@article {11417, title = {Occupational differences in advance care planning: Are medical professionals more likely to plan?}, journal = {Social Science \& Medicine}, volume = {272}, year = {2021}, pages = {113730}, abstract = {Advance care planning (ACP) helps ensure that treatment preferences are met at the end of life. Medical professionals typically are responsible for facilitating patients{\textquoteright} ACP, and may be especially effective in doing so if they have first-hand insights from their own planning. However, no large-scale U.S. studies examine whether persons working on the front lines of health care are more likely than other workers to have done ACP. We contrast the use of three ACP components (living wills, durable power of attorney for health care, and informal discussions) among persons working in medical, legal, social/health support services, other professional, and other non-professional occupations. Data are from the Health and Retirement Study (n = 7668) and Wisconsin Longitudinal Study (n = 5464). Multivariable logistic regression analyses are adjusted for socioeconomic, demographic, health, and psychosocial factors that may confound associations between occupational group and ACP. Medical professionals in both samples are more likely than other professional workers to discuss their own treatment preferences, net of all controls. Medical professionals in the WLS are more likely to execute living wills and DPAHC designations, whereas legal professionals in the HRS are more likely to name a DPAHC. Non-professional workers are significantly less likely to do all three types of planning, although these differences are accounted for by socioeconomic factors. Social and health services professionals are no more likely than other professionals to do ACP. The on-the-job experiences and expertise of medical professionals may motivate them to discuss their own end-of-life preferences, which may render them more trustworthy sources of information for patients and clients. The Affordable Care Act provides reimbursement for medical professionals{\textquoteright} end-of-life consultations with Medicare beneficiary patients, yet practitioners uncomfortable with such conversations may fail to initiate them. Programs to increase medical professionals{\textquoteright} own ACP may have the secondary benefit of increasing ACP among their patients.}, keywords = {Advance care planning, Employment, end-of-life, health, Occupations, Social stratification}, isbn = {0277-9536}, doi = {https://doi.org/10.1016/j.socscimed.2021.113730}, author = {Deborah Carr and Lucie Kalousova and Lin, Katherine and Sarah A. Burgard} } @article {9764, title = {Interdependence in Health and Functioning Among Older Spousal Caregivers and Care Recipients.}, journal = {Western Journal of Nursing Research}, volume = {41}, year = {2019}, pages = {685-703}, abstract = {Older spousal caregiving relationships involve support that may be affected by the health of either the caregiver or care recipient. We conducted a longitudinal analysis using pooled data from 4,632 community-dwelling spousal care recipients and caregivers aged ⩾50 from the 2002 to 2014 waves of the Health and Retirement Study. We specified logistic and negative binomial regression models using lagged predictor variables to assess the role of partner health status on spousal caregiver and care recipient health care utilization and physical functioning outcomes. Care recipients{\textquoteright} odds of hospitalization, odds ratio (OR): 0.83, p<.001, decreased when caregivers had more ADL difficulties. When spouses were in poorer versus better health, care recipients{\textquoteright} bed days decreased (4.69 vs. 2.54) while caregivers{\textquoteright} bed days increased (0.20 vs. 0.96). Providers should consider the dual needs of caregivers caring for care recipients and their own health care needs, in adopting a family-centered approach to management of older adult long-term care needs.}, keywords = {Activities of Daily Living, Caregiving, Marriage, Physical Ability}, issn = {1552-8456}, doi = {10.1177/0193945918781057}, author = {Geoffrey J Hoffman and Sarah A. Burgard and Carolyn A Mendez-Luck and Joseph E Gaugler} } @article {9562, title = {Association of a Negative Wealth Shock With All-Cause Mortality in Middle-aged and Older Adults in the United States.}, journal = {JAMA}, volume = {319}, year = {2018}, pages = {1341-1350}, abstract = {

Importance: A sudden loss of wealth-a negative wealth shock-may lead to a significant mental health toll and also leave fewer monetary resources for health-related expenses. With limited years remaining to regain lost wealth in older age, the health consequences of these negative wealth shocks may be long-lasting.

Objective: To determine whether a negative wealth shock was associated with all-cause mortality during 20 years of follow-up.

Design, Setting, and Participants: The Health and Retirement Study, a nationally representative prospective cohort study of US adults aged 51 through 61 years at study entry. The study population included 8714 adults, first assessed for a negative wealth shock in 1994 and followed biennially through 2014 (the most recent year of available data).

Exposures: Experiencing a negative wealth shock, defined as a loss of 75\% or more of total net worth over a 2-year period, or asset poverty, defined as 0 or negative total net worth at study entry.

Main Outcomes and Measures: Mortality data were collected from the National Death Index and postmortem interviews with family members. Marginal structural survival methods were used to account for the potential bias due to changes in health status that may both trigger negative wealth shocks and act as the mechanism through which negative wealth shocks lead to increased mortality.

Results: There were 8714 participants in the study sample (mean [SD] age at study entry, 55 [3.2] years; 53\% women), 2430 experienced a negative wealth shock during follow-up, 749 had asset poverty at baseline, and 5535 had continuously positive wealth without shock. A total of 2823 deaths occurred during 80 683 person-years of follow-up. There were 30.6 vs 64.9 deaths per 1000 person-years for those with continuously positive wealth vs negative wealth shock (adjusted hazard ratio [HR], 1.50; 95\% CI, 1.36-1.67). There were 73.4 deaths per 1000 person-years for those with asset poverty at baseline (adjusted HR, 1.67; 95\% CI, 1.44-1.94; compared with continuously positive wealth).

Conclusions and Relevance: Among US adults aged 51 years and older, loss of wealth over 2 years was associated with an increased risk of all-cause mortality. Further research is needed to better understand the possible mechanisms for this association and determine whether there is potential value for targeted interventions.

}, keywords = {Mortality, NDI, Wealth Shocks}, issn = {1538-3598}, doi = {10.1001/jama.2018.2055}, author = {Lindsay R Pool and Sarah A. Burgard and Belinda L Needham and Michael R. Elliott and Kenneth M. Langa and Carlos F. Mendes de Leon} } @article {9438, title = {Occupational Differences in BMI, BMI Trajectories, and Implications for Employment Status among Older U.S. Workers}, journal = {Work, Aging and Retirement}, volume = {4}, year = {2018}, pages = {21-36}, abstract = {We examined associations between employment and obesity, arguing that risk for unhealthy weight may vary across occupational groups because they shape workplace exposures, social class standing, material resources, and norms and expectations about healthy behaviors and weight. We used a large sample of 51-61-year-old workers from the Health and Retirement study, tracking their body mass index (BMI) over time while accounting for potentially confounding influences of socioeconomic status and gender and exploring whether gender modified associations between occupational group, BMI, and retirement timing. Compared with women in professional occupations, women managers were less likely to be obese at baseline and were less likely to be in the obese upward trajectory class, while female professionals and operators and laborers were less likely than women in farm and precision production to be in the normal stable trajectory. Male professionals were less likely than men in sales, service, and operator and laborer positions to be obese at baseline and more often followed the normal upward trajectory than most other groups, though they and farm and precision production men were more likely to be in the overweight to obese trajectory than men in service occupations. Adjustment for sociodemographic and lifestyle characteristics reduced associations more for men than for women. While retirement risk differed across occupational groups, most of these differences were explained by socioeconomic, demographic, and lifestyle characteristics, especially for men. Obesity at baseline was an independent predictor of retirement but did not further explain differences in the timing of retirement by occupational group.}, keywords = {BMI, Decision making, Employment and Labor Force}, issn = {2054-4642}, doi = {10.1093/workar/waw038}, url = {http://academic.oup.com/workar/article/4/1/21/2918780http://academic.oup.com/workar/article-pdf/4/1/21/23296108/waw038.pdf}, author = {Sarah A. Burgard and Amanda Sonnega}, editor = {Gwenith G Fisher} } @article {9040, title = {Negative wealth shock and short-term changes in depressive symptoms and medication adherence among late middle-aged adults.}, journal = {Journal of Epidemiology and Community Health}, volume = {71}, year = {2017}, pages = {758-763}, abstract = {

BACKGROUND: Experiencing a negative wealth shock in late middle age may cause high levels of stress and induce reductions in health-related consumption.

METHODS: We used data on late middle age individuals (51-64 years) from the longitudinal US-based Health and Retirement Study (N=19 281) to examine the relationship between negative wealth shock and short-term outcomes that serve as markers of the pathways from wealth shock to health: elevated depressive symptoms, as a marker of the stress pathway and cost-related medication non-adherence (CRN), as a marker of the consumption pathway. Negative wealth shock was considered to be a loss of total net worth of 75\% or more.

RESULTS: Using a nested cross-over approach-a within-person design among exposed individuals only that adjusts by design for all time-invariant individual characteristics-we found that negative wealth shock was significantly associated with increased odds of elevated depressive symptoms (OR=1.50, CI 1.10 to 2.05), but was not significantly associated with higher odds of CRN (OR=1.18, CI 0.76 to 1.82), even after further adjustment for time-varying sociodemographic and health covariates.

CONCLUSIONS: Negative wealth shock during late middle age confers an increased risk of elevated depressive symptoms, but does not change levels of CRN. Personal and policy factors that may buffer the mental health risks of negative wealth shock, such as social support and social welfare policy, should be considered.

}, keywords = {Depressive symptoms, Middle age, Prescription Medication, Wealth Shocks}, issn = {1470-2738}, doi = {10.1136/jech-2016-208347}, author = {Lindsay R Pool and Belinda L Needham and Sarah A. Burgard and Michael R. Elliott and Carlos F. Mendes de Leon} } @article {8212, title = {Are older adults living in more equal counties healthier than older adults living in more unequal counties? A propensity score matching approach.}, journal = {Soc Sci Med}, volume = {141}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Sep}, pages = {82-90}, publisher = {141}, abstract = {

We assessed the potential contextual effect of income inequality on health by: 1) comparing individuals with similar socioeconomic status (SES) but who reside in counties with different levels of income inequality; and 2) examining whether the potential effect of county-level income inequality on health varies across SES groups. We used the Health and Retirement Study, a nationally representative study of Americans over the age of 50. Using propensity score matching, we selected SES-comparable individuals living in high-income inequality counties and in low-income inequality counties. We examined differences in self-rated overall health outcomes and in other specific physical/mental health outcomes between the two groups using logistic regression (n~=~34,994) and imposing different sample restrictions based on residential duration in the area. We then used logistic regression with interactions to assess whether, and if so how, health outcomes differed among participants of different SES groups defined by wealth, income, and education. In bivariate analyses of the unmatched full sample, adults living in high-income inequality counties have worse health outcomes for most health measures. After propensity score matching, adults in high-income inequality counties had worse self-rated health status (AOR~=~1.12; 95\% CI 1.04-1.19) and were more likely to report diagnosed psychiatric problems (AOR~=~1.08; 95\% CI 0.99-1.19) than their matched counterparts in low-income inequality counties. These associations were stronger with longer-term residents in the area. Adverse health outcomes associated with living in high-income inequality counties were significant particularly for individuals in the 30(th) or greater percentiles of income/wealth distribution and those without a college education. In summary, after using more precise matching methods to compare individuals with similar characteristics and addressing measurement error by excluding more recently arrived county residents, adults living in high-income inequality counties had worse reported overall physical and mental health than adults living in low-income inequality counties.

}, keywords = {Aged, Aged, 80 and over, Female, Health Status Indicators, Health Surveys, Healthcare Disparities, Humans, Logistic Models, Male, Middle Aged, Propensity Score, Self Report, Socioeconomic factors}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2015.07.020}, author = {Choi, Hwajung and Sarah A. Burgard and Irma Elo and Michele M Heisler} } @article {8007, title = {Receipt of Care and Depressive Symptoms in Later Life: The Importance of Self-Perceptions of Aging}, journal = {The Journals of Gerontology Series B: Psychological Sciences and Social Sciences}, volume = {69}, year = {2014}, pages = {325-335}, publisher = {69}, abstract = {Objectives. This study examines the extent to which self-perceptions of aging and perceived loss of control explain the relationship between the receipt of care and depressive symptoms among older adults. Methods. The sample consists of individuals aged 51 and older from the 2006, 2008, and 2010 waves of the Health and Retirement Study (n = 5,938). Structural equation modeling was used to test an analytic model that focused on the mediating effects of self-perceptions of aging and perceived loss of control. The respondents demographic and health characteristics and depressive symptoms at baseline were included as control variables. Results. The results indicated that self-perceptions of aging mediated the relationship between receipt of care and depressive symptoms. That is, older adults who received a greater amount of care perceive their aging more negatively, which, in turn, increased depressive symptoms 2 years later. However, perceived loss of control did not significantly mediate the relationship between the receipt of care and depressive symptoms. Discussion. These findings suggest that the receipt of care may make frail older adults more vulnerable to negative self-perceptions of aging.}, keywords = {Health Conditions and Status, Healthcare, Other}, doi = {10.1093/geronb/gbt128}, author = {Kwak, Minyoung and Ingersoll-Dayton, Berit and Sarah A. Burgard} } @article {7903, title = {The Great Recession and Health: People, Populations, and Disparities}, journal = {Annals of the American Academy of Political and Social Science}, volume = {650}, year = {2013}, pages = {194}, publisher = {650}, abstract = {Two research traditions have evolved to assess links between recessions and health, with seemingly divergent findings. Aggregate-level studies generally find that mortality rates decline during recessionary periods. By contrast, individual-level studies generally find that events that frequently occur during recessions, like job loss, unemployment, and material hardship, carry negative health consequences. We comprehensively review evidence from these two bodies of research, illustrate key findings, and show how the different mechanisms can operate in parallel. We also outline some of the limitations of the extant evidence, discuss studies emerging to address these limits and directions for future research, and provide brief empirical examples to illustrate some of these limits and directions using the Health and Retirement Study and the Michigan Recession and Recovery Study. Our review emphasizes the importance of considering both the aggregate- and individual-level associations when evaluating the likely short- and longer-term consequences of the Great Recession for health and health disparities.}, keywords = {Consumption and Savings, Demographics, Employment and Labor Force, Health Conditions and Status, Healthcare, Public Policy, Retirement Planning and Satisfaction}, author = {Sarah A. Burgard and Jennifer A Ailshire and Lucie Kalousova} } @article {7813, title = {Healthier, Wealthier, and Wiser: A Demonstration of Compositional Changes in Aging Cohorts Due to Selective Mortality}, journal = {Population Research and Policy Review}, volume = {32}, year = {2013}, note = {Copyright - Springer Science Business Media Dordrecht 2013 Document feature - References; Tables Last updated - 2013-06-21 Adams P, Hurd MD, McFadden DL, Merrill A, Ribeiro T. Perspectives on the economics of aging. Adams, P; Hurd, M D; McFadden, D; Merrill, A; et al. Healthy, Wealthy, and Wise? Tests for Direct Causal Paths between Health and Socioeconomic Status. British Library Inside Conferences (2004): 415-526 BENGSTON, V.L.; SCHAIE, K.W. Handbook of theories of aging. Handbook of theories of aging. (1999): Springer Publishing Compagny Coale, A J; Kisker, E E. Mortality crossovers: reality or bad data? Population Studies, 40. 3 (1986): 389-401 Diprete, Thomas A; Eirich, Gregory M. Cumulative advantage as a mechanism for inequality : A review of theoretical and empirical developments. Annual review of sociology, 32. (2006): 271-297. Annual reviews Dupre, Matthew E; Franzese, Alexis T; Parrado, Emilio A; Dupre, Matthew E. Religious Attendance and Mortality: Implications for the Black-White Mortality Crossover. Demography, 43. 1 (2006): 141-164. Population Association of America, Silver Spring MD Dupre, Matthew E. Educational differences in health risks and illness over the life course: A test of cumulative disadvantage theory. SOCIAL SCIENCE RESEARCH, 37. 4 (2008): 1253-1266. ACADEMIC PRESS INC ELSEVIER SCIENCE Irma T. Elo, Pekka Martikainen, and Kirsten P. Smith. Socioeconomic differentials in mortality in Finland and the United States: the role of education and income. European Journal of Population 22:2 2006: 179-203 Elo, Irma T; Drevenstedt, Greg L; Elo, Irma T. Educational Differences in Cause-Specific Mortality in the United States. Yearbook of Population Research in Finland, 38 (2002): 37-54 Ferraro, Kenneth F.; Shippee, Tetyana Pylypiv; Schafer, Markus H. Cumulative inequality theory for research on aging and the life course. Handbook of theories of aging (2nd ed.). (2009): 413-433. Springer Publishing Co Ferraro, K F; Farmer, M M. Double jeopardy, aging as leveler, or persistent health inequality? A longitudinal analysis of White and Black Americans. JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES, 51. 6 (1996): S319-S328. GERONTOLOGICAL SOCIETY AMER 21. Groves RM, Couper MP. Nonresponse in household interview surveys. New York: John Wiley and Sons, 1998. Groves RM, Couper MP. Nonresponse in household interview surveys. Growing Older in America: The Health and Retirement Study. Incidence and Prevalence (2007) House, James S.; Kessler, Ronald C.; Herzog, A. Regula; Mero, Richard P. Age, socioeconomic status, and health. Milbank Quarterly, 68. 3 (1990): 383-411. Blackwell Publishing; Wiley-Blackwell Publishing Ltd HOUSE, J. S.; LEPKOWSKI, J. M.; KINNEY, A. M.; MERO, R. P.; et al. The social stratification of aging and health. Journal of health and social behavior, 35. 3 (1994): 213-234. American Sociological Association Johnson, N E. The racial crossover in comorbidity, disability, and mortality. DEMOGRAPHY, 37. 3 (2000): 267-283. POPULATION ASSN AMER Juster, F Thomas; Suzman, Richard. An overview of the Health and Retirement Study. Journal of Human Resources, v30. n1 (1995): pS7(50). University of Wisconsin Press Keyfitz, N. (1985). Heterogeneity and selection in population analysis. In Applied mathematical demography . New York: Springer. Keyfitz, N. (1985). Heterogeneity and selection in population analysis. In italic Applied mathematical demography /italic . New York: Springer. Korn, Edward L; Graubard, Barry I. Analysis of health surveys. Wiley series in probabalility and statistics. (1999): xiii, 382p. Korn EL, Graubard BI. Analysis of health surveys. Kurland, Brenda F.; Johnson, Laura L.; Egleston, Brian L.; Diehr, Paula H. Longitudinal Data with Follow-up Truncated by Death: Match the Analysis Method to Research Aims. STATISTICAL SCIENCE, 24. 2 (2009): 211-222. INST MATHEMATICAL STATISTICS Lauderdale, D S. Education and survival: Birth cohort, period, and age effects. DEMOGRAPHY, 38. 4 (2001): 551-561. POPULATION ASSOC AMER Lynch, S M. Cohort and life-course patterns in the relationship between education and health: A hierarchical approach. DEMOGRAPHY, 40. 2 (2003): 309-331. POPULATION ASSN AMER Manton, K G; Poss, S S; Wing, S. BLACK-WHITE MORTALITY CROSSOVER - INVESTIGATION FROM THE PERSPECTIVE OF THE COMPONENTS OF AGING. GERONTOLOGIST, 19. 3 (1979): 291-300. GERONTOLOGICAL SOCIETY AMER Manton, K G. Dynamic paradigms for human mortality and aging. JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES, 54. 6 (1999): B247-B254. GERONTOLOGICAL SOCIETY AMER Masters, Ryan K. Uncrossing the U.S. Black-White Mortality Crossover: The Role of Cohort Forces in Life Course Mortality Risk. DEMOGRAPHY, 49. 3 (2012): 773-796. SPRINGER Mirowsky, John; Ross, Catherine E. Education and self-rated health - Cumulative advantage and its rising importance. RESEARCH ON AGING, 30. 1 (2008): 93-122. SAGE PUBLICATIONS INC Montez, Jennifer Karas; Hummer, Robert A.; Hayward, Mark D. Educational Attainment and Adult Mortality in the United States: A Systematic Analysis of Functional Form. DEMOGRAPHY, 49. 1 (2012): 315-336. SPRINGER RAND Corp. (2011). The RAND HRS Data (Version L) 2012. http://www.rand.org/labor/aging/dataprod/hrs-data.html . Accessed 30 Mar 2012. nr. 6 (2002-2003). Action Plan Against Poverty. White paper on poverty reduction 2002. The Ministry of Social Affairs, Oslo. Trussell, J., and Rodr guez, G. (1990). Heterogeneity in demographic research. In J. Adams, D. A. Lam, A. I. Hermalin, and P. E. Smouse (Eds.), Convergent issues in genetics and demography (pp. 111 132). New York: Oxford University Press. Trussell, James; Richards, Toni; Trussell, James. Correcting for Unmeasured Heterogeneity in Hazard Models Using the Heckman-Singer Procedure. Sociological Methodology, 15. (1985): 242-276 Vaupel, J W. INHERITED FRAILTY AND LONGEVITY. DEMOGRAPHY, 25. 2 (1988): 277-287. POPULATION ASSN AMER Vaupel, J W; Manton, K G; Stallard, E. IMPACT OF HETEROGENEITY IN INDIVIDUAL FRAILTY ON THE DYNAMICS OF MORTALITY. DEMOGRAPHY, 16. 3 (1979): 439-454. POPULATION ASSN AMER Vaupel, James; Zhang, Zhen; Vaupel, James. Attrition in heterogeneous cohorts. Demographic Research, 23. (2010): 737-748. Max Planck Institute for Demographic Research, Rostock, Germany Vaupel, J.W.; Yashin, A.I. Heterogeneity{\textquoteright}s ruses: some surprising effects of selection on population dynamics. The American statistician, 39. 3 (1985): 176-185 Willson, Andrea E.; Shuey, Kim M.; Elder, Glen H., Jr. Cumulative advantage processes as mechanisms of inequality in life course health. AMERICAN JOURNAL OF SOCIOLOGY, 112. 6 (2007): 1886-1924. UNIV CHICAGO PRESS Zajacova, Anna; Hummer, Robert A; Zajacova, Anna. Gender differences in education effects on all-cause mortality for white and black adults in the United States. Social Science and Medicine, 69. 4 (2009): 529-537. Elsevier Science, Amsterdam The Netherlands Zajacova, Anna; Goldman, Noreen; Rodriguez, German. Unobserved Heterogeneity Can Confound the Effect of Education on Mortality. MATHEMATICAL POPULATION STUDIES, 16. 2 (2009): 153-173. TAYLOR and FRANCIS INC}, pages = {311-324}, publisher = {32}, abstract = {The gradual changes in cohort composition that occur as a result of selective mortality processes are of interest to all aging research. We present the first illustration of changes in the distribution of specific cohort characteristics that arise purely as a result of selective mortality. We use data on health, wealth, education, and other covariates from two cohorts (the AHEAD cohort, born 1900-1923 and the HRS cohort, born 1931-1941) included in the Health and Retirement Survey, a nationally representative panel study of older Americans spanning nearly two decades (N = 14,466). We calculate sample statistics for the surviving cohort at each wave. Repeatedly using only baseline information for these calculations so that there are no changes at the individual level (what changes is the set of surviving respondents at each specific wave), we obtain a demonstration of the impact of mortality selection on the cohort characteristics. We find substantial changes in the distribution of all examined characteristics across the nine survey waves. For instance, the median wealth increases from about 90,000 to 130,000 and the number of chronic conditions declines from 1.5 to 1 in the AHEAD cohort. We discuss factors that influence the rate of change in various characteristics. The mortality selection process changes the composition of older cohorts considerably, such that researchers focusing on the oldest old need to be aware of the highly select groups they are observing, and interpret their conclusions accordingly. PUBLICATION ABSTRACT}, keywords = {Health Conditions and Status, Methodology, Net Worth and Assets}, doi = {http://dx.doi.org/10.1007/s11113-013-9273-x}, url = {http://search.proquest.com.proxy.lib.umich.edu/docview/1356972849?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Aabiglobalandrft_val_fmt=info:ofi/fmt:kev:mtx:journalandrft.genre=articl}, author = {Zajacova, Anna and Sarah A. Burgard} } @mastersthesis {6400, title = {The Receipt of Care and Depressive Symptoms in Later Life}, volume = {PhD}, year = {2013}, month = {Jun 2013}, pages = {116}, school = {University of Michigan}, type = {Dissertation}, address = {Ann Arbor}, abstract = {Apace with the rapid increase in the aging population and steep reductions in federal funding for long-term care in the U.S., caregiving is emerging as an important issue for many families. Although caregiving relationships include both a caregiver and a care-recipient, existing research has focused heavily on caregivers and the experiences of care-receiving older adults have been less-well documented. This three-essay dissertation explores how the receipt of care influences depressive symptoms among older adults by analyzing nationally representative data from the Health and Retirement Study. Based on identity theory, the first essay examines the extent to which self-perceptions of aging explain the relationships among the receipt of care, perceived loss of control, and depressive symptoms among older adults. Structural equation modeling was used. Results indicated that self-perceptions of aging mediated the relationship between receipt of care and perceived loss of control as well as the relationship between receipt of care and depressive symptoms. That is, older adults who received a greater amount of care were more likely to perceive their aging negatively which, in turn, increased perceived loss of control and depressive symptoms. The second essay investigated whether older adults who receive care from their spouse are more vulnerable to the negative impact of their spouse{\textquoteright}s physical and mental health than older adults who do not receive care by using a linear mixed model. Results indicated that the receipt of care moderates only the impact of wives{\textquoteright} mental health on husbands{\textquoteright} depressive symptoms. Husbands who receive care from their wives are more sensitive to their wives{\textquoteright} depressive symptoms than husbands who do not receive care. Finally, the third essay assessed to what extent the effects of positive and negative supxi port from spouses are stronger for caregiving couples than for non-caregiving couples. Structural equation modeling demonstrated that positive support from spouses is more important for wives who provide or receive care than for those in non-caregiving relationships. No differences in the effects of negative support from spouses were observed between caregiving and non-caregiving couples.}, keywords = {Demographics, Health Conditions and Status, Healthcare, Other}, url = {http://hdl.handle.net/2027.42/97967http://mirlyn.lib.umich.edu/Record/012367084}, author = {Kwak, Minyoung} }