@article {9314, title = {Evaluating Strategies for Reducing Field Costs in a Longitudinal Study}, year = {2016}, month = {06/2017}, pages = {1-8}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, MI}, author = {David R Weir and Mary Beth Ofstedal} } @article {8046, title = {Cohort Profile: the Health and Retirement Study (HRS).}, journal = {Int J Epidemiol}, volume = {43}, year = {2014}, month = {2014 Apr}, pages = {576-85}, publisher = {43}, abstract = {

The Health and Retirement Study (HRS) is a nationally representative longitudinal survey of more than 37 000 individuals over age 50 in 23 000 households in the USA. The survey, which has been fielded every 2 years since 1992, was established to provide a national resource for data on the changing health and economic circumstances associated with ageing at both individual and population levels. Its multidisciplinary approach is focused on four broad topics-income and wealth; health, cognition and use of healthcare services; work and retirement; and family connections. HRS data are also linked at the individual level to administrative records from Social Security and Medicare, Veteran{\textquoteright}s Administration, the National Death Index and employer-provided pension plan information. Since 2006, data collection has expanded to include biomarkers and genetics as well as much greater depth in psychology and social context. This blend of economic, health and psychosocial information provides unprecedented potential to study increasingly complex questions about ageing and retirement. The HRS has been a leading force for rapid release of data while simultaneously protecting the confidentiality of respondents. Three categories of data-public, sensitive and restricted-can be accessed through procedures described on the HRS website (hrsonline.isr.umich.edu).

}, keywords = {Aged, Female, Genetic Predisposition to Disease, Health Status, Humans, Longitudinal Studies, Male, Mental Health, Middle Aged, Physical Fitness, Retirement, United States}, issn = {1464-3685}, doi = {10.1093/ije/dyu067}, author = {Amanda Sonnega and Jessica Faul and Mary Beth Ofstedal and Kenneth M. Langa and John W R Phillips and David R Weir} } @article {8024, title = {Does Sequence Matter in Multi-Mode Surveys: Results from an Experiment.}, journal = {Field methods}, volume = {26}, year = {2014}, month = {2014 May 01}, pages = {141-155}, publisher = {26}, abstract = {

Interest in a multi-mode approach to surveys has grown substantially in recent years, in part due to increased costs of face-to-face interviewing and the emergence of the internet as a survey mode. Yet, there is little systematic evidence of the impact of a multimode approach on survey costs and errors. This paper reports the results of an experiment designed to evaluate whether a mixed-mode approach to a large screening survey would produce comparable response rates at a lower cost than a face-to-face screening effort. The experiment was carried out in the Health and Retirement Study (HRS), an ongoing panel study of Americans over age 50. In 2010, HRS conducted a household screening survey to recruit new sample members to supplement the existing sample. The experiment varied the sequence of modes with which the screening interview was delivered. One treatment offered mail first, followed by face-to-face interviewing; the other started with face-to-face and then mail. A control group was offered only face-to-face interviewing. Results suggest that the mixed mode options reduced costs without reducing response rates to the screening interview. There is some evidence, however, that the sequence of modes offered may impact the response rate for a follow-up in-depth interview.

}, issn = {1525-822X}, doi = {10.1177/1525822X13491863}, url = {http://fmx.sagepub.com/content/early/2013/07/24/1525822X13491863.abstract}, author = {James Wagner and Arrieta, Jennifer and Heidi M Guyer and Mary Beth Ofstedal} } @article {5954, title = {Documentation of Biomarkers in the 2006 and 2008 Health and Retirement Study}, year = {2013}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, Michigan}, abstract = {Biomarkers refer to the general range of physiological, metabolic, biochemical, endocrine and genetic measures that can be obtained in living organisms. The term is most commonly used to refer to one-time biochemical or hematological measures made on blood or other available bodily fluids, but perhaps the term should be used for a broader range of measures. In 2006 and 2008, HRS included the following biomarkers measurements, administered in this order: Saliva collection for DNA extraction; Blood spot collection for cholesterol, hemoglobin A1C, CRP and cystatin C analysis (results for C-reactive protein and cystatin C are forthcoming). This report describes the following for each of the measures listed above: Rationale and key citations; Sample description; Measure description; Equipment; Protocol description; Special instructions.}, keywords = {Health Conditions and Status, Healthcare, Methodology}, author = {Eileen M. Crimmins and Jessica Faul and Jung K Kim and Heidi M Guyer and Kenneth M. Langa and Mary Beth Ofstedal and Amanda Sonnega and Robert B Wallace and David R Weir} } @article {8943, title = {Linking Survey and Administrative Records: Mechanisms of Consent}, journal = {Sociological Methods \& Research}, volume = {41}, year = {2012}, month = {2012 Nov}, pages = {535-569}, abstract = {

Survey records are increasingly being linked to administrative databases to enhance the survey data and increase research opportunities for data users. A necessary prerequisite to linking survey and administrative records is obtaining informed consent from respondents. Obtaining consent from all respondents is a difficult challenge and one that faces significant resistance. Consequently, data linkage consent rates vary widely from study-to-study. Several studies have found significant differences between consenters and non-consenters on socio-demographic variables, but no study has investigated the underlying mechanisms of consent from a theory-driven perspective. In this study, we describe and test several hypotheses related to respondents{\textquoteright} willingness to consent to an earnings and benefit data linkage request based on mechanisms related to financial uncertainty, privacy concerns, resistance towards the survey interview, level of attentiveness during the interview, the respondents{\textquoteright} preexisting relationship with the administrative data agency, and matching respondents and interviewers on observable characteristics. The results point to several implications for survey practice and suggestions for future research.

}, keywords = {Consent, Meta-analyses, Survey Methodology}, issn = {0049-1241}, doi = {10.1177/0049124112460381}, author = {Joseph W Sakshaug and Mick P. Couper and Mary Beth Ofstedal and David R Weir} } @article {7647, title = {Recruitment and retention of minority participants in the health and retirement study.}, journal = {Gerontologist}, volume = {51 Suppl 1}, year = {2011}, note = {Ofstedal, Mary B Weir, David R U01AG009740/AG/NIA NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural United States The Gerontologist Gerontologist. 2011 Jun;51 Suppl 1:S8-20.}, month = {2011 Jun}, pages = {S8-20}, publisher = {51 Suppl 1}, abstract = {

PURPOSE: Minority oversamples of African Americans and Hispanics have been a key feature of the Health and Retirement Study (HRS) design from its origins in 1992. The objective of this article was to assess the quality of the HRS with respect to the recruitment and retention of minority respondents.

DESIGN AND METHODS: To evaluate minority recruitment efforts, we examine baseline response rates for the early baby boom cohort that was added in the 2004 wave and the representativeness of this cohort with regard to demographic, socioeconomic, and health characteristics. To evaluate retention, we focus on minority differentials in 2008 interview, nonresponse and mortality outcomes for the full HRS sample. We also examine minority differentials in participation in supplemental components of the HRS.

RESULTS: Minority response rates at baseline and in longitudinal follow-ups for the main HRS interview have been equal to or better than that of majority Whites. Conversely, response rates to some specific supplemental components have been lower for minority sample members.

IMPLICATIONS: The oversample strategies that the HRS has employed have been successful at identifying and recruiting minority participants at response rates very comparable with that of Whites and others. Minority differentials in participation in supplemental components have been overcome to some extent through interviewer training and targeted follow-up strategies. The HRS experience suggests that well-trained interviewers can overcome most if not all of whatever race and ethnic differentials exist in willingness to participate in surveys, including those involving biological data collection.

}, keywords = {Aged, Biomarkers, Black or African American, Female, Health Promotion, Health Surveys, Hispanic or Latino, Humans, Male, Middle Aged, Minority Groups, Minority health, National Health Programs, Patient Dropouts, Patient Selection, Retirement, Sampling Studies, Surveys and Questionnaires, United States}, issn = {1758-5341}, doi = {10.1093/geront/gnq100}, author = {Mary Beth Ofstedal and David R Weir} } @article {5917, title = {Updates to HRS Sample Weights}, year = {2011}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, Michigan}, keywords = {Methodology}, author = {Mary Beth Ofstedal and David R Weir and Chen, K.T. and James Wagner} } @article {5761, title = {Aging, Demographics and Memory Study (ADAMS): Sample Design, Weighting and Analysis for ADAMS}, year = {2009}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, Michigan}, abstract = {This technical report describes the sample design, design-based weighting and analysis procedures for the Aging, Demographics and Memory Study (ADAMS), a national study that recruited Health and Retirement Study (HRS) panel members to undergo a psychometric evaluation and clinical assessment visit. Langa et al. (2005) describe the general design and methods for the ADAMS including relevant background on the HRS longitudinal sample. This document provides additional detail on the sample design for the ADAMS including a description of survey sample selection, sample attrition and nonresponse, population weights, design-based variance estimation and related topics of importance to analysts of the ADAMS data.}, keywords = {Health Conditions and Status, Methodology}, author = {Steven G Heeringa and Gwenith G Fisher and Michael D Hurd and Kenneth M. Langa and Mary Beth Ofstedal and Brenda L Plassman and Rogers, Willard and David R Weir} } @article {5736, title = {Documentation of Health Behaviors and Risk Factors Measured in the Health and Retirement Study (HRS/AHEAD)}, year = {2008}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, Michigan}, abstract = {The two most important negative behaviors for population health are smoking, which is declining over time, and obesity, which is on the rise. Recognizing the important role of health behaviors and risk factors with respect to issues of key importance to the HRS (health, employment, wealth, timing of retirement), the original designers of the HRS incorporated a set of core measures of health behaviors at the outset. These measures have been expanded over time. The health behaviors and risk factors that are covered in the HRS include: Cigarette smoking (current and past behavior); Alcohol consumption (current behavior and past drinking problems); Body mass index (derived from self-reports of height and weight); Exercise (current level); Preventive health screenings. This report is organized as follows. Section II provides an inventory of the measures of health behaviors and risk factors that are covered in HRS, noting additions and changes that have occurred across waves. Special methodological issues that must be considered when using these data are covered in Section III. Section IV (and corresponding Tables 2-28) presents prevalence estimates and frequency counts for each of the health behavior and risk factor measures over time. Lastly, Section V addresses data quality by comparing HRS prevalence estimates with those from other surveys, reviewing results from some of the studies that have used HRS data to study health behaviors and risk factors, and investigating the level of missing data for these measures.}, keywords = {Health Conditions and Status, Methodology}, author = {Kristi Rahrig Jenkins and Mary Beth Ofstedal and David R Weir} } @article {5734, title = {Documentation of Physical Measures, Anthropometrics and Blood Pressure in the Health and Retirement Study}, year = {2008}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, Michigan}, abstract = {The assessment of physical performance is an important component of the evaluation of functioning of older persons. The HRS has employed a set of standardized assessments of lung function, grip strength, balance, and walking speed. In addition, HRS collected measures of blood pressure, height, weight, and waist circumference. In 2006, HRS included the following measurements, administered in this order: Blood pressure; Lung function; Hand grip strength; Balance tests; Timed walk; Height; Weight; Waist circumference. This report describes the following for each of the measures listed above: Rationale and key citations; Sample description; Measure description; Equipment; Protocol description; Special instructions}, keywords = {Health Conditions and Status, Healthcare, Methodology}, author = {Eileen M. Crimmins and Heidi M Guyer and Kenneth M. Langa and Mary Beth Ofstedal and Robert B Wallace and David R Weir} } @article {7201, title = {Prevalence of cognitive impairment without dementia in the United States.}, journal = {Ann Intern Med}, volume = {148}, year = {2008}, month = {2008 Mar 18}, pages = {427-34}, publisher = {148}, abstract = {

BACKGROUND: Cognitive impairment without dementia is associated with increased risk for disability, increased health care costs, and progression to dementia. There are no population-based prevalence estimates of this condition in the United States.

OBJECTIVE: To estimate the prevalence of cognitive impairment without dementia in the United States and determine longitudinal cognitive and mortality outcomes.

DESIGN: Longitudinal study from July 2001 to March 2005.

SETTING: In-home assessment for cognitive impairment.

PARTICIPANTS: Participants in ADAMS (Aging, Demographics, and Memory Study) who were age 71 years or older drawn from the nationally representative HRS (Health and Retirement Study). Of 1770 selected individuals, 856 completed initial assessment, and of 241 selected individuals, 180 completed 16- to 18-month follow-up assessment.

MEASUREMENTS: Assessments, including neuropsychological testing, neurologic examination, and clinical and medical history, were used to assign a diagnosis of normal cognition, cognitive impairment without dementia, or dementia. National prevalence rates were estimated by using a population-weighted sample.

RESULTS: In 2002, an estimated 5.4 million people (22.2\%) in the United States age 71 years or older had cognitive impairment without dementia. Prominent subtypes included prodromal Alzheimer disease (8.2\%) and cerebrovascular disease (5.7\%). Among participants who completed follow-up assessments, 11.7\% with cognitive impairment without dementia progressed to dementia annually, whereas those with subtypes of prodromal Alzheimer disease and stroke progressed at annual rates of 17\% to 20\%. The annual death rate was 8\% among those with cognitive impairment without dementia and almost 15\% among those with cognitive impairment due to medical conditions.

LIMITATIONS: Only 56\% of the nondeceased target sample completed the initial assessment. Population sampling weights were derived to adjust for at least some of the potential bias due to nonresponse and attrition.

CONCLUSION: Cognitive impairment without dementia is more prevalent in the United States than dementia, and its subtypes vary in prevalence and outcomes.

}, keywords = {Aged, Aged, 80 and over, Cognition Disorders, Dementia, disease progression, Humans, Longitudinal Studies, Prevalence, United States}, issn = {1539-3704}, doi = {10.7326/0003-4819-148-6-200803180-00005}, author = {Brenda L Plassman and Kenneth M. Langa and Gwenith G Fisher and Steven G Heeringa and David R Weir and Mary Beth Ofstedal and James R Burke and Michael D Hurd and Guy G Potter and Willard L Rodgers and David C Steffens and John J McArdle and Robert J. Willis and Robert B Wallace} } @article {7289, title = {Unhealthy lifestyles among older adults: exploring transitions in Mexico and the US.}, journal = {Eur J Ageing}, volume = {5}, year = {2008}, month = {2008 Dec}, pages = {311-326}, publisher = {5}, abstract = {

Lifestyle risk factors are important precursors of old age disease and disability, and the population level impact of these factors likely differs across countries that vary in their economic growth and the attributes of the populations that adopt and abandon unhealthy lifestyles. This paper describes the stage of "lifestyle transition" among older adults in two countries with vastly different trajectories of socio-economic development. A series of hypotheses are proposed on the socioeconomic patterns of health risk factors that would be expected in the two countries, given their economic circumstances and the historical timing of policy interventions that were initiated to mitigate lifestyle risks in these populations. The paper compares the prevalence of smoking tobacco, drinking alcohol, obesity, and lack of physical exercise, as well as the socioeconomic and demographic covariates of these risk factors, among adults aged 55 and older in Mexico and the United States. The findings indicate that smoking- and physical-activity-related transitions toward healthier lifestyles are well under way among older adults in the United States but not in Mexico, whereas a trend toward reduced levels of obesity has just begun in the United States but not in Mexico. There is no evidence of a transition in heavy alcohol drinking in either country among older adults.

}, issn = {1613-9372}, doi = {10.1007/s10433-008-0098-0}, author = {Rebeca Wong and Mary Beth Ofstedal and Yount, Kathryn and Emily M. Agree} } @article {7164, title = {Prevalence of dementia in the United States: the aging, demographics, and memory study.}, journal = {Neuroepidemiology}, volume = {29}, year = {2007}, month = {2007}, pages = {125-32}, publisher = {29}, abstract = {

AIM: To estimate the prevalence of Alzheimer{\textquoteright}s disease (AD) and other dementias in the USA using a nationally representative sample.

METHODS: The Aging, Demographics, and Memory Study sample was composed of 856 individuals aged 71 years and older from the nationally representative Health and Retirement Study (HRS) who were evaluated for dementia using a comprehensive in-home assessment. An expert consensus panel used this information to assign a diagnosis of normal cognition, cognitive impairment but not demented, or dementia (and dementia subtype). Using sampling weights derived from the HRS, we estimated the national prevalence of dementia, AD and vascular dementia by age and gender.

RESULTS: The prevalence of dementia among individuals aged 71 and older was 13.9\%, comprising about 3.4 million individuals in the USA in 2002. The corresponding values for AD were 9.7\% and 2.4 million individuals. Dementia prevalence increased with age, from 5.0\% of those aged 71-79 years to 37.4\% of those aged 90 and older.

CONCLUSIONS: Dementia prevalence estimates from this first nationally representative population-based study of dementia in the USA to include subjects from all regions of the country can provide essential information for effective planning for the impending healthcare needs of the large and increasing number of individuals at risk for dementia as our population ages.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Cohort Studies, Dementia, Female, Geriatric Assessment, Health Surveys, Humans, Logistic Models, Male, Prevalence, Sex Distribution, United States}, issn = {1423-0208}, doi = {10.1159/000109998}, author = {Brenda L Plassman and Kenneth M. Langa and Gwenith G Fisher and Steven G Heeringa and David R Weir and Mary Beth Ofstedal and James R Burke and Michael D Hurd and Guy G Potter and Willard L Rodgers and David C Steffens and Robert J. Willis and Robert B Wallace} } @article {7002, title = {The Aging, Demographics and Memory Study: Study Design and Methods}, journal = {Neuroepidemiology}, volume = {25}, year = {2005}, pages = {181-191}, publisher = {25}, abstract = {Objective: We describe the design and methods of the Aging, Demographics, and Memory Study (ADAMS), a new national study that will provide data on the antecedents, prevalence, outcomes, and costs of dementia and cognitive impairment, not demented (CIND) using a unique study design based on the nationally representative Health and Retirement Study (HRS). We also illustrate potential uses of the ADAMS data and provide information to interested researchers on obtaining ADAMS and HRS data. Methods: The ADAMS is the first population-based study of dementia in the United States to include subjects from all regions of the country, while at the same time using a single standardized diagnostic protocol in a community-based sample. A sample of 856 individuals aged 70 or older who were participants in the on-going HRS received an extensive in-home clinical and neuropsychological assessment to determine a diagnosis of normal, CIND, or dementia. Within the CIND and dementia categories, subcategories (e.g., Alzheimer disease, vascular dementia) were assigned to denote the etiology of cognitive impairment. Conclusion: Linking the ADAMS dementia clinical assessment data to the wealth of available longitudinal HRS data on health, health care utilization, informal care, and economic resources and behavior, will provide a unique opportunity to study the onset of CIND and dementia in a nationally-representative population-based sample, as well as the risk factors, prevalence, outcomes, and costs of CIND and dementia.}, keywords = {Health Conditions and Status, Healthcare}, author = {Kenneth M. Langa and Brenda L Plassman and Robert B Wallace and A. Regula Herzog and Steven G Heeringa and Mary Beth Ofstedal and James F. Burke and Gwenith G Fisher and Fultz, Nancy H. and Michael D Hurd and Guy G Potter and Willard L Rodgers and David C Steffens and David R Weir} } @article {7005, title = {The Effect of Diabetes on Diability in Middle-Aged and Older Adults}, journal = {The Journals of Gerontology, Series A: Medical Sciences}, volume = {60A}, year = {2005}, pages = {1206-1211}, publisher = {60A}, abstract = {Background. Physical disability is increasingly recognized as an adverse health consequence of type 2 diabetes in older adults. We studied the effect of diabetes on disability in middle-aged and older adults to: 1) characterize the association of diabetes with physical disability in middle-aged adults, and 2) determine the extent to which the effect of diabetes is explained by related covariates in either or both age groups. Methods. We used data from two parallel national panel studies of middle-aged and older adults to study the effect of self-reported diabetes at baseline on disability 2 years later, adjusting for baseline covariates. Results. Diabetes was strongly associated with subsequent physical disability (measured by a composite variable combining activities of daily living, mobility, and strength tasks) in middle-aged and older adults. Controlling for socioeconomic characteristics and common diabetes-related and unrelated comorbidities and conditions reduced the diabetes effect substantially, but it remained a significant predictor of disability in both groups. Conclusions. Our analyses demonstrated that disability is an important diabetes-related health outcome in middle-aged and older adults that should be prevented or mitigated through appropriate diabetes management.}, keywords = {Demographics, Disabilities, Health Conditions and Status}, doi = {10.1093/gerona/60.9.1206}, url = {http://biomedgerontology.oxfordjournals.org/content/60/9/1206.long}, author = {Linda A. Wray and Mary Beth Ofstedal and Kenneth M. Langa and Caroline S Blaum} } @article {6939, title = {Diabetes Diagnosis and Weight Loss in Middle-Aged Adults}, journal = {Research on Aging}, volume = {26}, year = {2004}, pages = {62-81}, publisher = {26}, abstract = {Using three waves of Health and Retirement Study data, this study investigated whether (a) self-reported physician-diagnosed diabetes prior to 1994 predicted weight loss between 1994 and 1996 in adults who were aged 51 to 61 and relatively healthy but overweight in 1992 (n = 2,642) and (b) socioeconomic status influenced that relationship. The authors found that these overweight middle-aged adults were at least 50 more likely to report that they lost at least 10 pounds of excess body weight if they had been diagnosed with diabetes than if they had not. Furthermore, the authors found that neither education nor net worth predicted weight loss in these adults. Identifying the social, psychological, and physiological mechanisms linking chronic conditions and health behaviors can inform policy makers and health care providers and enhance the development of effective interventions to prevent or reduce health risks in middle-aged and older adults.}, keywords = {Demographics, Health Conditions and Status, Healthcare}, doi = {10.1177/0164027503258741}, url = {http://roa.sagepub.com/content/26/1/62.abstract}, author = {Linda A. Wray and Caroline S Blaum and Mary Beth Ofstedal and A. Regula Herzog} } @article {6863, title = {Additive and interactive effects of comorbid physical and mental conditions on functional health.}, journal = {J Aging Health}, volume = {15}, year = {2003}, month = {2003 Aug}, pages = {465-81}, publisher = {15}, abstract = {

OBJECTIVE: To understand the role of cognitive impairment and depressive symptoms on functional outcomes of stroke and diabetes. Evaluation approaches to functional outcomes have rarely focused on the presence of specific comorbidities, particularly those involving mental health disorders.

METHODS: Data are from the AHEAD cohort of the Health and Retirement Study (HRS), a nationally representative panel of persons 70+ years of age in 1993. Analyses are limited to 5,646 self-respondents for whom functional outcome data are available in 1995. Additive and interactive multiple regression models are compared for each outcome and focal condition combination.

RESULTS: The additive model is sufficient for the majority of outcome and focal condition combinations. The interaction term is significant in 4 of 12 comparisons.

DISCUSSION: Stroke, diabetes, cognitive impairment, and depressive symptoms exhibit strong independent effects on physical functioning. Support for the hypothesis that cognitive impairment and depression exacerbate the impact of stroke and diabetes is more limited.

}, keywords = {Activities of Daily Living, Aged, Aging, Black or African American, Cognition Disorders, depression, Diabetes Complications, Educational Status, Health Surveys, Hispanic or Latino, Humans, Stroke, United States, White People}, issn = {0898-2643}, doi = {10.1177/0898264303253502}, author = {Fultz, Nancy H. and Mary Beth Ofstedal and A. Regula Herzog and Robert B Wallace} } @article {6886, title = {Functional Status and Health Outcomes in Older Americans with Diabetes: Should diabetes management be targeted to health status?}, journal = {Journal of the American Geriatrics Society}, volume = {51}, year = {2003}, pages = {745-53}, publisher = {51}, abstract = {OBJECTIVES: To determine how baseline functional status affects health outcomes in older adults with diabetes mellitus (DM). DESIGN: Nationally representative cross-sectional and longitudinal health interview survey. SETTING: Waves I (1993) and II (1995) of the Assets and Health Dynamics of the Oldest Old Survey (AHEAD) in the United States. PARTICIPANTS: AHEAD respondents aged 70 and older (n = 7,447, including 995 with DM). MEASUREMENTS: At baseline, the entire sample was divided into three groups: high-functioning group, defined as having no physical limitations or instrumental activities of daily living/activities of daily living (IADL/ADL) disabilities (39\%); low-functioning group, having three or more limitations or IADL/ADL disabilities (24\%); and intermediate-functioning group, those in the middle (36\%). Older adults with and without DM, within each of the functioning groups, were compared at 2-year follow-up with respect to demographic characteristics, weight/body mass index, baseline and incident chronic diseases and conditions, and follow-up functioning. RESULTS: Of people aged 70 and older, 28\% with DM and 41\% without were high functioning; 38\% with DM and 22\% without were low functioning (both P < .001). High-functioning people with DM remained high functioning at 2 years but had a significantly higher incidence of heart disease and mortality than high-functioning people without DM. Low-functioning people with DM were significantly more likely to have vascular comorbidities at baseline than low-functioning people without DM, but their 2-year outcomes were similar. The intermediate-functioning group showed the most differences between those with and without DM; those with DM were significantly (P < .01) more likely to have baseline vascular disease, low cognitive performance, increased incident vascular disease, and significantly worse 2-year functioning and to have experienced falls (P < .001). CONCLUSION: Differences in baseline functional status in older adults with DM were associated with outcome differences. High-functioning older people with DM tended to remain high functioning but demonstrated significantly higher incidence of heart disease and mortality than those without DM, whereas low-functioning people with and without DM had similar outcomes. However, intermediate-functioning older diabetics had worse health and functioning outcomes than a similarly impaired group without DM. DM management adjusted to functional status can potentially address the most-relevant outcomes in the heterogeneous older population with DM.}, keywords = {Diabetes Mellitus, Functional status, Older Adults}, doi = {10.1046/j.1365-2389.2003.51256.x}, author = {Caroline S Blaum and Mary Beth Ofstedal and Kenneth M. Langa and Linda A. Wray} } @article {6738, title = {National estimates of the quantity and cost of informal caregiving for the elderly with dementia.}, journal = {J Gen Intern Med}, volume = {16}, year = {2001}, month = {2001 Nov}, pages = {770-8}, publisher = {16}, abstract = {

OBJECTIVE: Caring for the elderly with dementia imposes a substantial burden on family members and likely accounts for more than half of the total cost of dementia for those living in the community. However, most past estimates of this cost were derived from small, nonrepresentative samples. We sought to obtain nationally representative estimates of the time and associated cost of informal caregiving for the elderly with mild, moderate, and severe dementia.

DESIGN: Multivariable regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people age 70 years or older (N = 7,443).

SETTING: National population-based sample of the community-dwelling elderly.

MAIN OUTCOME MEASURES: Incremental weekly hours of informal caregiving and incremental cost of caregiver time for those with mild dementia, moderate dementia, and severe dementia, as compared to elderly individuals with normal cognition. Dementia severity was defined using the Telephone Interview for Cognitive Status.

RESULTS: After adjusting for sociodemographics, comorbidities, and potential caregiving network, those with normal cognition received an average of 4.6 hours per week of informal care. Those with mild dementia received an additional 8.5 hours per week of informal care compared to those with normal cognition (P < .001), while those with moderate and severe dementia received an additional 17.4 and 41.5 hours (P < .001), respectively. The associated additional yearly cost of informal care per case was 3,630 dollars for mild dementia, 7,420 dollars for moderate dementia, and 17,700 dollars for severe dementia. This represents a national annual cost of more than 18 billion dollars.

CONCLUSION: The quantity and associated economic cost of informal caregiving for the elderly with dementia are substantial and increase sharply as cognitive impairment worsens. Physicians caring for elderly individuals with dementia should be mindful of the importance of informal care for the well-being of their patients, as well as the potential for significant burden on those (often elderly) individuals providing the care.

}, keywords = {Aged, Aged, 80 and over, Caregivers, Cost of Illness, Dementia, Female, Health Care Costs, Humans, Male, Multivariate Analysis, Regression Analysis, Severity of Illness Index, Time Factors, United States}, issn = {0884-8734}, doi = {10.1111/j.1525-1497.2001.10123.x}, author = {Kenneth M. Langa and M.E. Chernew and Mohammed U Kabeto and A. Regula Herzog and Mary Beth Ofstedal and Robert J. Willis and Robert B Wallace and Mucha, L.M. and Walter L. Straus and A. Mark Fendrick} }