodriguez, Francisca S and Hofbauer, Lena M and R{\"o}hr, Susanne} } @article {Hurd2020117, title = {Reducing cross-wave variability in survey measures of household wealth}, journal = {Journal of Economic and Social Measurement}, volume = {44}, year = {2020}, note = {cited By 0}, pages = {117-139}, abstract = {Survey measures of household wealth often incorporate measurement error. The resulting excess variability in the first difference in wealth makes meaningful statistical inference difficult on changes in household-level wealth. We study the effects of two methods intended to reduce this problem: Asset verification confronts respondents with large discrepancies between wealth reports from the current wave and from the previous wave. Cross-wave imputation uses adjacent wave information in the imputation procedures for missing data. In the U.S. Health and Retirement Study, the corrections from asset verification substantially reduced wave-To-wave changes in wealth. The cross-wave imputations also reduced variation, but to a lesser extent. {\textcopyright} 2019-IOS Press and the authors. All rights reserved.}, keywords = {household income, Panel data, social structure, survey design, United States}, issn = {07479662}, doi = {10.3233/JEM-190465}, author = {Michael D Hurd and Erik Meijer and Moldoff, Michael and Susann Rohwedder} } @article {11294, title = {Relationships Among Types of Activity Engagement and Sleep Quality Among Older Adults}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {429}, abstract = {There is increasing awareness that lack of activity engagement is associated with poor sleep quality. However, the majority of studies have focused on the effect of a single type of activity engagement on sleep quality. Little is known about the combined effect of multiple types of activity engagement on sleep quality. The aim of this study is to identify relationships among different types of activity engagement and sleep quality among older adults. This study is a secondary data analysis using the Health and Retirement Study data. The participants included 3,357 persons who were age 65 or older and who responded to survey modules on activity engagement and sleep quality in 2016. Before we conducted primary analysis, factor analyses and calculating coefficient omega were conducted to identify factor structure, construct validity and reliability of the activity engagement questionnaire. Then, regression was conducted to examine the relationships among multiple types of activity engagement and sleep quality after adjusting for covariates based on the senescent sleep model. Exploratory and confirmatory factor analysis showed the 14-item questionnaire was comprised of three factors; social, cognitive, and physical activity and the three-factor model showed adequate validity and reliability. In the regression model social (β=0.25, p=0.033) and cognitive (β=0.36, p=0.001) activity engagement were positively related to better sleep quality. Based on these results, future research is needed to identify the mechanisms in which social and cognitive activities influence sleep quality positively and to develop targeted activity interventions for older adults.}, keywords = {activity, sleep quality}, isbn = {2399-5300}, doi = {10.1093/geroni/igaa057.1385}, author = {Kim, Da Eun and Roberts, Tonya} } @article {doi:10.1111/jgs.16414, title = {Residential Setting and the Cumulative Financial Burden of Dementia in the 7 Years Before Death}, journal = {Journal of the American Geriatrics Society}, year = {2020}, type = {Journal}, abstract = {OBJECTIVES Care for older adults with dementia during the final years of life is costly, and families shoulder much of this burden. We aimed to assess the financial burden of care for those with and without dementia, and to explore differences across residential settings. DESIGN Using the Health and Retirement Study (HRS) and linked claims, we examined total healthcare spending and proportion by payer{\textemdash}Medicare, Medicaid, out-of-pocket, and calculated costs of informal caregiving{\textemdash}over the last 7 years of life, comparing those with and without dementia and stratifying by residential setting. SETTING The HRS is a nationally representative longitudinal study of older adults in the United States. PARTICIPANTS We sampled HRS decedents from 2004 to 2015. To ensure complete data, we limited the sample to those 72 years or older at death who had continuous fee-for-service Medicare Parts A and B coverage during the 7-year period (n = 2909). MEASUREMENTS We compared decedents with dementia at last HRS assessment with those without dementia across annual and cumulative 7-year spending measures, and personal characteristics. We present annual and cumulative spending by payer, and the changing proportion of spending by payer over time, comparing those with and without dementia and stratifying results by residential setting. RESULTS We found that, consistent with prior studies, people with dementia experience significantly higher costs, with a disproportionate share falling on patients and families. This pattern is most striking among community residents with dementia, whose families shoulder 64\% of total expenditures (including \$176,180 informal caregiving costs and \$55,550 out-of-pocket costs), compared with 43\% for people with dementia residing in nursing homes (\$60,320 informal caregiving costs and \$105,590 out-of-pocket costs). CONCLUSION These findings demonstrate disparities in financial burden shouldered by families of those with dementia, particularly among those residing in the community. They highlight the importance of considering the residential setting in research, programs, and policies.}, keywords = {community-dwelling older adults, Dementia, health-related costs, Medicare and Medicaid, nursing home}, doi = {10.1111/jgs.16414}, url = {https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16414}, author = {Amy Kelley and Kathleen McGarry and Bollens-Lund, Evan and Rahman, Omari-Khalid and Husain, Mohammed and Ferreira, Katelyn B. and Jonathan S Skinner} } @mastersthesis {10974, title = {Retirement Wealth Inequality: A Critical and Institutional Review}, volume = {Doctor of Philosophy}, year = {2020}, school = {The New School}, address = {New York City}, abstract = {This dissertation presents an institutional analysis of wealth accumulation processes of United States working-class households as the main determinant of inequality in living standards at older ages. The first chapter describes why retirement wealth inequality matters and how it should be measured in an institutional framework. I describethe pattern of wealth accumulation among different socioeconomic groups and the importance of retirement wealth, both as a share of household wealth and as the main source of income and determinant of living standards at older ages. I argue for separate analysis of retirement wealth from other components of household wealth (home equity and nonretirement financial wealth) due to its different functions, and the institutions of wealth accumulation and consumption formed around these functions. The second chapter discusses the measurement of retirement wealth inequality and the methodological challenges it raises. I identify the technical and methodological issues regarding the availability and accuracy of data, which can undermine the results of previous studies on similar or related topics. I suggest and utilize a method for correcting inaccuracies in self-reported survey data from the Health and Retirement Study (HRS) with linked administrative data on retirement plans and earnings. I use the adjusted data to calculate retirement wealth inequality among employees {\textendash} ages 51 to 56 {\textendash} in years 1992, 1998, 2004, and 2010. I find that retirement wealth has historically been distributed unequally and that low-income workers were in even worse-off at the end of the period of study than at the beginning, even though the overall change in some measures of retirement wealth inequality may seem insignificant. In the third chapter, using data from two consecutive waves of the Survey of Income and Program Participation (SIPP) in 2011 and 2012, I showcase the socioeconomic disparities in facing economic shocks and the disparate effects of such shocks on retirement wealth accumulation in defined contribution (DC) plans. Compared to high income workers, low income workers are more exposed to adverse economic shocks. They are also more likely to withdraw their retirement savings after facing such shocks, possibly due to a lack of other emergency funds. The results demonstrate how socioeconomic status and institutional factors can affect retirement wealth accumulation processes beyond that which can be explained through their effects on wage distributions.}, keywords = {Earnings, Inequality, Retirement wealth, SIPP}, url = {https://search.proquest.com/openview/a53a1fc8571fab46def49c2dd7ece8d2/1?pq-origsite=gscholar\&cbl=18750\&diss=y}, author = {Siavash Radpour} } @article {9364, title = {The race paradox in subjective wellbeing among older Americans}, journal = {Ageing and Society}, volume = {39}, year = {2019}, pages = {568-589}, abstract = {This study aims to assess racial differences in subjective wellbeing (SWB) and to examine whether the pathways of social support and social engagement to SWB vary by racial groups in the United States of America. Using a local sample (N = 1,035) and a nationally representative sample of the Health and Retirement Study (N = 7,718), we compared life satisfaction and happiness between non-Hispanic Whites and Blacks aged 55 and over. We evaluated the extent to which race, other socio-demographic characteristics, health, social engagement and social support explained the variances in SWB and examined the moderation effects of race on the relationships of SWB with age, social support and social engagement. Multiple regression analyses showed that non-Hispanic Blacks were at least as satisfied as, and even happier than White peers, after equalising social resources and health variables. Social support was significantly related to SWB, and it seemed that positive support was more important to Whites than to Blacks in predicting life satisfaction. In addition, the racial crossover effect existed, that is, the old-old (80+) Blacks were happier than their White peers. Findings indicate a national trend of the race paradox in SWB and underscore the importance of social support in promoting older adults{\textquoteright} wellbeing. Future research is recommended to investigate other potential mechanisms among Black older Americans to explain their relatively better SWB.}, keywords = {Happiness, Racial/ethnic differences, Social Support, Well-being}, issn = {0144-686X}, doi = {10.1017/S0144686X17001064}, url = {https://www.cambridge.org/core/product/identifier/S0144686X17001064/type/journal_articlehttps://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0144686X17001064}, author = {Tang, Fengyan and Heejung Jang and Mary Beth Rauktis and Donald Musa and Scott Beach} } @article {9944, title = {Racial disparities in eligibility for low-dose computed tomography lung cancer screening among older adults with a history of smoking.}, journal = {Cancer Causes \& Control}, volume = {30}, year = {2019}, pages = {235-240}, abstract = {

PURPOSE: Lung cancer early detection screening has been demonstrated to decrease lung cancer mortality among high-risk smokers. This study aimed to examine whether current screening guidelines may disproportionately exclude African American smokers who are at higher overall risk for lung cancer.

METHODS: Data from the 2014 Health and Retirement Study were analyzed. Older African Americans and Whites with a history of smoking were included in the analyses (n = 7,348). Eligibility criteria established by the U.S. Preventive Services Task Force (USPSTF) for LDCT lung cancer screening were used. Multivariate logistic regression analyses were conducted to examine racial differences in eligibility for LDCT lung cancer screening.

RESULTS: Overall, 21.1\% of current and 10.5\% of former smokers met USPSTF{\textquoteright}s eligibility criteria for LDCT screening. In multivariate logistic regression analyses, African American smokers were less likely to be eligible for LDCT lung cancer screening compared to Whites (odds ratio = 0.5; p < 0.001).

CONCLUSION: African American smokers were less likely to meet established lung cancer screening eligibility criteria compared to Whites. Current lung cancer screening criteria may not adequately capture African Americans at risk and may widen the health disparities in African Americans. Further longitudinal studies are needed to evaluate the efficacy of current lung cancer screening guideline.

}, keywords = {Cancer, Cancer screenings, Racial/ethnic differences, Smoking}, issn = {1573-7225}, doi = {10.1007/s10552-018-1092-2}, author = {Li, Chien-Ching and Alicia K Matthews and Mantle M Rywant and Hallgren, Emily and Raj C Shah} } @article {10427, title = {Recession vs Policy Shock: 2008, Medicare Part D \& Grandparent Childcare}, year = {2019}, pages = {48}, abstract = {Many studies have found grandparent provided childcare (GPCC) is of higher quality on average than center-based care, and that the availability of childcare itself increases the labor foce participation rates of women. This has led to this investigation into the influence of income and wealth on the supply of GPCC. Using restricted-use data from the Health and Retirement Survey, this investigation focuses on labor income, household wealth, age, health factors, family size, and period dummies to understand how the 2008 recession affected GPCC provision. This study is the first of its kind to include state fixed-effects and to focus on the 2008 recession. Results suggest that there is no difference between the recession and recovery periods themselves but that work income and wealth are significant predictors with small magnitude. Sub-sample regressions run by sex and coupled status suggest that work income influences female GPCC decisions more than male and coupled respondents more than single. This finding suggests that socially constructed systems of constraint may be present in the decision making studied. Finally, using an inverseprobability weighted regression adjusted estimator, the effect of Medicare Part D on providing any GPCC is tested. Limits to the data leaves the effect ambiguous but suggests confirmation of the fixed-effects model. }, keywords = {Economics, Medicare, Medicare Part D, Recession}, url = {http://www.essentiallyeconomics.com/wp-content/uploads/2019/05/Job-Market-Paper.pdf}, author = {Michael Ewing Roberts} } @article {11138, title = {Reciprocal Effects Between Loneliness and Sleep Disturbance in Older Americans.}, journal = {Journal of Aging and Health}, year = {2019}, abstract = {

To model the relationship between loneliness and sleep disturbance over time. : Data came from the Health and Retirement Study (2006, 2010, 2014 waves; age >= 65 years; = 5,067). Loneliness was measured via the Hughes Loneliness Scale and sleep disturbance via a four-item scale assessing sleep and restedness. Cross-lagged panel modeling (path analysis) was used to jointly examine reciprocal effects between loneliness and sleep disturbance. : Higher loneliness correlated with higher sleep disturbance at baseline. There was evidence of reciprocal effects between loneliness and sleep across timepoints. These associations overall remained when accounting for demographics, objective isolation, and depression. : Although causality cannot be established, the findings indicate that the relationship between loneliness and sleep disturbance is bidirectional. This requires revision to the current theory on sleep disturbance as a mechanism for the relationship between loneliness and health and indicates that effective treatment of sleep disturbance may reduce loneliness.

}, keywords = {health, insomnia, Loneliness, Older Adults, Sleep}, issn = {1552-6887}, doi = {10.1177/0898264319894486}, author = {Sarah C. Griffin and Williams, Allison Baylor and Samantha N Mladen and Paul B. Perrin and Joseph M. Dzierzewski and Bruce D. Rybarczyk} } @article {9908, title = {The relationship between lifetime out-of-pocket medical expenditures, dementia, and socioeconomic status in the U.S}, journal = {The Journal of the Economics of Ageing}, volume = {14}, year = {2019}, pages = {100181}, type = {Journal}, abstract = {Dementia is one of the most expensive medical conditions. The costs are borne by families, by private insurance and by society via public programs such as Medicaid in the U.S.. There is extensive research on the relationship between dementia and annual medical spending. This paper, instead, estimates cumulative lifetime medical expenditures that can be attributed to the onset of dementia using a nationally representative longitudinal survey from the U.S., the Health and Retirement Study. The lifetime expenditures are estimated by summing any out-of-pocket medical spending reported in the panel from age 65 to death. Censored cases are imputed using a non-parametric matching algorithm called splicing. For example, survivors to the most recent wave are matched to similar individuals from older cohorts who are observed at the relevant ages all the way through death. We find that those who live with dementia for at least half a year pay, on average, $38,540 more out of pocket from age 65 to death when controlling for length of life, demographics, lifetime earnings and comorbidities. The costs of dementia are almost exclusively due to spending on nursing homes. Spending on drugs, doctor visits or hospitals, is not significantly related to dementia. The lifetime costs of dementia are significantly larger for white and rich individuals, perhaps because they use higher quality nursing homes and because they have more financial resources to spend down before becoming eligible for Medicaid support.}, keywords = {Cognitive Ability, Dementia, Medical Expenses, Out-of-pocket payments, Socioeconomic factors}, issn = {2212828X}, doi = {10.1016/j.jeoa.2018.11.006}, url = {https://www.sciencedirect.com/science/article/pii/S2212828X18300690}, author = {P{\'e}ter Hudomiet and Michael D Hurd and Susann Rohwedder} } @article {10090, title = {Retiring earlier than planned: What matters most?}, number = {IB$\#$19-3}, year = {2019}, institution = {Center for Retirement Research at Boston College}, address = {Newton, MA}, abstract = {The brief{\textquoteright}s key findings are: More than a third of older workers retire earlier than planned: the question is why? This study looks at: 1) the impact of unexpected changes in health, employment, family, and finances on early retirement; and 2) the prevalence of these shocks.The findings suggest that: Health shocks play the largest role, mainly because they are widespread.Job loss without finding a new job, while not as prevalent, is also important. Family transitions have a modest impact, while financial shocks appear to have little effect. A key caveat is that all the shocks combined explain only about a quarter of earlier-than-planned retirements, so clearly other factors are also at play.}, keywords = {Health Shocks, Retirement Planning \& Satisfaction, Wealth Shocks}, url = {https://crr.bc.edu/briefs/retiring-earlier-than-planned-what-matters-most/}, author = {Alicia H. Munnell and Matthew S. Rutledge and Geoffrey T. Sanzenbacher} } @article {doi:10.1002/sim.8423, title = {Robust estimation of the causal effect of time-varying neighborhood factors on health outcomes}, journal = {Statistics in Medicine}, volume = {n/a}, year = {2019}, abstract = {The fundamental difficulty of establishing causal relationships between an exposure and an outcome in observational data involves disentangling causality from confounding factors. This problem underlies much of neighborhoods research, which abounds with studies that consider associations between neighborhood characteristics and health outcomes in longitudinal data. Such analyses are confounded by selection issues; individuals with above average health outcomes (or associated characteristics) may self-select into advantaged neighborhoods. Techniques commonly used to assess causal inferences in observational longitudinal data, such as inverse probability of treatment weighting (IPTW), may be inappropriate in neighborhoods data due to unique characteristics of such data. We advance the IPTW toolkit by introducing a procedure based on a multivariate kernel density function which is more appropriate for neighborhoods data. The proposed weighting method is applied in conjunction with a marginal structural model. Our empirical analyses use longitudinal data from the Health and Retirement Study; our exposure of interest is an index of neighborhood socioeconomic status (NSES), and we examine its influence on cognitive function. Our findings illustrate the importance of the choice of method for IPTW{\textemdash}the comparison weighting methods provide poor balance across the set of covariates (which is not the case for our preferred procedure) and yield misleading results when applied in the outcomes models. The utility of the multivariate kernel is also validated via simulation. In addition, our findings emphasize the importance of IPTW{\textemdash}controlling for covariates within a regression without IPTW indicates that NSES affects cognition, whereas IPTW-weighted models fail to show a statistically significant effect.}, keywords = {Causality, doubly robust, inverse probability of treatment weighting, kernel density, longitudinal, neighborhood}, doi = {10.1002/sim.8423}, url = {https://onlinelibrary.wiley.com/doi/abs/10.1002/sim.8423}, author = {Robbins, Michael W. and Griffin, Beth Ann and Regina A Shih and Mary E Slaughter} } @article {9359, title = {Racial/Ethnic and Nativity Differences in Cognitive Life Expectancies Among Older Adults in the United States.}, journal = {Gerontologist}, volume = {38}, year = {2018}, pages = {155-168}, abstract = {

Background and Objectives: To document racial/ethnic and nativity differences by gender in cognitive life expectancies among older adults in the United States.

Research Design and Methods: Sullivan-based life tables were used to estimate cognitively normal, cognitively impaired/no dementia (CIND), and dementia life expectancies by gender for White, Black, U.S.-born Hispanic, and foreign-born Hispanic adults 50 years and older in the Health and Retirement Study.

Results: Among women, the number of years spent living with dementia for Whites, Blacks, U.S.-born Hispanics, and foreign-born Hispanics was 1.6, 3.9, 4.7, and 6.0 years, respectively. For men, Whites lived 1.1 years with dementia compared to 3.1 years for Blacks, 3.0 years for U.S.-born Hispanics and 3.2 years for foreign-born Hispanics. Similar patterns were observed for race/ethnic and nativity differences in CIND life expectancies. Blacks and Hispanics spend a larger fraction of their remaining years with CIND and dementia relative to Whites, regardless of gender. Foreign-born Hispanic men and women and Black men are particularly disadvantaged in the proportion of years spent after age 50 with CIND and/or dementia.

Discussion and Implications: Disparities in cognitive life expectancies indicate that intervention strategies should target the specific needs of minority and immigrant older adults with dementia. Given that education is a strong predictor of cognitive health, improving access to the social and economic resources that delay dementia onset is key to improving the well-being of diverse older adults.

}, keywords = {Cognitive Ability, Dementia, Mortality, Racial/ethnic differences}, issn = {1758-5341}, doi = {10.1093/geront/gnx142}, author = {Marc Garcia and Brian Downer and Chi-Tsun Chiu and Joseph L Saenz and Rote, Sunshine and Rebeca Wong} } @article {9361, title = {The Relation of Volunteering and Subsequent Changes in Physical Disability in Older Adults.}, journal = {Journals of Gerontology Series B: Psychological Sciences \& Social Sciences}, volume = {73}, year = {2018}, pages = {511-521}, abstract = {

Objectives: To describe the association between initiating volunteering and changes in physical disability in older adults, and whether intensity and gender modify this relationship.

Methods: Employing propensity score weighted regression adjustment, we calculate changes in disability using a sample of U.S. adults (n = 7,135) in the Health and Retirement Study (1996-2012) not volunteering at baseline but later initiating volunteering (1-99 hr/year or 100+ hours per year) or remaining a nonvolunteer.

Results: Relative to continuous nonvolunteers, low-intensity volunteering is related to 34\% lower disability in the low-intensity group (average treatment effect [ATE] = -0.12) and 63\% lower in the higher-intensity group (ATE = -0.23). For men, progression was lower only in the highest intensity group (ATE = +0.02), but women experienced similarly less progression of disability (38\%-39\%) at either level of new engagement (ATE = -0.17 and -0.18).

Discussion: Initiating a new volunteer role in later life is related to decreased progression of disability, at low or high levels for women and only at higher levels for men. This study suggests that volunteer intervention programs may represent a major public health strategy to delay the progression of physical disability for older adults.

}, keywords = {Disabilities, Health Conditions and Status, Volunteerism}, issn = {1758-5368}, doi = {10.1093/geronb/gbx102}, author = {Dawn C Carr and Ben Lennox Kail and John W Rowe} } @article {9639, title = {Relationship Between Expectation of Death and Location of Death Varies by Race/Ethnicity.}, journal = {American Journal of Hospital Palliative Care}, year = {2018}, abstract = {

BACKGROUND: Older black and Latino Americans are more likely than white Americans to die in the hospital. Whether ethnic differences in expectation of death account for this disparity is unknown.

OBJECTIVES: To determine whether surviving family members{\textquoteright} expectation of death has a differential association with site of death according to race or ethnicity.

METHODS: We conducted an analysis of decedents from the Health and Retirement Study, a nationally representative study of US older adults. Telephone surveys were conducted with family members for 5979 decedents (decedents were 55\% were women, 85\% white, 9\% black, and 6\% Latino). The outcome of interest was death in the hospital; the predictor variable was race/ethnicity, and the intervening variable was expectation of death. Covariates included sociodemographics (gender, age, household net worth, educational attainment level, religion) and health factors (chronic conditions, symptoms, health-care utilization).

RESULTS: Decedents{\textquoteright} race/ethnicity was statistically related to the expectation of death and death in the hospital. When death was not expected, whites and Latinos were more likely to die in the hospital than when death was expected (49\% vs 29\% for whites and 55\% vs 37\% for Latinos; P < .001). There was no difference in site of death according to family{\textquoteright}s expectation of death among blacks.

CONCLUSION: Expectation of death did not fully account for site of death and played a greater role among whites and Latinos than among black Americans. Discussing prognosis by itself is unlikely to address ethnic disparities. Other factors appear to play an important role as well.

}, keywords = {End of life decisions, Mortality, Racial/ethnic differences, Subjective Expectations}, issn = {1938-2715}, doi = {10.1177/1049909118773989}, author = {Rafael D Romo and Irena Cenzer and Brie A Williams and Alexander K Smith} } @article {8886, title = {Rare and low-frequency coding variants alter human adult height.}, journal = {Nature}, volume = {542}, year = {2017}, month = {2017 Feb 09}, pages = {186-190}, abstract = {

Height is a highly heritable, classic polygenic trait with approximately 700 common associated variants identified through genome-wide association studies so far. Here, we report 83 height-associated coding variants with lower minor-allele frequencies (in the range of 0.1-4.8\%) and effects of up to 2 centimetres per allele (such as those in IHH, STC2, AR and CRISPLD2), greater than ten times the average effect of common variants. In functional follow-up studies, rare height-increasing alleles of STC2 (giving an increase of 1-2 centimetres per allele) compromised proteolytic inhibition of PAPP-A and increased cleavage of IGFBP-4 in vitro, resulting in higher bioavailability of insulin-like growth factors. These 83 height-associated variants overlap genes that are mutated in monogenic growth disorders and highlight new biological candidates (such as ADAMTS3, IL11RA and NOX4) and pathways (such as proteoglycan and glycosaminoglycan synthesis) involved in growth. Our results demonstrate that sufficiently large sample sizes can uncover rare and low-frequency variants of moderate-to-large effect associated with polygenic human phenotypes, and that these variants implicate relevant genes and pathways.

}, issn = {1476-4687}, doi = {10.1038/nature21039}, author = {Marouli, Eirini and Graff, Mariaelisa and Medina-Gomez, Carolina and Ken Sin Lo and Andrew R Wood and Kjaer, Troels R and Fine, Rebecca S and Lu, Yingchang and Schurmann, Claudia and Highland, Heather M and R{\"u}eger, Sina and Thorleifsson, Gudmar and Justice, Anne E and Lamparter, David and Kathleen E Stirrups and Turcot, Val{\'e}rie and Young, Kristin L and Thomas W Winkler and T{\~o}nu Esko and Karaderi, Tugce and Locke, Adam E and Masca, Nicholas G D and Ng, Maggie C Y and Mudgal, Poorva and Rivas, Manuel A and Vedantam, Sailaja and Mahajan, Anubha and Guo, Xiuqing and Gon{\c c}alo R Abecasis and Aben, Katja K and Adair, Linda S and Alam, Dewan S and Albrecht, Eva and Allin, Kristine H and Matthew A. Allison and Amouyel, Philippe and Appel, Emil V and Arveiler, Dominique and Asselbergs, Folkert W and Auer, Paul L and Balkau, Beverley and Banas, Bernhard and Bang, Lia E and Benn, Marianne and Bergmann, Sven and Bielak, Lawrence F and Bl{\"u}her, Matthias and Boeing, Heiner and Boerwinkle, Eric and B{\"o}ger, Carsten A and Bonnycastle, Lori L and Bork-Jensen, Jette and Bots, Michiel L and Erwin P Bottinger and Bowden, Donald W and Brandslund, Ivan and Breen, Gerome and Brilliant, Murray H and Broer, Linda and Burt, Amber A and Adam S Butterworth and Carey, David J and Caulfield, Mark J and Chambers, John C and Daniel I Chasman and Yii-Der I Chen and Chowdhury, Rajiv and Cramer Christensen and Chu, Audrey Y and Cocca, Massimiliano and Collins, Francis S and Cook, James P and Corley, Janie and Jordi Corominas Galbany and Cox, Amanda J and Cuellar-Partida, Gabriel and Danesh, John and Gail Davies and de Bakker, Paul I W and de Borst, Gert J and de Denus, Simon and de Groot, Mark C H and de Mutsert, Ren{\'e}e and Ian J Deary and George Dedoussis and Ellen W Demerath and Anneke I den Hollander and Joe G Dennis and Di Angelantonio, Emanuele and Drenos, Fotios and Du, Mengmeng and Dunning, Alison M and Easton, Douglas F and Ebeling, Tapani and Edwards, Todd L and Ellinor, Patrick T and Elliott, Paul and Evangelou, Evangelos and Farmaki, Aliki-Eleni and Jessica Faul and Feitosa, Mary F and Feng, Shuang and Ferrannini, Ele and Marco M Ferrario and Ferri{\`e}res, Jean and Florez, Jose C and Ford, Ian and Myriam Fornage and Franks, Paul W and Frikke-Schmidt, Ruth and Galesloot, Tessel E and Gan, Wei and Gandin, Ilaria and Paolo P. Gasparini and Giedraitis, Vilmantas and Giri, Ayush and Giorgia G Girotto and Gordon, Scott D and Gordon-Larsen, Penny and Gorski, Mathias and Grarup, Niels and Grove, Megan L and Gudnason, Vilmundur and Gustafsson, Stefan and Hansen, Torben and Kathleen Mullan Harris and Tamara B Harris and Andrew T Hattersley and Caroline Hayward and He, Liang and Iris M Heid and Heikkil{\"a}, Kauko and Helgeland, {\O}yvind and Hernesniemi, Jussi and Hewitt, Alex W and Lynne J Hocking and Hollensted, Mette and Oddgeir L Holmen and Hovingh, G Kees and Howson, Joanna M M and Hoyng, Carel B and Huang, Paul L and Hveem, Kristian and Mohammed Arfan Ikram and Ingelsson, Erik and Jackson, Anne U and Jansson, Jan-H{\r a}kan and Jarvik, Gail P and Jensen, Gorm B and Jhun, Min A and Jia, Yucheng and Jiang, Xuejuan and Johansson, Stefan and J{\o}rgensen, Marit E and J{\o}rgensen, Torben and Jousilahti, Pekka and Jukema, J Wouter and Kahali, Bratati and Kahn, Ren{\'e} S and K{\"a}h{\"o}nen, Mika and Kamstrup, Pia R and Kanoni, Stavroula and Kaprio, Jaakko and Karaleftheri, Maria and Sharon L R Kardia and Karpe, Fredrik and Kee, Frank and Keeman, Renske and Lambertus A Kiemeney and Kitajima, Hidetoshi and Kluivers, Kirsten B and Kocher, Thomas and Komulainen, Pirjo and Kontto, Jukka and Kooner, Jaspal S and Charles Kooperberg and Kovacs, Peter and Kriebel, Jennifer and Kuivaniemi, Helena and K{\"u}ry, S{\'e}bastien and Kuusisto, Johanna and La Bianca, Martina and Laakso, Markku and Lakka, Timo A and Lange, Ethan M and Leslie A Lange and Langefeld, Carl D and Langenberg, Claudia and Eric B Larson and Lee, I-Te and Lehtim{\"a}ki, Terho and Lewis, Cora E and Li, Huaixing and Li, Jin and Li-Gao, Ruifang and Lin, Honghuang and Lin, Li-An and Lin, Xu and Lars Lind and Lindstr{\"o}m, Jaana and Linneberg, Allan and Liu, Yeheng and Yongmei Liu and Lophatananon, Artitaya and Luan, Jian{\textquoteright}an and Lubitz, Steven A and Lyytik{\"a}inen, Leo-Pekka and Mackey, David A and Pamela A F Madden and Alisa Manning and M{\"a}nnist{\"o}, Satu and Marenne, Ga{\"e}lle and Marten, Jonathan and Nicholas G Martin and Mazul, Angela L and Meidtner, Karina and Andres Metspalu and Mitchell, Paul and Mohlke, Karen L and Dennis O Mook-Kanamori and Morgan, Anna and Morris, Andrew D and Morris, Andrew P and M{\"u}ller-Nurasyid, Martina and Munroe, Patricia B and Michael A Nalls and Nauck, Matthias and Nelson, Christopher P and Neville, Matt and Sune Fallgaard Nielsen and Nikus, Kjell and Nj{\o}lstad, P{\r a}l R and B{\o}rge G Nordestgaard and Ntalla, Ioanna and Jeff O{\textquoteright}Connell and Oksa, Heikki and Loes M Olde Loohuis and Ophoff, Roel A and Owen, Katharine R and Packard, Chris J and Padmanabhan, Sandosh and Palmer, Colin N A and Pasterkamp, Gerard and Patel, Aniruddh P and Pattie, Alison and Pedersen, Oluf and Peissig, Peggy L and Peloso, Gina M and Pennell, Craig E and Markus Perola and Perry, James A and Perry, John R B and Person, Thomas N and Pirie, Ailith and Polasek, Ozren and Posthuma, Danielle and Olli T Raitakari and Rasheed, Asif and Rauramaa, Rainer and Reilly, Dermot F and Reiner, Alex P and Renstrom, Frida and Ridker, Paul M and Rioux, John D and Neil R Robertson and Robino, Antonietta and Rolandsson, Olov and Rudan, Igor and Ruth, Katherine S and Saleheen, Danish and Veikko Salomaa and Nilesh J Samani and Sandow, Kevin and Sapkota, Yadav and Sattar, Naveed and Schmidt, Marjanka K and Schreiner, Pamela J and Schulze, Matthias B and Scott, Robert A and Segura-Lepe, Marcelo P and Svati H Shah and Sim, Xueling and Sivapalaratnam, Suthesh and Small, Kerrin S and Albert Vernon Smith and Jennifer A Smith and Southam, Lorraine and Timothy Spector and Elizabeth K Speliotes and John M Starr and Steinthorsdottir, Valgerdur and Heather M Stringham and Stumvoll, Michael and Surendran, Praveen and {\textquoteright}t Hart, Leen M and Tansey, Katherine E and Tardif, Jean-Claude and Kent D Taylor and Teumer, Alexander and Thompson, Deborah J and Thorsteinsdottir, Unnur and Thuesen, Betina H and T{\"o}njes, Anke and Tromp, Gerard and Trompet, Stella and Tsafantakis, Emmanouil and Tuomilehto, Jaakko and Tybjaerg-Hansen, Anne and Tyrer, Jonathan P and Uher, Rudolf and Andr{\'e} G Uitterlinden and Ulivi, Sheila and van der Laan, Sander W and Van Der Leij, Andries R and Cornelia M van Duijn and van Schoor, Natasja M and van Setten, Jessica and Varbo, Anette and Varga, Tibor V and Varma, Rohit and Digna R Velez Edwards and Vermeulen, Sita H and Vestergaard, Henrik and Vitart, Veronique and Vogt, Thomas F and Vozzi, Diego and Walker, Mark and Wang, Feijie and Wang, Carol A and Wang, Shuai and Wang, Yiqin and Wareham, Nicholas J and Warren, Helen R and Wessel, Jennifer and Willems, Sara M and Wilson, James G and Daniel Witte and Woods, Michael O and Wu, Ying and Yaghootkar, Hanieh and Yao, Jie and Yao, Pang and Laura M Yerges-Armstrong and Young, Robin and Zeggini, Eleftheria and Zhan, Xiaowei and Zhang, Weihua and Jing Hua Zhao and Wei Zhao and Wei Zhao and Zheng, He and Zhou, Wei and Rotter, Jerome I and Boehnke, Michael and Kathiresan, Sekar and McCarthy, Mark I and Willer, Cristen J and Stefansson, Kari and Ingrid B Borecki and Liu, Dajiang J and Kari E North and Heard-Costa, Nancy L and Pers, Tune H and Lindgren, Cecilia M and Oxvig, Claus and Kutalik, Zolt{\'a}n and Fernando Rivadeneira and Ruth J F Loos and Timothy M Frayling and Joel N Hirschhron and Deloukas, Panos and Lettre, Guillaume} } @article {12137, title = {Rare variants in fox-1 homolog A (RBFOX1) are associated with lower blood pressure.}, journal = {PLoS Genetics}, volume = {13}, year = {2017}, pages = {e1006678}, abstract = {

Many large genome-wide association studies (GWAS) have identified common blood pressure (BP) variants. However, most of the identified BP variants do not overlap with the linkage evidence observed from family studies. We thus hypothesize that multiple rare variants contribute to the observed linkage evidence. We performed linkage analysis using 517 individuals in 130 European families from the Cleveland Family Study (CFS) who have been genotyped on the Illumina OmniExpress Exome array. The largest linkage peak was observed on chromosome 16p13 (MLOD = 2.81) for systolic blood pressure (SBP). Follow-up conditional linkage and association analyses in the linkage region identified multiple rare, coding variants in RBFOX1 associated with reduced SBP. In a 17-member CFS family, carriers of the missense variant rs149974858 are normotensive despite being obese (average BMI = 60 kg/m2). Gene-based association test of rare variants using SKAT-O showed significant association with SBP (p-value = 0.00403) and DBP (p-value = 0.0258) in the CFS participants and the association was replicated in large independent replication studies (N = 57,234, p-value = 0.013 for SBP, 0.0023 for PP). RBFOX1 is expressed in brain tissues, the atrial appendage and left ventricle in the heart, and in skeletal muscle tissues, organs/tissues which are potentially related to blood pressure. Our study showed that associations of rare variants could be efficiently detected using family information.

}, keywords = {Adult, Blood pressure, Body Mass Index, Chromosomes, Human, Pair 16, Family Health, Female, Gene Expression, Gene Frequency, Genetic Linkage, Genetic Predisposition to Disease, Genome-Wide Association Study, Genotype, Humans, Male, Middle Aged, Pedigree, Polymorphism, Single Nucleotide, RNA Splicing Factors, Whites}, issn = {1553-7404}, doi = {10.1371/journal.pgen.1006678}, author = {He, Karen Y and Wang, Heming and Brian E Cade and Nandakumar, Priyanka and Giri, Ayush and Erin B Ware and Jeffrey Haessler and Liang, Jingjing and Smith, Jennifer A and Franceschini, Nora and Le, Thu H and Charles Kooperberg and Edwards, Todd L and Sharon L R Kardia and Lin, Xihong and Chakravarti, Aravinda and Redline, Susan and Zhu, Xiaofeng} } @article {8678, title = {Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study.}, journal = {J Gen Intern Med}, volume = {32}, year = {2017}, month = {2017 Feb}, pages = {153-158}, abstract = {

BACKGROUND: Knowledge about expected recovery after hip fracture is essential to help patients and families set realistic expectations and plan for the future.

OBJECTIVES: To determine rates of functional recovery in older adults who sustained a hip fracture based on one{\textquoteright}s previous function.

DESIGN: Observational study.

PARTICIPANTS: We identified subjects who sustained a hip fracture while enrolled in the nationally representative Health and Retirement Study (HRS) using linked Medicare claims. HRS interviews subjects every 2~years. Using information from interviews collected during the interview preceding the fracture and the first interview 6 or more months after the fracture, we determined the proportion of subjects who returned to pre-fracture function.

MAIN MEASURES: Functional outcomes of interest were: (1) ADL dependency, (2) mobility, and (3) stair-climbing ability. We examined baseline characteristics associated with a return to: (1) ADL independence, (2) walking one block, and (3) climbing a flight of stairs.

KEY RESULTS: A total of 733 HRS subjects >=65~years of age sustained a hip fracture (mean age 84 {\textpm} 7~years, 77~\% female). Thirty-one percent returned to pre-fracture ADL function, 34~\% to pre-fracture mobility function, and 41~\% to pre-fracture climbing function. Among those who were ADL independent prior to fracture, 36~\% returned to independence, 27~\% survived but needed ADL assistance, and 37~\% died. Return to ADL independence was less likely for those >=85~years old (26~\% vs. 44~\%), with dementia (8~\% vs. 39~\%), and with a Charlson comorbidity score >2 (23~\% vs. 44~\%). Results were similar for those able to walk a block and for those able to climb a flight of stairs prior to fracture.

CONCLUSIONS: Recovery rates are low, even among those with higher levels of pre-fracture functional status, and are worse for patients who are older, cognitively impaired, and who have multiple comorbidities.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Comorbidity, Dementia, Female, Geriatric Assessment, Hip Fractures, Humans, Longitudinal Studies, Male, Mobility Limitation, Recovery of Function, Walking}, issn = {1525-1497}, doi = {10.1007/s11606-016-3848-2}, author = {Victoria L. Tang and Rebecca L. Sudore and Irena Cenzer and W John Boscardin and Alexander K Smith and Christine S Ritchie and Margaret Wallhagen and Finlayson, Emily and Petrillo, Laura and Kenneth E Covinsky} } @article {8593, title = {Racial and Socioeconomic Variation in Genetic Markers of Telomere Length: A Cross-Sectional Study of U.S. Older Adults.}, journal = {EBioMedicine}, volume = {11}, year = {2016}, pages = {296-301}, abstract = {

BACKGROUND: Shorter telomere length (TL) has been associated with stress and adverse socioeconomic conditions, yet U.S. blacks have longer TL than whites. The role of genetic versus environmental factors in explaining TL by race and socioeconomic position (SEP) remains unclear.

METHODS: We used data from the U.S. Health and Retirement Study (N=11,934) to test the hypothesis that there are differences in TL-associated SNPs by race and SEP. We constructed a TL polygenic risk score (PRS) and examined its association with race/ethnicity, educational attainment, assets, gender, and age.

RESULTS: U.S. blacks were more likely to have a lower PRS for TL, as were older individuals and men. Racial differences in TL were statistically accounted for when controlling for population structure using genetic principal components. The GWAS-derived SNPs for TL, however, may not have consistent associations with TL across different racial/ethnic groups.

CONCLUSIONS: This study showed that associations of race/ethnicity with TL differed when accounting for population stratification. The role of race/ethnicity for TL remains uncertain, however, as the genetic determinants of TL may differ by race/ethnicity. Future GWAS samples should include racially diverse participants to allow for better characterization of the determinants of TL in human populations.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Alleles, Cross-Sectional Studies, Ethnic Groups, Female, Gene Frequency, Genetic Markers, Genome-Wide Association Study, Geriatric Assessment, Humans, Male, Middle Aged, Polymorphism, Single Nucleotide, Population Surveillance, Socioeconomic factors, Telomere Homeostasis, United States}, issn = {2352-3964}, doi = {10.1016/j.ebiom.2016.08.015}, author = {Hamad, Rita and Tuljapurkar, Shripad and David Rehkopf} } @article {9524, title = {Reciprocal relations of loneliness and cognitive function in older U.S. adults}, year = {2015}, abstract = {In older adults, loneliness has been associated with functional decline and increased progression to dementia. The objective of this study was to examine the reciprocal relations of loneliness and cognitive function in older adults, adjusting for sociodemographic and health-related factors, social network and depression.}, keywords = {Cognitive Ability, Lone, Relationships}, doi = {10.1016/j.jalz.2015.07.194}, url = {http://www.alzheimersanddementia.com/article/S1552-5260(15)02344-4/fulltext}, author = {Nancy J. Donovan and Bei Wu and Dorene M. Rentz and Reisa A. Sperling and Gad A. Marshall and M. Maria Glymour} } @article {6480, title = {The relationships among perceived discrimination, self-perceptions of aging, and depressive symptoms: a longitudinal examination of age discrimination}, journal = {Aging and Mental Health}, volume = {19}, year = {2015}, pages = {747-755}, chapter = {747}, abstract = {Objectives: This study examined the relationship between changes in perceived discrimination and changes in depressive symptoms among older people. The association between perceived age discrimination and depressive symptoms was also analyzed longitudinally along with tests to determine whether self-perception of aging mediates this association. Method: Data from two waves (2008 and 2012) of the Health and Retirement Study were used. Longitudinal models were tested using a nationally representative sample of 3921 participants who responded to psychosocial questionnaires in both waves and answered questions about perceived everyday discrimination and attributions of discrimination in 2008. Results: Changes in perceived discrimination was significantly associated with changes in depressive symptoms over time. Perceived age discrimination was significantly related to a change in depressive symptoms over four years and self-perceptions of aging mediated the relationship between perceived age discrimination and depressive symptoms. Conclusion: Findings demonstrate the importance of recognizing perceived discrimination and negative self-perceptions of aging as well as how the negative effects of age discrimination on self-perceptions of aging can be risk factors for the development of depressive symptoms in late life.}, keywords = {Demographics, Employment and Labor Force, Health Conditions and Status}, doi = {10.1080/13607863.2014.962007}, url = {http://dx.doi.org/10.1080/13607863.2014.962007}, author = {Jina Han and Virginia E. Richardson} } @article {8327, title = {Risk of Cognitive and Functional Impairment in Spouses of People With Dementia: Evidence From the Health and Retirement Study}, journal = {Journal of Geriatric Psychiatry and Neurology}, volume = {28}, year = {2015}, pages = {260-271}, publisher = {28}, abstract = {Caring for a spouse with dementia is a chronic stressor that may compromise caregivers own cognitive functioning and capacity to provide adequate care. We examined whether having (i) a spouse with dementia and (ii) a spouse who requires assistance with activities of daily living predicted cognitive and functional impairments in respondents to the Health and Retirement Study (n = 7965). Respondents who had a spouse who requires care had poorer cognitive functioning, whereby this relationship was significantly stronger for male respondents. Having a spouse with dementia moderated the relationship between income and cognition and predicted caregiver functional impairment, though not when depression was controlled. Although we found no significant differences on any individual cognitive domains between 179 dementia caregivers and sociodemographically matched noncaregivers, our findings suggest that caregivers, especially men, and low-income individuals who have a spouse with dementia are more vulnerable to adverse cognitive outcomes. Targeting depression in spouses of people with dementia may help to prevent functional impairments.}, keywords = {Health Conditions and Status, Healthcare}, doi = {10.1177/0891988715588834}, url = {http://jgp.sagepub.com/content/early/2015/06/10/0891988715588834.abstract}, author = {Pertl, Maria M. and Lawlor, Brian A. and Robertson, Ian H. and Walsh, Cathal and Brennan, Sabina} } @article {7879, title = {Relationships of Disability with Age Among Adults Aged 50 to 85: Evidence from the United States, England and Continental Europe}, journal = {PloS one}, volume = {8}, year = {2013}, note = {Times Cited: 0}, publisher = {8}, abstract = {Objectives: To extend existing research on the US health disadvantage relative to Europe by studying the relationships of disability with age from midlife to old age in the US and four European regions (England/Northern and Western Europe/Southern Europe/Eastern Europe) including their wealth-related differences, using a flexible statistical approach to model the age-functions. Methods: We used data from three studies on aging, with nationally representative samples of adults aged 50 to 85 from 15 countries (N = 48225): the US-American Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing and Retirement in Europe (SHARE). Outcomes were mobility limitations and limitations in instrumental activities of daily living. We applied fractional polynomials of age to determine best fitting functional forms for age on disability in each region, while controlling for socio-demographic characteristics and important risk factors (hypertension, diabetes, obesity, smoking, physical inactivity). Results: Findings showed high levels of disability in the US with small age-related changes between 50 and 85. Levels of disability were generally lower in Eastern Europe, followed by England and Southern Europe and lowest in Northern and Western Europe. In these latter countries age-related increases of disability, though, were steeper than in the US, especially in Eastern and Southern Europe. For all countries and at all ages, disability levels were higher among adults with low wealth compared to those with high wealth, with largest wealth-related differences among those in early old age in the USA. Conclusions: This paper illustrates considerable variations of disability and its relationship with age. It supports the hypothesis that less developed social policies and more pronounced socioeconomic inequalities are related to higher levels of disability and an earlier onset of disability.}, keywords = {Cross-National, Disabilities, ELSA, Net Worth and Assets, SHARE}, doi = {10.1371/journal.pone.0071893}, author = {Morten Wahrendorf and Reinhardt, Jan D. and Johannes Siegrist} } @article {7693, title = {Race/ethnic and nativity disparities in later life physical performance: the role of health and socioeconomic status over the life course.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {67}, year = {2012}, month = {2012 Mar}, pages = {238-48}, publisher = {67B}, abstract = {

OBJECTIVES: We examine race/ethnic and nativity differences in objective measures of physical performance (i.e., peak expiratory flow, grip strength, and gait speed) in a nationally representative sample of older Whites, Blacks, and Hispanics. We also examine whether detailed measures of childhood and adult health and socioeconomic status (SES) mediate race/ethnic differences in physical performance.

METHOD: We use data from the Health and Retirement Study, a population-based sample of older Americans born before 1947, and 3 measures of physical performance. Nested ordinary least squares models examine whether childhood and adult health and SES mediate race/ethnic differences in performance.

RESULTS: We find large and significant race/ethnic and nativity differences in lung function, grip strength, and gait speed. Adjusting for childhood and current adult health and SES reduces race/ethnic differences in physical performance but does not eliminate them entirely. Childhood health and SES as well as more proximal levels of SES are important determinants of race/ethnic disparities in later life physical performance.

DISCUSSION: The analysis highlights that a large proportion of race/ethnic and nativity disparities result from health and socioeconomic disadvantages in both early life and adulthood and thus suggests multiple intervention points at which disparities can be reduced.

}, keywords = {Aged, Aged, 80 and over, Aging, ethnicity, Female, Gait, Hand Strength, Health Status, Health Status Disparities, Health Surveys, Humans, Male, Middle Aged, Racial Groups, Respiratory Function Tests, Social Class, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr155}, author = {Steven A Haas and Patrick M. Krueger and Leah Rohlfsen} } @article {7637, title = {Recent trends in chronic disease, impairment and disability among older adults in the United States.}, journal = {BMC Geriatr}, volume = {11}, year = {2011}, note = {Hung, William W Ross, Joseph S Boockvar, Kenneth S Siu, Albert L K08 AG032886/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t England BMC geriatrics BMC Geriatr. 2011 Aug 18;11:47.}, month = {2011 Aug 18}, pages = {47}, publisher = {11}, abstract = {

BACKGROUND: To examine concurrent prevalence trends of chronic disease, impairment and disability among older adults.

METHODS: We analyzed the 1998, 2004 and 2008 waves of the Health and Retirement Study, a nationally representative survey of older adults in the United States, and included 31,568 community dwelling adults aged 65 and over. Measurements include: prevalence of chronic diseases including hypertension, heart disease, stroke, diabetes, cancer, chronic lung disease and arthritis; prevalence of impairments, including impairments of cognition, vision, hearing, mobility, and urinary incontinence; prevalence of disability, including activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

RESULTS: The proportion of older adults reporting no chronic disease decreased from 13.1\% (95\% Confidence Interval [CI], 12.4\%-13.8\%) in 1998 to 7.8\% (95\% CI, 7.2\%-8.4\%) in 2008, whereas the proportion reporting 1 or more chronic diseases increased from 86.9\% (95\% CI, 86.2\%-89.6\%) in 1998 to 92.2\% (95\% CI, 91.6\%-92.8\%) in 2008. In addition, the proportion reporting 4 or more diseases increased from 11.7\% (95\% CI, 11.0\%-12.4\%) in 1998 to 17.4\% (95\% CI, 16.6\%-18.2\%) in 2008. The proportion of older adults reporting no impairments was 47.3\% (95\% CI, 46.3\%-48.4\%) in 1998 and 44.4\% (95\% CI, 43.3\%-45.5\%) in 2008, whereas the proportion of respondents reporting 3 or more was 7.2\% (95\% CI, 6.7\%-7.7\%) in 1998 and 7.3\% (95\% CI, 6.8\%-7.9\%) in 2008. The proportion of older adults reporting any ADL or IADL disability was 26.3\% (95\% CI, 25.4\%-27.2\%) in 1998 and 25.4\% (95\% CI, 24.5\%-26.3\%) in 2008.

CONCLUSIONS: Multiple chronic disease is increasingly prevalent among older U.S. adults, whereas the prevalence of impairment and disability, while substantial, remain stable.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Disabled Persons, Female, Health Surveys, Humans, Longitudinal Studies, Male, United States, Visually Impaired Persons}, issn = {1471-2318}, doi = {10.1186/1471-2318-11-47}, author = {William W. Hung and Joseph S. Ross and Boockvar, Kenneth S and Albert L Siu} } @article {7498, title = {Retiree Health Insurance and Disengagement from a Career Job}, journal = {Journal of Labor Research}, volume = {31}, year = {2010}, pages = {247-262}, publisher = {31}, abstract = {Over the past two decades the prevalence of partial/phased retirements has increased dramatically, redefining retirement and the way in which retirement benefits are evaluated. Specifically the effect of retirement benefits on the transition away from a state of career employment has become the primary issue of interest. This study uses data obtained from the Health and Retirement Study (HRS) and the Rand HRS files, to examine the relationship between access to retiree health insurance (RHI) and the decision to leave one s career job. We employ a Cox Proportional Hazard Model to estimate how RHI affects the probability that an individual disengages from their career job, given they have not yet done so. Results indicate that those with access to RHI are 21 more likely to leave their career employer in all time periods than similar individuals without RHI. Several robustness tests including stratified estimation and propensity score matching are performed and no evidence of bias is detected.}, keywords = {Employment and Labor Force, Medicare/Medicaid/Health Insurance, Retirement Planning and Satisfaction}, doi = {https://doi.org/10.1007/s12122-010-9091-4}, author = {Christina A. Robinson and Robert Clark} } @article {7405, title = {Recent hospitalization and the risk of hip fracture among older Americans.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {64}, year = {2009}, month = {2009 Feb}, pages = {249-55}, publisher = {64}, abstract = {

BACKGROUND: We identified hip fracture risks in a prospective national study.

METHODS: Baseline (1993-1994) interview data were linked to Medicare claims for 1993-2005. Participants were 5,511 self-respondents aged 70 years and older and not in managed Medicare. ICD9-CM 820.xx (International Classification of Diseases, 9th Edition, Clinical Modification) codes identified hip fracture. Participants were censored at death or enrollment into managed Medicare. Static risk factors included sociodemographic, socioeconomic, place of residence, health behavior, disease history, and functional and cognitive status measures. A time-dependent marker reflecting postbaseline hospitalizations was included.

RESULTS: A total of 495 (8.9\%) participants suffered a postbaseline hip fracture. In the static proportional hazards model, the greatest risks involved age (adjusted hazard ratios [AHRs] of 2.01, 2.82, and 4.91 for 75-79, 80-84, and > or =85 year age groups vs those aged 70-74 years; p values <.001), sex (AHR = 0.45 for men vs women; p < .001), race (AHRs of 0.37 and 0.46 for African Americans and Hispanics vs whites; p values <.001 and <.01), body mass (AHRs of 0.40, 0.77, and 1.73 for obese, overweight, and underweight vs normal weight; p values <.001, <.05, and <.01), smoking status (AHRs = 1.49 and 1.52 for current and former smokers vs nonsmokers; p values <.05 and <.001), and diabetes (AHR = 1.99; p < .001). The time-dependent recent hospitalization marker did not alter the static model effect estimates, but it did substantially increase the risk of hip fracture (AHR = 2.51; p < .001).

CONCLUSIONS: Enhanced discharge planning and home care for non-hip fracture hospitalizations could reduce subsequent hip fracture rates.

}, keywords = {Accidental Falls, Age Distribution, Aged, Aged, 80 and over, Aging, Cohort Studies, Female, Follow-Up Studies, Geriatric Assessment, Hip Fractures, Hospitalization, Humans, Logistic Models, Male, Multivariate Analysis, Probability, Proportional Hazards Models, Prospective Studies, Risk Factors, Sex Distribution, Survival Analysis, United States}, issn = {1758-535X}, doi = {10.1093/gerona/gln027}, author = {Frederic D Wolinsky and Suzanne E Bentler and Li Liu and Maksym Obrizan and Elizabeth A Cook and Kara B Wright and John F Geweke and Elizabeth A Chrischilles and Claire E Pavlik and Robert L. Ohsfeldt and Michael P Jones and Kelly K Richardson and Gary E Rosenthal and Robert B Wallace} } @inbook {NBERc4543, title = {Reducing Social Security PRA Risk at the Individual Level: Life-Cycle Funds and No-Loss Strategies}, booktitle = {Social Security Policy in a Changing Environment}, year = {2009}, pages = {255-292}, publisher = {University of Chicago Press}, organization = {University of Chicago Press}, abstract = {Retirement savers in a Social Security system with a personal retirement account (PRA) component would face the challenge of deciding how to allocate their PRA portfolios across a broad range of asset classes and across many different financial products. Asset allocation decisions have important consequences for retirement wealth accumulation because they affect the expenses of investing as well as the risk of low returns. The goal of this chapter is to assess the relative risk associated with alternative asset allocation strategies in PRAs. It also offers insight on the consequences of different asset allocation rules in current private-sector defined contribution (DC) plans, such as 401(k) plans. Quantifying the risk associated with }, keywords = {Social Security}, url = {http://www.nber.org/chapters/c4543}, author = {James M. Poterba and Joshua Rauh and Steven F Venti and David A Wise} } @article {7371, title = {Retirement Preparedness in Non-Married Women Near Retirement}, journal = {Journal of Family and Consumer Sciences}, volume = {101}, year = {2009}, pages = {53}, publisher = {101}, abstract = {Using data from the 2004 Health and Retirement Study (HRS), the authors examined the savings and retirement preparedness of non-married women between the ages of 51 and 64. Approximately 68 of the non-married women did not meet one of the criteria for retirement preparedness (i.e., having investment assets greater than 25 of their net worth). Multivariate regression analyses show that all else being equal, divorced women held significantly lower levels of net worth and were less likely to meet the criterion for being financially prepared for retirement than their widowed counterparts. The findings suggest that women with less income, less education, who were Black, and in poor health had lower levels of net worth and were less likely to meet the criterion for being prepared for retirement.}, keywords = {Consumption and Savings, Retirement Planning and Satisfaction, Women and Minorities}, author = {Lee, Yoon G. and Rowley, Megan} } @article {7239, title = {Retirement and weight changes among men and women in the health and retirement study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 May}, pages = {S146-53}, publisher = {63B}, abstract = {

OBJECTIVES: Older adults may experience weight changes upon retirement for a number of reasons, such as being less physically active; having less structured meal times; and consuming food in response to losing personal identity, the potential for social interactions, or the sense of accomplishment derived from working. The purpose of this study was to determine whether retirement was associated with either weight gain or weight loss.

METHODS: We used the 1994-2002 Health and Retirement Study to determine whether retirement between biennial interviews was associated with weight change, separately for men (n = 1,966) and women (n = 1,759). We defined weight change as a 5\% increase or decrease in body mass index between interviews.

RESULT: . We did not find a significant association between retirement and weight change among men. Women who retired were more likely to gain weight than women who continued to work at least 20 hr per week (odds ratio [OR] = 1.24, 95\% confidence interval [CI] = 1.04-1.48). We found a significant relationship between retirement and weight gain only for women who were normal weight upon retiring (OR = 1.30, 95\% CI = 1.01-1.69) and who retired from blue-collar jobs (OR = 1.58, 95\% CI = 1.13-2.21).

DISCUSSION: Public health interventions may be indicated for women, particularly those working in blue-collar occupations, in order to prevent weight gain upon retirement.

}, keywords = {Aged, Aging, Body Mass Index, Body Weight, Demography, depression, Female, Health Behavior, Health Status, Humans, Interviews as Topic, Male, Middle Aged, Obesity, Retirement}, issn = {1079-5014}, doi = {10.1093/geronb/63.3.s146}, author = {Valerie L Forman-Hoffman and Kelly K Richardson and Jon W. Yankey and Stephen L Hillis and Robert B Wallace and Frederic D Wolinsky} } @article {5733, title = {The Retirement Consumption Puzzle: Actual Spending Change in Panel Data}, number = {13929}, year = {2008}, institution = {National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {The simple one-good model of life-cycle consumption requires that consumption be continuous over retirement; yet prior research based on partial measures of consumption or on synthetic panels indicates that spending drops at retirement, a result that has been called the retirement-consumption puzzle. Using panel data on total spending, nondurable spending and food spending, we find that spending declines at small rates over retirement, at rates that could be explained by mechanisms such as the cessation of work-related expenses, unexpected retirement due to a health shock or by the substitution of time for spending. In the low-wealth population where spending did decline at higher rates, the main explanation for the decline appears to be a high rate of early retirement due to poor health. We conclude that at the population level there is no retirement consumption puzzle in our data, and that in subpopulations where there were substantial declines, conventional economic theory can provide the main explanation.}, keywords = {Event History/Life Cycle, Health Conditions and Status, Retirement Planning and Satisfaction}, doi = {10.3386/w13929}, author = {Michael D Hurd and Susann Rohwedder} } @article {7138, title = {Risk of nursing home admission among older americans: does states{\textquoteright} spending on home- and community-based services matter?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 May}, pages = {S169-78}, publisher = {62B}, abstract = {

OBJECTIVE: States vary greatly in their support for home- and community-based services (HCBS) that are intended to help disabled seniors live in the community. This article examines how states{\textquoteright} generosity in providing HCBS affects the risk of nursing home admission among older Americans and how family availability moderates such effects.

METHODS: We conducted discrete time survival analysis of first long-term (90 or more days) nursing home admissions that occurred between 1995 and 2002, using Health and Retirement Study panel data from respondents born in 1923 or earlier.

RESULT: State HCBS effects were conditional on child availability among older Americans. Living in a state with higher HCBS expenditures was associated with lower risk of nursing home admission among childless seniors (p <.001). However, the association was not statistically significant among seniors with living children. Doubling state HCBS expenditures per person aged 65 or older would reduce the risk of nursing home admission among childless seniors by 35\%.

DISCUSSION: Results provided modest but important evidence supportive of increasing state investment in HCBS. Within-state allocation of HCBS resources, however, requires further research and careful consideration about fairness for individual seniors and their families as well as cost effectiveness.

}, keywords = {Aged, Aged, 80 and over, Caregivers, Cohort Studies, Cost Savings, Cost-Benefit Analysis, Female, Financing, Government, Health Expenditures, Home Care Services, Homes for the Aged, Humans, Insurance Coverage, Long-term Care, Male, Medicaid, Medicare, Nursing homes, Patient Admission, Patient Readmission, Risk Assessment, Risk Factors, State Health Plans, United States}, issn = {1079-5014}, doi = {10.1093/geronb/62.3.s169}, author = {Muramatsu, Naoko and yin, Hongjun and Richard T. Campbell and Ruby L Hoyem and Martha A. Jacob and Christopher Ross} } @article {13116, title = {The Role of Health Insurance in Joint Retirement among Married Couples}, journal = {Industrial \& Labor Relations Review}, volume = {60}, year = {2007}, pages = {397 - 407}, abstract = {Because the near-elderly have high expected medical expenditures, availability of health insurance is an important factor in their retirement decisions. Using Health and Retirement Study data collected in 1992-2002, the authors of this study investigate whether access to employer-provided retiree health insurance enabled dual working couples to time their retirement together{\textendash}a behavior called {\textquotedblleft}joint retirement.{\textquotedblright} They find that when wives had employer-provided retiree health insurance, the likelihood of joint retirement more than doubled. The effect of retiree health insurance on overall employment patterns, in contrast, was modest: estimates indicate that a hypothetical change from universal availability of such insurance to its universal unavailability would have increased employment levels by only two percentage points.}, keywords = {Health Insurance, Joint Retirement}, issn = {0019-7939}, url = {http://hdl.handle.net/10197/257}, author = {Kanika Kapur and Jeannette Rogowski} } @article {5538, title = {The Retirement-Consumption Puzzle: Anticipated and Actual Declines in Spending at Retirement}, number = {9586}, year = {2003}, institution = {The National Bureau of Economic Research}, address = {Cambridge, MA}, abstract = {The simple one-good model of life-cycle consumption requires consumption smoothing. However, British and U.S. households apparently reduce consumption at retirement and the reduction cannot be explained by the life-cycle model. An interpretation is that retirees are surprised by the inadequacy of resources. This interpretation challenges the life-cycle model where consumers are forward looking. However, data on anticipated consumption changes at retirement and on realized consumption changes following retirement show that the reductions are fully anticipated. Apparently the decline is due to the cessation of work-related expenses and the substitution of home production for market-purchased goods and services.}, keywords = {Consumption and Savings, Retirement Planning and Satisfaction}, doi = {10.3386/w9586}, author = {Michael D Hurd and Susann Rohwedder} } @article {6840, title = {Retirement Planning and Health Outcomes in the Health and Retirement Study}, journal = {Southwest Journal on Aging}, volume = {18}, year = {2002}, pages = {5-16}, publisher = {18}, keywords = {Healthcare, Retirement Planning and Satisfaction}, author = {L.M. Albert and Sandra L Reynolds} } @inbook {5169, title = {Retirement Expectations and Realizations: The Role of Health Shocks and Economic Factors}, booktitle = {Forecasting Retirement Needs and Retirement Wealth}, year = {2000}, note = {ProCite field 8 : eds.}, pages = {274-287}, publisher = {Univ. of Pennsylvania Press}, organization = {Univ. of Pennsylvania Press}, address = {Philadelphia}, abstract = {This chapter explores the relationship between peoples{\textquoteright} expectations about retirement, their realizations of retirement, and the role of health shocks in this process. We look at how accurately people predict retirement and we examine the determinants of changes in retirement expectations. Expectations are made under uncertainty about future health, labor force status, household characteristics, and economic variables; therefore plans must frequently be updated with new information. While many factors influence the decision to retire, we are specifically interested in the role of health shocks in peoples{\textquoteright} decisions to alter their plans to retire. Research to date has recognized the importance of understanding the relationship between health and retirement; however, until now, information about health, work, and economic well-being was difficult to obtain in a single survey. The Health and Retirement Study (HRS) is the first national survey to combine comprehensive data on all of these areas. Nevertheless much of the early HRS research has used only the first wave of data, at which time many in the cohort were too young to retire. In this chapter we use new information on this group of people from wave 2, enabling us to observe this cohort moving into retirement. In what follows we first offer a brief discussion of the literature, and then discuss empirical models, data used in the analysis, results and conclusions.}, keywords = {Expectations, Health Conditions and Status, Retirement Planning and Satisfaction}, url = {https://www.researchgate.net/publication/23739676_Retirement_Expectations_and_Realizations_The_Role_of_Health_Shocks_and_Economic_Factors}, author = {Debra S. Dwyer and Hu, Jianting}, editor = {Olivia S. Mitchell and Hammond, B. and Rappaport, A.} } @article {5376, title = {Retiree Health Benefits and Retirement Behavior: Implications for Health Policy}, year = {1998}, institution = {Washington, DC, U.S. Dept. of Labor}, keywords = {Healthcare, Medicare/Medicaid/Health Insurance, Retirement Planning and Satisfaction}, author = {Lynn A Karoly and Jeannette Rogowski} }