@article {13249, title = {Gender differences in the association of polygenic risk and divergent depression trajectories from mid to late life: a national longitudinal study.}, journal = {Biodemography Soc Biol}, volume = {68}, year = {2023}, pages = {32-53}, abstract = {

Our research fills a critical gap in the depression literature by utilizing a life course perspective to examine gender-gene interactions in association with depression trajectories over time. Using data from the Health and Retirement Study, we estimated multi-level negative binomial and logistic mixed models to analyze gender-specific trajectories of depressive symptoms (CESD-8) and potential clinical depression risk from middle to late adulthood in relation to gender-by-polygenic-risk (PRS) interactions. We found increasingly greater female-male gaps in the CESD-8 scale and a higher probability of clinical depression risk with increasing polygenic risk scores. Furthermore, females{\textquoteright} higher genetic vulnerabilities to depressive conditions than males vary from ages 51 to 90 years, (e.g. 0.28 higher CESD-8 scale for females at ages 76-85 years than for similar-aged males; higher 3.44\% probability of depression risk for females at ages 81-85 compared to similar-aged males) (e.g. about 2.40\% higher probability of depression risk for females at ages 61-70 years than for similar-aged males) . This study contributes to new knowledge of how gender-by-polygenic-risk interactions are associated with depression trajectories across the life course.

}, keywords = {Adult, Aged, Aged, 80 and over, depression, Depressive Disorder, Major, Female, Humans, Longitudinal Studies, Male, Middle Aged, Risk Factors, Sex Factors}, issn = {1948-5573}, doi = {10.1080/19485565.2023.2196710}, author = {Chen, Ping and Li, Yi and Wu, Fang} } @article {12709, title = {Gender and Social Isolation across the Life Course.}, journal = {Journal of Health and Social Behavior}, volume = {63}, year = {2022}, pages = {319-335}, abstract = {

Social isolation has robust adverse effects on health, well-being, dementia risk, and longevity. Although most studies suggest similar effects of isolation on the health of men and women, there has been much less attention to gendered patterns of social isolation over the life course-despite decades of research suggesting gender differences in social ties. We build on theoretical frames of constrained choice and gender-as-relational to argue that gender differences in isolation are apparent but depend on timing in the life course and marital/partnership history. Results indicate that boys/men are more isolated than girls/women through most of the life course, and this gender difference is much greater for the never married and those with disrupted relationship histories. Strikingly, levels of social isolation steadily increase from adolescence through later life for both men and women.

}, keywords = {Adolescent, Life Change Events, Marriage, Sex Factors, social isolation}, issn = {2150-6000}, doi = {10.1177/00221465221109634}, author = {Umberson, Debra and Lin, Zhiyong and Cha, Hyungmin} } @article {8808, title = {Childhood Misfortune and Handgrip Strength Among Black, White, and Hispanic Americans.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {74}, year = {2019}, month = {2019 02 15}, pages = {526-535}, abstract = {

OBJECTIVE: Although early-life insults may affect health, few studies use objective physical measures of adult health. This study investigated whether experiencing misfortune during childhood is associated with handgrip strength (HGS) in later life.

METHOD: Data on childhood misfortune and adult characteristics from the Health and Retirement Study were used to predict baseline and longitudinal change in HGS among White, Black, and Hispanic American men and women.

RESULTS: Regression analyses revealed that multiple indicators of childhood misfortune were related to HGS at baseline, but the relationships were distinct for men and women. Over the study, having one childhood impairment predicted steeper declines in HGS for men, but childhood misfortune was unrelated to HGS change among women. Hispanic Americans had lower baseline HGS than their non-Hispanic counterparts and manifested steeper declines in HGS.

DISCUSSION: The relationship between childhood exposures and adult HGS varied by the type of misfortune, but there was no evidence that the relationship varied by race/ethnicity. The significant and enduring Hispanic disadvantage in HGS warrants greater attention in gerontology.

}, keywords = {Adult, Adult Survivors of Child Abuse, African Americans, Aged, European Continental Ancestry Group, Female, Hand Strength, Health Status, Hispanic Americans, Humans, Male, Risk Factors, Sex Factors}, issn = {1758-5368}, doi = {10.1093/geronb/gbw147}, url = {http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbw147https://academic.oup.com/psychsocgerontology/article/2645640/Childhood-Misfortune-and-Handgrip-Strength-Among}, author = {Natalie R Smith and Kenneth F Ferraro and Blakelee R Kemp and Patricia M Morton and Sarah A Mustillo and Jacqueline L. Angel} } @article {8584, title = {Activity Engagement and Activity-Related Experiences: The Role of Personality.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 10 10}, pages = {1480-1490}, abstract = {

Objectives: The associations of personality with activity participation and well-being have been well studied. However, less is known concerning the relationship between personality and specific aspects of activity engagement in older adults. We conducted a fine-grained examination of the effects of extraversion and conscientiousness on reported activity engagement-which we define as participation, time allocated, and affective experience-during 8 everyday activities.

Method: Data were obtained using a day reconstruction measure from a subgroup of participants in the 2012 Health and Retirement Study (HRS: N = 5,484; mean age = 67.98 years).

Results: We found mixed support for hypotheses suggesting that specific personality traits would be associated with activity participation, time allocated, and activity-affective experience. For example, extraverts were more likely to socialize and experienced higher socializing-related positive affect, but did not spend more time socializing.

Discussion: Results are discussed in light of the value of including personality in, and its contribution to, studies of activity engagement in later life. In addition, the need to acknowledge the complexity of the concept of activity engagement in future research is highlighted.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Educational Status, Female, Humans, Interviews as Topic, Male, Marital Status, Middle Aged, Personality, Personality Inventory, Sex Factors, Social participation, Surveys and Questionnaires}, issn = {1758-5368}, doi = {10.1093/geronb/gbw098}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2016/08/12/geronb.gbw098.long}, author = {Nicky J Newton and Pladevall-Guyer, Jana and Gonzalez, Richard and Jacqui Smith} } @article {8508, title = {Drinking Patterns Among Older Couples: Longitudinal Associations With Negative Marital Quality.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 04 16}, pages = {655-665}, abstract = {

Objectives: Research with younger couples indicates that alcohol use has powerful effects on marital quality, but less work has examined the effects of drinking among older couples. This study examined whether dyadic patterns of drinking status among older couples are associated with negative marital quality over time.

Method: Married participants (N = 4864) from the Health and Retirement Study reported on alcohol consumption (whether they drink alcohol and average amount consumed per week) and negative marital quality (e.g., criticism and demands) across two waves (Wave 1 2006/2008 and Wave 2 2010/2012).

Results: Concordant drinking couples reported decreased negative marital quality over time, and these links were significantly greater among wives. Wives who reported drinking alcohol reported decreased negative marital quality over time when husbands also reported drinking and increased negative marital quality over time when husbands reported not drinking.

Discussion: The present findings stress the importance of considering the drinking status rather than the amount of alcohol consumed of both members of the couple when attempting to understand drinking and marital quality among older couples. These findings are particularly salient given the increased drinking among baby boomers and the importance of marital quality for health among older couples.

}, keywords = {Aged, Aged, 80 and over, Alcohol Drinking, Family Conflict, Female, Humans, Longitudinal Studies, Male, Marriage, Middle Aged, Sex Factors, Spouses}, issn = {1758-5368}, doi = {10.1093/geronb/gbw073}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27353031}, author = {Kira S. Birditt and James A. Cranford and Jasmine A Manalel and Toni C Antonucci} } @article {8807, title = {Educational and Gender Differences in Health Behavior Changes After a Gateway Diagnosis.}, journal = {J Aging Health}, volume = {30}, year = {2018}, month = {2018 03}, pages = {342-364}, abstract = {

OBJECTIVE: Hypertension represents a gateway diagnosis to more serious health problems that occur as people age. We examine educational differences in three health behavior changes people often make after receiving this diagnosis in middle or older age, and test whether these educational differences depend on (a) the complexity of the health behavior change and (b) gender.

METHOD: We use data from the Health and Retirement Study and conduct logistic regression analysis to examine the likelihood of modifying health behaviors post diagnosis.

RESULTS: We find educational differences in three behavior changes-antihypertensive medication use, smoking cessation, and physical activity initiation-after a hypertension diagnosis. These educational differences in health behaviors were stronger among women compared with men.

DISCUSSION: Upon receiving a hypertension diagnosis, education is a more important predictor of behavior changes for women compared with men, which may help explain gender differences in the socioeconomic gradient in health in the United States.

}, keywords = {Aged, Attitude to Health, Educational Status, Exercise, Female, Health Behavior, Humans, Hypertension, Male, Middle Aged, Retirement, Sex Factors, Smoking cessation, United States}, issn = {1552-6887}, doi = {10.1177/0898264316678756}, url = {http://jah.sagepub.com/cgi/doi/10.1177/0898264316678756}, author = {Elaine M Hernandez and Rachel Margolis and Robert A Hummer} } @article {8598, title = {"Taking a Turn for the Better": Does Self-reported Recovery From Walking Limitation Improve Disability and Mortality Outcomes?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 09 20}, pages = {1278-1291}, chapter = {1278-1291}, abstract = {

Objectives: Recovery from self-reported walking limitation may be a turning point in an individual{\textquoteright}s health trajectory and may lead to better physical and mental health in the future. This research examines whether recovery from walking limitation is associated with onset of mobility disability, activities of daily living (ADLs) disability, or mortality among a national sample of older Americans.

Data and Methods: Using Waves 4 through 11 (1998-2012) of the Health and Retirement Study (HRS), discrete-time event history models (N = 12,579 person-intervals) with multiple competing events were estimated using multinomial logistic regression. The risk group was defined as respondents with walking limitation, but free of disability. A lagged measure of recovery was created using 2 adjacent waves, and disability and mortality outcomes were assessed in the subsequent wave (i.e., 2 years later).

Results: Recovery from walking limitation (i.e., difficulty walking one or several blocks) was associated with lower odds of mobility disability (i.e., difficulty walking across the room) onset, ADL with mobility disability onset, ADL without mobility disability onset, and mortality. Recovery from walking limitation was not only predictive of mobility-related outcomes, but also nonmobility-related ADLs and mortality-suggesting that the predictive capacity of recovery extends to multiple physical health outcomes.

Discussion: This research suggests that self-reported recovery from walking limitation may be a turning point in the disabling process and signals a meaningful change in an older adult{\textquoteright}s functional health trajectory.

}, keywords = {Age Factors, Aged, Disabled Persons, Female, Humans, Logistic Models, Male, Mobility Limitation, Mortality, Recovery of Function, Risk Factors, Self Report, Sex Factors, Socioeconomic factors, Walking}, issn = {1758-5368}, doi = {10.1093/geronb/gbw113}, url = {http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbw113}, author = {Kenzie Latham} } @article {6522, title = {Body weight status and telomere length in U.S. middle-aged and older adults.}, journal = {Obes Res Clin Pract}, volume = {11}, year = {2017}, month = {2017 Jan-Feb}, pages = {51-62}, abstract = {

OBJECTIVE: Telomere length has been proposed as a biomarker of biological aging. This study examined the relationship between body weight status and telomere length in U.S. middle-aged and older adults.

METHODS: Nationally representative data (N=2749) came from the Health and Retirement Study. Linear regressions were performed to examine the relationship between baseline body weight status reported in 1992 and telomere length measured in 2008 in the overall sample and by sex and racial/ethnic groups, adjusted for individual characteristics.

RESULTS: Baseline overweight (25kg/m<=body mass index [BMI]<30kg/m) and obesity (BMI>=30kg/m) status positively predicted telomere length 17 years later. Compared with their normal weight counterparts, telomere length ratio was on average 0.062 (95\% confidence interval=0.016, 0.109) and 0.125 (0.048, 0.202) larger among overweight and obese adults, respectively. In comparison to women and racial/ethnic minorities, the estimated positive associations between overweight and obesity status and telomere length were more salient among men and non-Hispanic whites, respectively.

CONCLUSIONS: The positive association between body weight status and telomere length found in this study was opposite to what existing biological model predicts, and could partially relate to the nonlinear relationship between body weight status and telomere length across age cohorts, and/or the lack of reliability of BMI as an indicator for adiposity in the older population. Large-scale longitudinal studies with baseline telomere length measures are warranted to replicate this study finding and explore the potential heterogeneous relationship between body weight status and telomere length.

}, keywords = {Aged, Aging, Body Mass Index, Body Weight, ethnicity, Female, Humans, Linear Models, Male, Middle Aged, Obesity, Overweight, Racial Groups, Risk Factors, Sex Factors, Telomere, Telomere Shortening, United States, White People}, issn = {1871-403X}, doi = {10.1016/j.orcp.2016.01.003}, author = {An, Ruopeng and Yan, Hai} } @article {8670, title = {Caregiver stressors and depressive symptoms among older husbands and wives in the United States.}, journal = {J Women Aging}, volume = {29}, year = {2017}, month = {2017 Nov-Dec}, pages = {494-504}, abstract = {

Framed by Pearlin{\textquoteright}s Stress Process Model, this study prospectively examines the effects of primary stress factors reflecting the duration, amount, and type of care on the depressive symptoms of spousal caregivers over a2-year period, and whether the effects of stressors differ between husbands and wives. Data are from the 2004 and 2006 waves of the Health and Retirement Study and we included community-dwelling respondents providing activities of daily life (ADL) and/or instrumental activities of daily life (IADL) help to their spouses/partners (N = 774). Results from multivariate regression models indicate that none of the primary stressors were associated with depressive symptoms. However, wives providing only personal care had significantly more depressive symptoms than wives providing only instrumental care, while husbands providing different types of care showed no such differences. To illuminate strategies for reducing the higher distress experienced by wife caregivers engaged in personal care assistance, further studies are needed incorporating couples{\textquoteright} relational dynamics and gendered experiences in personal care.

}, keywords = {Activities of Daily Living, Aged, Caregivers, depression, Female, Humans, Independent Living, Longitudinal Studies, Male, Middle Aged, Multivariate Analysis, Prospective Studies, Regression Analysis, Sex Factors, Spouses, Stress, Psychological, United States}, issn = {1540-7322}, doi = {10.1080/08952841.2016.1223962}, author = {Kim, Min Hee and Ruth E Dunkle and Amanda J Lehning and Shen, Huei-Wern and Sheila Feld and Angela K Perone} } @article {8686, title = {The Costs of Fall-Related Injuries among Older Adults: Annual Per-Faller, Service Component, and Patient Out-of-Pocket Costs.}, journal = {Health Serv Res}, volume = {52}, year = {2017}, month = {2017 10}, pages = {1794-1816}, abstract = {

OBJECTIVE: To estimate expenditures for fall-related injuries (FRIs) among older Medicare beneficiaries.

DATA SOURCES: The 2007-2009 Medicare claims and 2008 Health and Retirement Study (HRS) data for 5,497 (228 FRI and 5,269 non-FRI) beneficiaries.

STUDY DESIGN: FRIs were indicated by inpatient/outpatient ICD-9 diagnostic codes for fractures, trauma, dislocations, and by e-codes. A pre-post comparison group design was used to estimate the differential change in pre-post expenditures for the FRI relative to the non-FRI cohort (FRI expenditures). Out-of-pocket (OOP) costs, service category total annual FRI-related Medicare expenditures, expenditures related to the type of initial FRI treatment (inpatient, ED, outpatient), and the risk of persistently high expenditures (4th quartile for each post-FRI quarter) were estimated.

PRINCIPAL FINDINGS: Estimated FRI expenditures were $9,389 (95 percent CI: $5,969-$12,808). Inpatient, physician/outpatient, skilled nursing facility, and home health comprised 31, 18, 39, and 12 percent of the total. OOP costs were $1,363.0 (95 percent CI: $889-$1,837). Expenditures for FRIs initially treated in inpatient/ED/outpatient settings were $21,424/$6,142/$8,622. The FRI cohort had a 64 percent increased risk of persistently high expenditures. Total Medicare expenditures were $13 billion (95 percent CI: $9-$18 billion).

CONCLUSIONS: FRIs are associated with substantial, persistent Medicare expenditures. Cost-effectiveness of multifactorial falls prevention programs should be assessed using these expenditure estimates.

}, keywords = {Accidental Falls, Age Factors, Aged, Aged, 80 and over, Female, Financing, Personal, Health Expenditures, Health Services, Humans, Male, Medicare, Models, Econometric, Sex Factors, Socioeconomic factors, United States, Wounds and Injuries}, issn = {1475-6773}, doi = {10.1111/1475-6773.12554}, author = {Geoffrey J Hoffman and Hays, Ron D and Martin F Shapiro and Steven P Wallace and Susan L Ettner} } @article {8829, title = {Depressive Symptoms and Salivary Telomere Length in a Probability Sample of Middle-Aged and Older Adults.}, journal = {Psychosom Med}, volume = {79}, year = {2017}, month = {2017 Feb/Mar}, pages = {234-242}, abstract = {

OBJECTIVE: To examine the association between depressive symptoms and salivary telomere length in a probability sample of middle-aged and older adults, and to evaluate age and sex as potential moderators of this association and test whether this association was incremental to potential confounds.

METHODS: Participants were 3,609 individuals from the 2008 wave of the Health and Retirement Study. Telomere length assays were performed using quantitative real-time polymerase chain reaction on DNA extracted from saliva samples. Depressive symptoms were assessed via interview, and health and lifestyle factors, traumatic life events, and neuroticism were assessed via self-report. Regression analyses were conducted to examine the associations between predictor variables and salivary telomere length.

RESULTS: After adjusting for demographics, depressive symptoms were negatively associated with salivary telomere length (b = -.003; p = .014). Furthermore, this association was moderated by sex (b = .005; p = .011), such that depressive symptoms were significantly and negatively associated with salivary telomere length for men (b = - .006; p < .001) but not for women (b = - .001; p = .644). The negative association between depressive symptoms and salivary telomere length in men remained statistically significant after additionally adjusting for cigarette smoking, body mass index, chronic health conditions, childhood and lifetime exposure to traumatic life events, and neuroticism.

CONCLUSIONS: Higher levels of depressive symptoms were associated with shorter salivary telomeres in men, and this association was incremental to several potential confounds. Shortened telomeres may help account for the association between depression and poor physical health and mortality.

}, keywords = {Aged, Anxiety Disorders, Body Mass Index, Chronic disease, depression, Female, Humans, Life Style, Male, Middle Aged, Neuroticism, Psychological Trauma, Saliva, Sex Factors, Smoking, Telomere Shortening}, issn = {1534-7796}, doi = {10.1097/PSY.0000000000000383}, url = {http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage\&an=00006842-900000000-98910}, author = {Mark A Whisman and Emily D Richardson} } @article {6448, title = {From Noise to Signal: The Age and Social Patterning of Intra-Individual Variability in Late-Life Health.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {72}, year = {2017}, month = {2017 Jan}, pages = {168-179}, abstract = {

OBJECTIVES: Despite a long tradition of attending to issues of intra-individual variability in the gerontological literature, large-scale panel studies on late-life health disparities have primarily relied on average health trajectories, relegating intra-individual variability over time to random error terms, or "noise." This article reintegrates the systematic study of intra-individual variability back into standard growth curve modeling and investigates the age and social patterning of intra-individual variability in health trajectories.

METHOD: Using panel data from the Health and Retirement Study, we estimate multilevel growth curves of functional limitations and cognitive impairment and examine whether intra-individual variability in these two health outcomes varies by age, gender, race/ethnicity, and socioeconomic status, using level-1 residuals extracted from the adjusted growth curve models.

RESULTS: For both outcomes, intra-individual variability increases with age. Racial/ethnic minorities and individuals with lower socioeconomic status tend to have greater intra-individual variability in health. Relying exclusively on average health trajectories may have masked important "signals" of life course health inequality.

DISCUSSION: The findings contribute to scientific understanding of the source of heterogeneity in late-life health and highlight the need to further investigate specific life course mechanisms that generate the social patterning of intra-individual variability in health status.

}, keywords = {Activities of Daily Living, Aged, cognitive aging, Cognitive Dysfunction, Disability Evaluation, Female, Health Behavior, Health Status Disparities, Humans, Individuality, Male, Middle Aged, Minority Groups, Models, Statistical, Multilevel Analysis, Reference Values, Sex Characteristics, Sex Factors, Socioeconomic factors}, issn = {1758-5368}, doi = {10.1093/geronb/gbv081}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/08/26/geronb.gbv081.abstract}, author = {Lin, Jielu and Jessica Kelley-Moore} } @article {8489, title = {Gender Differences in Spousal Care Across the Later Life Course.}, journal = {Res Aging}, volume = {39}, year = {2017}, month = {2017 09}, pages = {934-959}, abstract = {

Spouses often serve as the primary caregivers to their ill or disabled partners. Studies have shown that men receive more care from their wives than vice versa, but few studies have focused on how the gender gap in care varies across the later life course. Drawing on data from the Health and Retirement Study, this study examined the moderating effects of age, gender, and full-time employment on married women{\textquoteright}s and men{\textquoteright}s receipt of spousal care. This study found that among community-dwelling married adults, the gender gap in care was larger among those in middle age (50-65) than it was among those in older age. As women and men aged, the gender gap decreased primarily because men left full-time work and increased the amount of time that they spent caring for their wives. As gender differences in full-time employment narrowed, the gender gap in spousal care narrowed.

}, keywords = {Activities of Daily Living, Aged, Caregivers, Cross-Sectional Studies, Employment, Female, Home Care Services, Humans, Male, Marriage, Middle Aged, Sex Factors, Spouses}, issn = {1552-7573}, doi = {10.1177/0164027516644503}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27193046}, author = {Glauber, Rebecca} } @article {8573, title = {Glycated haemoglobin (HbA1c), diabetes and trajectories of change in episodic memory performance.}, journal = {J Epidemiol Community Health}, volume = {71}, year = {2017}, month = {2017 02}, pages = {115-120}, abstract = {

BACKGROUND: As the ageing population grows, it is important to identify strategies to moderate cognitive ageing.

OBJECTIVE: We examined glycated haemoglobin (HbA1c) and diabetes in relation to level and change in episodic memory in older adults with and without diabetes.

METHODS: Data from 4419 older adults with (n=950) and without (n=3469) diabetes participating in a nationally representative longitudinal panel study (the Health and Retirement Study) were examined. Average baseline age was 72.66 years and 58\% were women. HbA1c was measured in 2006 and episodic memory was measured using immediate and delayed list recall over 4 biennial waves between 2006 and 2012. Growth curve models were used to assess trajectories of episodic memory change.

RESULTS: In growth curve models adjusted for age, sex, education, race, depressive symptoms and waist circumference, higher HbA1c levels and having diabetes were associated with poorer baseline episodic memory (p=0.036 and <0.001, respectively) and greater episodic memory decline (p=0.006 and 0.004, respectively). The effect of HbA1c on episodic memory decline was smaller than the effect of age. The results were stronger for women than men and were not modified by age or race. When the main analyses were estimated for those with and without diabetes separately, HbA1c was significantly linked to change in episodic memory only among those with diabetes.

CONCLUSIONS: Higher HbA1c and diabetes were both associated with declines in episodic memory, with this relationship further exacerbated by having diabetes and elevated HbA1c. HbA1c appeared more important for episodic memory performance among women than men.

}, keywords = {Aged, cognitive aging, Demography, Diabetes Mellitus, Female, Glycated Hemoglobin A, Humans, Longitudinal Studies, Male, Memory, Episodic, Risk Factors, Sex Factors, United States}, issn = {1470-2738}, doi = {10.1136/jech-2016-207588}, author = {Pappas, Colleen and Andel, Ross and Frank J Infurna and Seetharaman, Shyam} } @article {8854, title = {Sociodemographic disparities in chronic pain, based on 12-year longitudinal data.}, journal = {Pain}, volume = {158}, year = {2017}, pages = {313-322}, abstract = {

Existing estimates of sociodemographic disparities in chronic pain in the United States are based on cross-sectional data, often treat pain as a binary construct, and rarely test for nonresponse or other types of bias. This study uses 7 biennial waves of national data from the Health and Retirement Study (1998-2010; n = 19,776) to describe long-term pain disparities among older (age 51+) American adults. It also investigates whether pain severity, reporting heterogeneity, survey nonresponse, and/or mortality selection might bias estimates of social disparities in pain. In the process, the article clarifies whether 2 unexpected patterns observed cross-sectionally-plateauing of pain above age 60, and lower pain among racial/ethnic minorities-are genuine or artefactual. Findings show high prevalence of chronic pain: 27.3\% at baseline, increasing to 36.6\% thereafter. Multivariate latent growth curve models reveal extremely large disparities in pain by sex, education, and wealth, which manifest primarily as differences in intercept. Net of these variables, there is no racial/ethnic minority disadvantage in pain scores, and indeed a black advantage vis-{\`a}-vis whites. Pain levels are predictive of subsequent death, even a decade in the future. No evidence of pain-related survey attrition is found, but surveys not accounting for pain severity and reporting heterogeneity are likely to underestimate socioeconomic disparities in pain. The lack of minority disadvantage (net of socioeconomic status) appears genuine. However, the age-related plateauing of pain observed cross-sectionally is not replicated longitudinally, and seems partially attributable to mortality selection, as well as to rising pain levels by birth cohort.

}, keywords = {Age Distribution, Age Factors, Aged, Aged, 80 and over, Chronic disease, Ethnic Groups, Female, Healthcare Disparities, Humans, Longitudinal Studies, Male, Middle Aged, Sex Factors, Social Class}, issn = {1872-6623}, doi = {10.1097/j.pain.0000000000000762}, author = {Grol-Prokopczyk, Hanna} } @article {8537, title = {Correlates and predictors of loneliness in older-adults: a review of quantitative results informed by qualitative insights.}, journal = {Int Psychogeriatr}, volume = {28}, year = {2016}, month = {2016 Apr}, pages = {557-76}, abstract = {

BACKGROUND: Older persons are particularly vulnerable to loneliness because of common age-related changes and losses. This paper reviews predictors of loneliness in the older population as described in the current literature and a small qualitative study.

METHODS: Peer-reviewed journal articles were identified from psycINFO, MEDLINE, and Google Scholar from 2000-2012. Overall, 38 articles were reviewed. Two focus groups were conducted asking older participants about the causes of loneliness.

RESULTS: Variables significantly associated with loneliness in older adults were: female gender, non-married status, older age, poor income, lower educational level, living alone, low quality of social relationships, poor self-reported health, and poor functional status. Psychological attributes associated with loneliness included poor mental health, low self-efficacy beliefs, negative life events, and cognitive deficits. These associations were mainly studied in cross-sectional studies. In the focus groups, participants mentioned environmental barriers, unsafe neighborhoods, migration patterns, inaccessible housing, and inadequate resources for socializing. Other issues raised in the focus groups were the relationship between loneliness and boredom and inactivity, the role of recent losses of family and friends, as well as mental health issues, such as shame and fear.

CONCLUSIONS: Future quantitative studies are needed to examine the impact of physical and social environments on loneliness in this population. It is important to better map the multiple factors and ways by which they impact loneliness to develop better solutions for public policy, city, and environmental planning, and individually based interventions. This effort should be viewed as a public health priority.

}, keywords = {Aged, Aged, 80 and over, Aging, Cross-Sectional Studies, Female, Focus Groups, Humans, Loneliness, Male, Marital Status, Motor Activity, Qualitative Research, Quality of Life, Residence Characteristics, Sex Factors, Social Environment, social isolation, Socioeconomic factors}, issn = {1741-203X}, doi = {10.1017/S1041610215001532}, url = {http://www.journals.cambridge.org/abstract_S1041610215001532}, author = {Cohen-Mansfield, Jiska and Hazan, Haim and Lerman, Yaffa and Shalom, Vera} } @article {8383, title = {Healthcare Stereotype Threat in Older Adults in the Health and Retirement Study.}, journal = {American Journal of Preventive Medicine}, volume = {50}, year = {2016}, pages = {191-198}, publisher = {50}, abstract = {

INTRODUCTION: Healthcare stereotype threat is the threat of being personally reduced to group stereotypes that commonly operate within the healthcare domain, including stereotypes regarding unhealthy lifestyles and inferior intelligence. The objective of this study was to assess the extent to which people fear being judged in healthcare contexts on several characteristics, including race/ethnicity and age, and to test predictions that experience of such threats would be connected with poorer health and negative perceptions of health care.

METHODS: Data were collected as part of the 2012 Health and Retirement Study (HRS). A module on healthcare stereotype threat, designed by the research team, was administered to a random subset (n=2,048 of the total 20,555) of HRS participants. The final sample for the present healthcare stereotype threat experiment consists of 1,479 individuals. Logistic regression was used to test whether healthcare stereotype threat was associated with self-rated health, reported hypertension, and depressive symptoms, as well as with healthcare-related outcomes, including physician distrust, dissatisfaction with health care, and preventative care use.

RESULTS: Seventeen percent of respondents reported healthcare stereotype threat with respect to one or more aspects of their identities. As predicted, healthcare stereotype threat was associated with higher physician distrust and dissatisfaction with health care, poorer mental and physical health (i.e., self-rated health, hypertension, and depressive symptoms), and lower odds of receiving the influenza vaccine.

CONCLUSIONS: The first of its kind, this study demonstrates that people can experience healthcare stereotype threat on the basis of various stigmatized aspects of social identity, and that these experiences can be linked with larger health and healthcare-related outcomes, thereby contributing to disparities among minority groups.

}, keywords = {Age Factors, Aged, Ageism, Attitude of Health Personnel, depression, Female, Health Status, Humans, Hypertension, Male, Mental Health, Middle Aged, Overweight, Physician-Patient Relations, Physicians, Prejudice, Racism, Sex Factors, Socioeconomic factors, Stereotyping}, issn = {1873-2607}, doi = {10.1016/j.amepre.2015.07.034}, author = {Cleopatra M Abdou and Adam W. Fingerhut and James S Jackson and Felicia V Wheaton} } @article {8585, title = {Marital quality, marital dissolution, and mortality risk during the later life course.}, journal = {Soc Sci Med}, volume = {165}, year = {2016}, month = {2016 09}, pages = {119-127}, abstract = {

This study examines the relationship between later-life marital quality, marital dissolution, and mortality using discrete-time event history models with data from nine waves (1992-2008) of the Health and Retirement Study (n~=~7388). Results show marital status is more important for men{\textquoteright}s mortality risk than women{\textquoteright}s, whereas marital quality is more important for women{\textquoteright}s survival than men{\textquoteright}s. Being widowed or divorced more than two years raises mortality risk for men, but later-life marital dissolution is not significantly associated with women{\textquoteright}s mortality risk, regardless of the type of dissolution or length of time since it occurred. Low-quality marital interaction is negatively related to women{\textquoteright}s odds of death, but none of the marital quality measures are significantly associated with mortality for men. Marital satisfaction moderates the relationship between widowhood and mortality for women, but the relationship between marital dissolution and mortality is similar for men regardless of marital quality prior to divorce/widowhood. Results suggest the importance of accounting for both marital status and marital quality when examining older individuals{\textquoteright} mortality risk.

}, keywords = {Aged, Aged, 80 and over, Female, Humans, Male, Marital Status, Marriage, Middle Aged, Mortality, Retirement, Sex Factors}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2016.07.025}, url = {http://www.sciencedirect.com/science/article/pii/S0277953616303860}, author = {Jennifer R. Bulanda and J Scott Brown and Takashi Yamashita} } @article {8488, title = {Self-reported herpes zoster, pain, and health care seeking in the Health and Retirement Study: implications for interpretation of health care-based studies.}, journal = {Ann Epidemiol}, volume = {26}, year = {2016}, month = {2016 06}, pages = {441-446.e3}, abstract = {

PURPOSE: To describe self-reported herpes zoster (HZ) and explore factors that could impact interpretation of results from health care-based HZ studies.

METHODS: We performed logistic regression using data from the 2008 Health and Retirement Study (HRS) to evaluate risk factors for having a history of HZ and experiencing severe HZ pain, and predictors for seeking health care for HZ.

RESULTS: Among 14,564 respondents aged >=55~years, women were more likely than men to report a history of HZ (15.7\% vs. 11.6\%, P~<~.01). Blacks (6.4\% vs. 14.7\% in whites, P~<~.01) and respondents with less than a high school diploma (12.2\% vs.14.2\% in respondents with at least a high school diploma, P~= .01) were less likely to report a history of HZ. Women, blacks, Hispanics, and those with less than a high school diploma were more likely to report severe HZ pain. Most (91.1\%) respondents sought health care for HZ; Hispanics (64.2\% vs. 92.1\% in whites, P~<~.001) and those with recurrent HZ were less likely to seek health care for HZ, whereas those with severe pain were more likely (95.4\% vs. 87.9\% in those without severe pain, P~<~.01).

CONCLUSIONS: HRS provides a new platform for studies of HZ, one which allowed us to uncover issues that warrant particular attention when interpreting results of health care-based studies.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Health Surveys, Herpes Zoster, Humans, Independent Living, Logistic Models, Male, Middle Aged, Outcome Assessment, Health Care, pain, Pain Measurement, Patient Acceptance of Health Care, Reproducibility of Results, Retirement, Risk Assessment, Self Report, Severity of Illness Index, Sex Factors, Treatment Outcome, United States}, issn = {1873-2585}, doi = {10.1016/j.annepidem.2016.04.006}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27180114}, author = {Hales, Craig M and Harpaz, Rafael and Bialek, Stephanie R} } @article {8529, title = {Using Multiple-hierarchy Stratification and Life Course Approaches to Understand Health Inequalities: The Intersecting Consequences of Race, Gender, SES, and Age.}, journal = {J Health Soc Behav}, volume = {57}, year = {2016}, month = {2016 06}, pages = {200-22}, abstract = {

This study examines how the intersecting consequences of race-ethnicity, gender, socioeconomics status (SES), and age influence health inequality. We draw on multiple-hierarchy stratification and life course perspectives to address two main research questions. First, does racial-ethnic stratification of health vary by gender and/or SES? More specifically, are the joint health consequences of racial-ethnic, gender, and socioeconomic stratification additive or multiplicative? Second, does this combined inequality in health decrease, remain stable, or increase between middle and late life? We use panel data from the Health and Retirement Study (N = 12,976) to investigate between- and within-group differences in in self-rated health among whites, blacks, and Mexican Americans. Findings indicate that the effects of racial-ethnic, gender, and SES stratification are interactive, resulting in the greatest racial-ethnic inequalities in health among women and those with higher levels of SES. Furthermore, racial-ethnic/gender/SES inequalities in health tend to decline with age. These results are broadly consistent with intersectionality and aging-as-leveler hypotheses.

}, keywords = {Age Factors, Aged, Aging, Continental Population Groups, Female, Health Status Disparities, Health Surveys, Humans, Male, Middle Aged, Sex Factors, Social Class, Socioeconomic factors}, issn = {2150-6000}, doi = {10.1177/0022146516645165}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4905600/}, author = {Tyson H Brown and Liana J Richardson and Taylor W. Hargrove and Courtney S Thomas} } @article {8294, title = {Becoming centenarians: disease and functioning trajectories of older US Adults as they survive to 100.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {70}, year = {2015}, month = {2015 Feb}, pages = {193-201}, publisher = {70}, abstract = {

BACKGROUND: Little is known about the health and functioning of individuals who become centenarians in the years prior to reaching age 100. We examined long-term trajectories of disease, disability, and cognitive function in a sample of U.S. centenarians to determine how their aging experience differs from their nonsurviving cohort counterparts, and if there is heterogeneity in the aging experience of centenarians.

METHODS: Data are from the 1993-2010 waves of the nationally representative Health and Retirement Study. Among those who had the potential to become centenarians, we identified 1,045 respondents who died before reaching age 100 and 96 who survived to their 100th birthday. Respondents, or their proxies, reported on diagnosis of six major diseases (hypertension, heart disease, lung disease, stroke, cancer, and diabetes), limitations in activities of daily living, and cognitive function.

RESULTS: As they age to 100, centenarians are generally healthier than nonsurviving members of their cohort, and a number of individuals who become centenarians reach 100 with no self-reported diseases or functional impairments. About 23\% of centenarians reached age 100 with no major chronic disease and approximately the same number had no disability (18\%). Over half (55\%) reached 100 without cognitive impairment. Disease and functioning trajectories of centenarians differ by sex, education, and marital status.

CONCLUSIONS: While some centenarians have poor health and functioning upon reaching age 100, others are able to achieve exceptional longevity in relatively good health and without loss of functioning. This study underscores the importance of examining variation in the growing centenarian population.

}, keywords = {Activities of Daily Living, Aged, 80 and over, Aging, Chronic disease, Cognition, Disability Evaluation, Educational Status, Female, Geriatric Assessment, Health Status, Health Surveys, Humans, Longevity, Longitudinal Studies, Male, Marital Status, Prospective Studies, Sex Factors, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glu124}, url = {http://biomedgerontology.oxfordjournals.org/content/70/2/193.abstract}, author = {Jennifer A Ailshire and Hiram Beltr{\'a}n-S{\'a}nchez and Eileen M. Crimmins} } @article {8330, title = {Changes in Depressive Symptoms and Incidence of First Stroke Among Middle-Aged and Older US Adults.}, journal = {J Am Heart Assoc}, volume = {4}, year = {2015}, month = {2015 May 13}, publisher = {4}, abstract = {

BACKGROUND: Although research has demonstrated that depressive symptoms predict stroke incidence, depressive symptoms are dynamic. It is unclear whether stroke risk persists if depressive symptoms remit.

METHODS AND RESULTS: Health and Retirement Study participants (n=16 178, stroke free and noninstitutionalized at baseline) were interviewed biennially from 1998 to 2010. Stroke and depressive symptoms were assessed through self-report of doctors{\textquoteright} diagnoses and a modified Center for Epidemiologic Studies - Depression scale (high was >=3 symptoms), respectively. We examined whether depressive symptom patterns, characterized across 2 successive interviews (stable low/no, onset, remitted, or stable high depressive symptoms) predicted incident stroke (1192 events) during the subsequent 2 years. We used marginal structural Cox proportional hazards models adjusted for demographics, health behaviors, chronic conditions, and attrition. We also estimated effects stratified by age (>=65 years), race or ethnicity (non-Hispanic white, non-Hispanic black, Hispanic), and sex. Stroke hazard was elevated among participants with stable high (adjusted hazard ratio 2.14, 95\% CI 1.69 to 2.71) or remitted (adjusted hazard ratio 1.66, 95\% CI 1.22 to 2.26) depressive symptoms compared with participants with stable low/no depressive symptoms. Stable high depressive symptom predicted stroke among all subgroups. Remitted depressive symptoms predicted increased stroke hazard among women (adjusted hazard ratio 1.86, 95\% CI 1.30 to 2.66) and non-Hispanic white participants (adjusted hazard ratio 1.66, 95\% CI 1.18 to 2.33) and was marginally associated among Hispanics (adjusted hazard ratio 2.36, 95\% CI 0.98 to 5.67).

CONCLUSIONS: In this cohort, persistently high depressive symptoms were associated with increased stroke risk. Risk remained elevated even if depressive symptoms remitted over a 2-year period, suggesting cumulative etiologic mechanisms linking depression and stroke.

}, keywords = {Adult, Aged, Aged, 80 and over, Aging, depression, Female, Humans, Incidence, Longitudinal Studies, Male, Middle Aged, Proportional Hazards Models, Risk Factors, Sex Factors, Stroke, Time Factors}, issn = {2047-9980}, doi = {10.1161/JAHA.115.001923}, author = {Stefan Walter and Eric J. Tchetgen Tchetgen and Kristen K Patton and J Robin Moon and Benjamin D Capistrant and Jessica R Marden and Laura D Kubzansky and Paola Gilsanz and Ichiro Kawachi and M. Maria Glymour} } @article {8314, title = {Childhood and later life stressors and increased inflammatory gene expression at older ages.}, journal = {Soc Sci Med}, volume = {130}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Apr}, pages = {16-22}, publisher = {130}, abstract = {

Adverse experiences in early life have the ability to "get under the skin" and affect future health. This study examined the relative influence of adversities during childhood and adulthood in accounting for individual differences in pro-inflammatory gene expression in late life. Using a pilot-sample from the Health and Retirement Study (N = 114) aged from 51 to 95, OLS regression models were run to determine the association between a composite score from three proinflammatory gene expression levels (PTGS2, ILIB, and IL8) and 1) childhood trauma, 2) childhood SES, 3) childhood health, 4) adult traumas, and 5) low SES in adulthood. Our results showed that only childhood trauma was found to be associated with increased inflammatory transcription in late life. Furthermore, examination of interaction effects showed that childhood trauma exacerbated the influence of low SES in adulthood on elevated levels of inflammatory gene expression-signifying that having low SES in adulthood was most damaging for persons who had experienced traumatic events during their childhood. Overall our study suggests that traumas experienced during childhood may alter the stress response, leading to more sensitive reactivity throughout the lifespan. As a result, individuals who experienced greater adversity in early life may be at higher risk of late life health outcomes, particularly if adulthood adversity related to SES persists.

}, keywords = {Adolescent, Age Factors, Aged, Aged, 80 and over, Body Mass Index, Continental Population Groups, Cyclooxygenase 2, Female, Health Status, Health Surveys, Humans, Interleukin-1beta, Interleukin-8, Life Change Events, Male, Middle Aged, Obesity, RNA, Sex Factors, Smoking, Socioeconomic factors, Stress, Psychological}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2015.01.030}, author = {Morgan E. Levine and Steven W. Cole and David R Weir and Eileen M. Crimmins} } @article {8296, title = {Disaggregating activities of daily living limitations for predicting nursing home admission.}, journal = {Health Serv Res}, volume = {50}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Apr}, pages = {560-78}, publisher = {50}, abstract = {

OBJECTIVE: To examine whether disaggregated activities of daily living (ADL) limitations better predict the risk of nursing home admission compared to conventionally used ADL disability counts.

DATA SOURCES: We used panel data from the Health and Retirement Study (HRS) for years 1998-2010. The HRS is a nationally representative survey of adults older than 50 years (n = 18,801).

STUDY DESIGN: We fitted Cox regressions in a continuous time survival model with age at first nursing home admission as the outcome. Time-varying ADL disability types were the key explanatory variables.

PRINCIPAL FINDINGS: Of the six ADL limitations, bathing difficulty emerged as the strongest predictor of subsequent nursing home placement across cohorts. Eating and dressing limitations were also influential in driving admissions among more recent cohorts. Using simple ADL counts for analysis yielded similar adjusted R(2) s; however, the amount of explained variance doubled when we allowed the ADL disability measures to time-vary rather than remain static.

CONCLUSIONS: Looking beyond simple ADL counts can provide health professionals insights into which specific disability types trigger long-term nursing home use. Functional disabilities measured closer in time carry more prognostic power than static measures.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Female, Geriatric Assessment, Homes for the Aged, Humans, Male, Middle Aged, Nursing homes, Patient Admission, Residence Characteristics, Risk Factors, Sex Factors, Socioeconomic factors}, issn = {1475-6773}, doi = {10.1111/1475-6773.12235}, author = {Joelle H Fong and Olivia S. Mitchell and Benedict S K Koh} } @article {8307, title = {The effects of income on mental health: evidence from the social security notch.}, journal = {J Ment Health Policy Econ}, volume = {18}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Mar}, pages = {27-37}, publisher = {18}, abstract = {

BACKGROUND: Mental health is a key component of overall wellbeing and mental disorders are relatively common, including among older adults. Yet the causal effect of income on mental health status among older adults is poorly understood.

AIMS: This paper considers the effects of a major source of transfer income, Social Security retirement benefits, on the mental health of older adults.

METHODS: The Social Security benefit "Notch" is as a large, permanent, and exogenous shock to Social Security income in retirement. The "Notch" is used to identify the causal effect of Social Security income on mental health among older ages using data from the AHEAD cohort of the Health and Retirement Study.

RESULTS: We find that increases in Social Security income significantly improve mental health status and the likelihood of a psychiatric diagnosis for women, but not for men.

DISCUSSION: The effects of income on mental health for older women are statistically significant and meaningful in magnitude. While this is one of the only studies to use plausibly exogenous variation in household income to identify the effect of income on mental health, a limitation of this work is that the results only directly pertain to lower-education households.

IMPLICATIONS: Public policy proposals that alter retirement benefits for the elderly may have important effects on the mental health of older adults.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Female, Humans, Income, Male, Mental Health, Models, Econometric, Retirement, Sex Factors, Social Security, Socioeconomic factors, United States}, issn = {1091-4358}, author = {Ezra Golberstein} } @article {8313, title = {Functional impairment and hospital readmission in Medicare seniors.}, journal = {JAMA Intern Med}, volume = {175}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Apr}, pages = {559-65}, publisher = {175}, abstract = {

IMPORTANCE: Medicare currently penalizes hospitals for high readmission rates for seniors but does not account for common age-related syndromes, such as functional impairment.

OBJECTIVE: To assess the effects of functional impairment on Medicare hospital readmissions given the high prevalence of functional impairments in community-dwelling seniors.

DESIGN, SETTING, AND PARTICIPANTS: We created a nationally representative cohort of 7854 community-dwelling seniors in the Health and Retirement Study, with 22,289 Medicare hospitalizations from January 1, 2000, through December 31, 2010.

MAIN OUTCOMES AND MEASURES: Outcome was 30-day readmission assessed by Medicare claims. The main predictor was functional impairment determined from the Health and Retirement Study interview preceding hospitalization, stratified into the following 5 levels: no functional impairments, difficulty with 1 or more instrumental activities of daily living, difficulty with 1 or more activities of daily living (ADL), dependency (need for help) in 1 to 2 ADLs, and dependency in 3 or more ADLs. Adjustment variables included age, race/ethnicity, sex, annual income, net worth, comorbid conditions (Elixhauser score from Medicare claims), and prior admission. We performed multivariable logistic regression to adjust for clustering at the patient level to characterize the association of functional impairments and readmission.

RESULTS: Patients had a mean (SD) age of 78.5 (7.7) years (range, 65-105 years); 58.4\% were female, 84.9\% were white, 89.6\% reported 3 or more comorbidities, and 86.0\% had 1 or more hospitalizations in the previous year. Overall, 48.3\% had some level of functional impairment before admission, and 15.5\% of hospitalizations were followed by readmission within 30 days. We found a progressive increase in the adjusted risk of readmission as the degree of functional impairment increased: 13.5\% with no functional impairment, 14.3\% with difficulty with 1 or more instrumental activities of daily living (odds ratio [OR], 1.06; 95\% CI, 0.94-1.20), 14.4\% with difficulty with 1 or more ADL (OR, 1.08; 95\% CI, 0.96-1.21), 16.5\% with dependency in 1 to 2 ADLs (OR, 1.26; 95\% CI, 1.11-1.44), and 18.2\% with dependency in 3 or more ADLs (OR, 1.42; 95\% CI, 1.20-1.69). Subanalysis restricted to patients admitted with conditions targeted by Medicare (ie, heart failure, myocardial infarction, and pneumonia) revealed a parallel trend with larger effects for the most impaired (16.9\% readmission rate for no impairment vs 25.7\% for dependency in 3 or more ADLs [OR, 1.70; 95\% CI, 1.04-2.78]).

CONCLUSIONS AND RELEVANCE: Functional impairment is associated with increased risk of 30-day all-cause hospital readmission in Medicare seniors, especially those admitted for heart failure, myocardial infarction, or pneumonia. Functional impairment may be an important but underaddressed factor in preventing readmissions for Medicare seniors.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Cohort Studies, Comorbidity, Female, Heart Failure, Humans, Income, Logistic Models, Male, Medicare, Myocardial Infarction, Patient Readmission, Pneumonia, Risk Assessment, Risk Factors, Sex Factors, United States}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2014.7756}, author = {S. Ryan Greysen and Irena Cenzer and Andrew D. Auerbach and Kenneth E Covinsky} } @article {8163, title = {Measurement Invariance of Cognitive Abilities Across Ethnicity, Gender, and Time Among Older Americans.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 May}, pages = {386-97}, publisher = {70}, abstract = {

OBJECTIVES: The aim of this research was to test the invariance of the cognitive variables in the Health and Retirement Study/Asset Health Dynamics Among the Oldest Old studies (HRS/AHEAD) across ethnicity, gender, and time.

METHOD: Analyses were conducted using a selected subsample of the HRS/AHEAD data set. The cognitive performance tests measuring episodic memory and mental status were used, and invariance of a two-factor structure was tested using confirmatory factor analyses and multilevel modeling for longitudinal data.

RESULTS: Results provided some support for "strict" factorial invariance of the episodic memory and mental status measures across ethnicity and gender. Further support of weak ("metric") measurement invariance was found across time.

DISCUSSION: Results of the research further our understanding of invariance of the HRS/AHEAD cognitive ability measures. Further implications are discussed.

}, keywords = {Aged, Aged, 80 and over, Black People, Female, Hispanic or Latino, Humans, Male, Memory, Episodic, Mental Processes, Middle Aged, Neuropsychological tests, Psychometrics, Psychomotor Performance, Reproducibility of Results, Sex Factors, Time Factors, United States, White People}, issn = {1758-5368}, doi = {10.1093/geronb/gbt106}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2013/10/25/geronb.gbt106.abstract}, author = {A Nayena Blankson and John J McArdle} } @article {8240, title = {Social Relationships, Gender, and Recovery From Mobility Limitation Among Older Americans.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 Sep}, pages = {769-81}, publisher = {70}, abstract = {

OBJECTIVES: Evidence suggests social relationships may be important facilitators for recovery from functional impairment, but the extant literature is limited in its measurement of social relationships including an over emphasis on filial social support and a paucity of nationally representative data.

METHODS: Using data from Waves 4-9 (1998-2008) of the Health and Retirement Study (HRS), this research examines the association between social relationships and recovery from severe mobility limitation (i.e., difficulty walking one block or across the room) among older Americans. Using a more nuanced measure of recovery that includes complete and partial recovery, a series of discrete-time event history models with multiple competing recovery outcomes were estimated using multinomial logistic regression.

RESULTS: Providing instrumental support to peers increased the odds of complete and partial recovery from severe mobility limitation, net of numerous social, and health factors. Having relatives living nearby decreased the odds of complete recovery, while being engaged in one{\textquoteright}s neighborhood increased the odds of partial recovery. The influence of partner status on partial and complete recovery varied by gender, whereby partnered men were more likely to experience recovery relative to partnered women. The effect of neighborhood engagement on partial recovery also varied by gender. Disengaged women were the least likely to experience partial recovery compared with any other group.

DISCUSSION: The rehabilitative potential of social relationships has important policy implications. Interventions aimed at encouraging older adults with mobility limitation to be engaged in their neighborhoods and/or provide instrumental support to peers may improve functional health outcomes.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Family, Female, Humans, Interpersonal Relations, Male, Middle Aged, Mobility Limitation, Peer Group, Recovery of Function, Residence Characteristics, Sex Factors, Social Support, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu181}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/01/11/geronb.gbu181.abstract}, author = {Kenzie Latham and Philippa J Clarke and Gregory Pavela} } @article {8029, title = {Short- and long-term associations between widowhood and mortality in the United States: longitudinal analyses.}, journal = {J Public Health (Oxf)}, volume = {36}, year = {2014}, month = {2014 Sep}, pages = {382-9}, publisher = {36}, abstract = {

BACKGROUND: Past research shows that spousal death results in elevated mortality risk for the surviving spouse. However, most prior studies have inadequately controlled for socioeconomic status (SES), and it is unclear whether this {\textquoteright}widowhood effect{\textquoteright} persists over time.

METHODS: Health and Retirement Study participants aged 50+ years and married in 1998 (n = 12 316) were followed through 2008 for widowhood status and mortality (2912 deaths). Discrete-time survival analysis was used to compare mortality for the widowed versus the married.

RESULTS: Odds of mortality during the first 3 months post-widowhood were significantly higher than in the continuously married (odds ratio (OR) for men = 1.87, 95\% CI: 1.27, 2.75; OR for women = 1.47, 95\% CI: 0.96, 2.24) in models adjusted for age, gender, race and baseline SES (education, household wealth and household income), behavioral risk factors and co-morbidities. Twelve months following bereavement, men experienced borderline elevated mortality (OR = 1.16, 95\% CI: 1.00, 1.35), whereas women did not (OR = 1.07, 95\% CI: 0.90, 1.28), though the gender difference was non-significant.

CONCLUSION: The {\textquoteright}widowhood effect{\textquoteright} was not fully explained by adjusting for pre-widowhood SES and particularly elevated within the first few months after widowhood. These associations did not differ by sex.

}, keywords = {Bereavement, Female, Humans, Longitudinal Studies, Male, Middle Aged, Mortality, Risk Factors, Sex Factors, Socioeconomic factors, Time Factors, United States, Widowhood}, issn = {1741-3850}, doi = {10.1093/pubmed/fdt101}, url = {http://jpubhealth.oxfordjournals.org/content/early/2013/10/27/pubmed.fdt101.abstract}, author = {J Robin Moon and M. Maria Glymour and Anusha M Vable and Sze Y Liu and S. V. Subramanian} } @article {8034, title = {Why do older people change their ratings of childhood health?}, journal = {Demography}, volume = {51}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Dec}, pages = {1999-2023}, publisher = {51}, abstract = {

A growing number of studies in life course epidemiology and biodemography make use of a retrospective question tapping self-rated childhood health to assess overall physical health status. Analyzing repeated measures of self-rated childhood health from the Health and Retirement Study (HRS), this study examines several possible explanations for why respondents might change their ratings of childhood health. Results reveal that nearly one-half of the sample revised their rating of childhood health during the 10-year observation period. Whites and relatively advantaged older adults-those with more socioeconomic resources and better memory-were less likely to revise their rating of childhood health, while those who experienced multiple childhood health problems were more likely to revise their childhood health rating, either positively or negatively. Changes in current self-rated health and several incident physical health problems were also related to the revision of one{\textquoteright}s rating of childhood health, while the development of psychological disorders was associated with more negative revised ratings. We then illustrate the impact that these changes may have on an adult outcomes: namely, depressive symptoms. Whereas adult ratings of childhood health are likely to change over time, we recommend their use only if adjusting for factors associated with these changes, such as memory, psychological disorder, adult self-rated health, and socioeconomic resources.

}, keywords = {Adaptation, Psychological, Age Factors, Aged, Aged, 80 and over, Aging, Female, Health Status, Humans, Male, Memory, Middle Aged, Retrospective Studies, Self Report, Sex Factors, Socioeconomic factors}, issn = {0070-3370}, doi = {10.1007/s13524-014-0344-3}, author = {Vuolo, Mike and Kenneth F Ferraro and Patricia M Morton and Ting-Ying Yang} } @article {10279, title = {Chiropractic use and changes in health among older medicare beneficiaries: a comparative effectiveness observational study.}, journal = {J Manipulative Physiol Ther}, volume = {36}, year = {2013}, month = {2013 Nov-Dec}, pages = {572-84}, abstract = {

OBJECTIVE: The purpose of this study was to investigate the effect of chiropractic on 5 outcomes among Medicare beneficiaries: increased difficulties performing activities of daily living (ADLs), instrumental ADLs (IADLs), and lower body functions, as well as lower self-rated health and increased depressive symptoms.

METHODS: Among all beneficiaries, we estimated the effect of chiropractic use on changes in health outcomes among those who used chiropractic compared with those who did not, and among beneficiaries with back conditions, we estimated the effect of chiropractic use relative to medical care, both during a 2- to 15-year period. Two analytic approaches were used--one assumed no selection bias, whereas the other adjusted for potential selection bias using propensity score methods.

RESULTS: Among all beneficiaries, propensity score analyses indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, and depressive symptoms, although there were increased risks associated with chiropractic for declines in lower body function and self-rated health. Propensity score analyses among beneficiaries with back conditions indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, lower body function, and depressive symptoms, although there was an increased risk associated with chiropractic use for declines in self-rated health.

CONCLUSION: The evidence in this study suggests that chiropractic treatment has comparable effects on functional outcomes when compared with medical treatment for all Medicare beneficiaries, but increased risk for declines in self-rated health among beneficiaries with back conditions.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Cohort Studies, Databases, Factual, Disability Evaluation, Female, Geriatric Assessment, Humans, Low Back Pain, Male, Manipulation, Chiropractic, Medicare, Mobility Limitation, Musculoskeletal Diseases, Patient Satisfaction, Quality of Life, Risk Assessment, Sex Factors, Treatment Outcome, United States}, issn = {1532-6586}, doi = {10.1016/j.jmpt.2013.08.008}, url = {https://www.ncbi.nlm.nih.gov/pubmed/24636108}, author = {Paula A Weigel and Jason Hockenberry and Suzanne E Bentler and Frederic D Wolinsky} } @article {7788, title = {Pain as a risk factor for disability or death.}, journal = {J Am Geriatr Soc}, volume = {61}, year = {2013}, note = {Date revised - 2013-05-01 Last updated - 2013-05-31 DOI - 0b2ff290-e53b-4073-a3d7csamfg102v; 17944301; 0002-8614; 1532-5415 SubjectsTermNotLitGenreText - Demography; Mortality; Mobility; Risk factors; Disabilities; Survival; Pain}, month = {2013 Apr}, pages = {583-9}, publisher = {61}, abstract = {

OBJECTIVES: To determine whether pain predicts future activity of daily living (ADL) disability or death in individuals aged 60 and older.

DESIGN: Prospective cohort study.

SETTING: The 1998 to 2008 Health and Retirement Study (HRS), a nationally representative study of older community-living individuals.

PARTICIPANTS: Twelve thousand six hundred thirty-one participants in the 1998 HRS aged 60 and older who did not need help in any ADL.

MEASUREMENTS: Participants reporting that they had moderate or severe pain most of the time were defined as having significant pain. The primary outcome was time to development of ADL disability or death over 10~yrs, assessed at five successive 2-year intervals. ADL disability was defined as needing help performing any ADL: bathing, dressing, transferring, toileting, eating, or walking across a room. A discrete hazards survival model was used to examine the relationship between pain and incident disability over each 2-year interval using only participants who started the interval with no ADL disability. Several potential confounders were adjusted for at the start of each interval: demographic factors, seven chronic health conditions, and functional limitations (ADL difficulty and difficulty with five measures of mobility).

RESULTS: At baseline, 2,283 (18\%) participants had significant pain. Participants with pain were more likely (all P~<~.001) to be female (65\% vs 54\%), have ADL difficulty (e.g., transferring 12\% vs 2\%, toileting 11\% vs 2\%), have difficulty walking several blocks (60\% vs 21\%), and have difficulty climbing one flight of stairs (40\% vs 12\%). Over 10~years, participants with pain were more likely to develop ADL disability or death (58\% vs 43\%, unadjusted hazard ratio (HR)~=~1.67, 95\% confidence interval~(CI)~=~1.57-1.79), although after adjustment for confounders, participants with pain were not at greater risk for ADL disability or death (HR~=~0.98, 95\% CI~=~0.91-1.07). Adjustment for functional status almost entirely explained the difference between the unadjusted and adjusted results.

CONCLUSION: Although there are strong cross-sectional relationships between pain and functional limitations, individuals with pain are not at higher risk of subsequent disability or death after accounting for functional limitations. Like many geriatric syndromes, pain and disability may represent interrelated phenomena that occur simultaneously and require unified treatment paradigms.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Cohort Studies, Disabled Persons, Female, Geriatric Assessment, Health Status, Humans, Life Style, Male, Middle Aged, pain, Prevalence, Prognosis, Prospective Studies, Severity of Illness Index, Sex Distribution, Sex Factors, United States}, issn = {1532-5415}, doi = {10.1111/jgs.12172}, url = {http://search.proquest.com.proxy.lib.umich.edu/docview/1356928876?accountid=14667}, author = {James S Andrews and Irena Cenzer and Yelin, Edward and Kenneth E Covinsky} } @article {7860, title = {Personality and all-cause mortality: individual-participant meta-analysis of 3,947 deaths in 76,150 adults.}, journal = {Am J Epidemiol}, volume = {178}, year = {2013}, note = {Times Cited: 0}, month = {2013 Sep 01}, pages = {667-75}, publisher = {178}, abstract = {

Personality may influence the risk of death, but the evidence remains inconsistent. We examined associations between personality traits of the five-factor model (extraversion, neuroticism, agreeableness, conscientiousness, and openness to experience) and the risk of death from all causes through individual-participant meta-analysis of 76,150 participants from 7 cohorts (the British Household Panel Survey, 2006-2009; the German Socio-Economic Panel Study, 2005-2010; the Household, Income and Labour Dynamics in Australia Survey, 2006-2010; the US Health and Retirement Study, 2006-2010; the Midlife in the United States Study, 1995-2004; and the Wisconsin Longitudinal Study{\textquoteright}s graduate and sibling samples, 1993-2009). During 444,770 person-years at risk, 3,947 participants (54.4\% women) died (mean age at baseline = 50.9 years; mean follow-up = 5.9 years). Only low conscientiousness-reflecting low persistence, poor self-control, and lack of long-term planning-was associated with elevated mortality risk when taking into account age, sex, ethnicity/nationality, and all 5 personality traits. Individuals in the lowest tertile of conscientiousness had a 1.4 times higher risk of death (hazard ratio = 1.37, 95\% confidence interval: 1.18, 1.58) compared with individuals in the top 2 tertiles. This association remained after further adjustment for health behaviors, marital status, and education. In conclusion, of the higher-order personality traits measured by the five-factor model, only conscientiousness appears to be related to mortality risk across populations.

}, keywords = {Age Factors, Anxiety Disorders, Cohort Studies, Extraversion, Psychological, Female, Humans, Male, Middle Aged, Mortality, Neuroticism, Personality, Prospective Studies, Risk Factors, Sex Factors, Socioeconomic factors}, issn = {1476-6256}, doi = {10.1093/aje/kwt170}, url = {http://www.ncbi.nlm.nih.gov/pubmed/23911610}, author = {Markus Jokela and G David Batty and Solja T. Nyberg and Virtanen, Marianna and Nabi, Hermann and Archana Singh-Manoux and Mika Kivim{\"a}ki} } @article {7800, title = {Personality profile of the children of long-lived parents.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {68}, year = {2013}, month = {2013 Sep}, pages = {730-8}, abstract = {

OBJECTIVES: Past research has shown that parental longevity is related to offspring physical health and longevity. Preliminary studies suggest that parental longevity may be linked to the offspring{\textquoteright}s personality traits. A comprehensive 5-factor personality model has been related to physical health, but the association with parental longevity has not yet been investigated. We used a 5-factor personality model to investigate the relationship between parental longevity and offspring personality.

METHOD: Data from the longitudinal Health and Retirement Study (HRS) was used in the analyses. Using the Midlife Development Inventory and the Life Orientation test, the relationship between parental attained age and offspring personality was assessed using regression models for both men and women.

RESULTS: Male offspring of long-lived fathers and mothers were more likely to be open to new experiences (p < .01) and be more extroverted (p = .03) compared with male offspring of short-lived fathers or mothers. Maternal or paternal attained age had no effect on the female offspring personality traits.

DISCUSSION: Personality is an important phenotype to consider when investigating genetic and environmental determinants of longevity. Further research is needed to investigate the potential of gender-specific mechanisms.

}, keywords = {Aged, Extraversion, Psychological, Fathers, Female, Health Status, Humans, Interviews as Topic, Longevity, Longitudinal Studies, Male, Mothers, Parents, Personality, Personality Inventory, Sex Factors}, issn = {1758-5368}, doi = {10.1093/geronb/gbt003}, author = {Evangelia E Antoniou and Ambarish Dutta and Kenneth M. Langa and David Melzer and David J Llewellyn} } @article {7941, title = {The socioeconomic origins of physical functioning among older U.S. adults.}, journal = {Adv Life Course Res}, volume = {18}, year = {2013}, month = {2013 Dec}, pages = {244-56}, publisher = {18}, abstract = {

Mounting evidence finds that adult health reflects socioeconomic circumstances (SES) in early life and adulthood. However, it is unclear how the health consequences of SES in early life and adulthood accumulate-for example, additively, synergistically. This study tests four hypotheses about how the health effects of early-life SES (measured by parental education) and adult SES (measured by own education) accumulate to shape functional limitations, whether the accumulation differs between men and women, and the extent to which key mechanisms explain the accumulation. It uses data from the 1994-2010 Health and Retirement Study on U.S. adults 50-100 years of age (N=24,026). The physical functioning benefits of parental and own education accumulated additively among men. While the physical functioning benefits generally accumulated among women, the functioning benefits from one{\textquoteright}s own education were dampened among women with low-educated mothers. The dampening partly reflected a strong tie between mothers{\textquoteright} education level and women{\textquoteright}s obesity risk. Taken together, the findings reveal subtle differences between men and women in the life course origins of physical functioning. They also shed light on a key mechanism-obesity-that may help explain why a growing number of studies find that early-life SES is especially important for women{\textquoteright}s health.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Educational Status, Female, Health Behavior, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Obesity, Sex Factors, Socioeconomic factors, United States}, issn = {1879-6974}, doi = {10.1016/j.alcr.2013.08.001}, author = {Jennifer Karas Montez} } @article {7838, title = {Is working later in life good or bad for health? An investigation of multiple health outcomes.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {68}, year = {2013}, month = {2013 Sep}, pages = {807-15}, publisher = {68}, abstract = {

OBJECTIVES: To examine the mutual influences between changes in work status and multiple dimensions of health outcomes (immediate memory, physical disability, and depressive symptoms) over later years.

METHODS: We used a subsample of 8,524 older adults who participated in the Health and Retirement Study from 1998 to 2008 and were 62 years or older in 1998 to examine work status and health outcomes after controlling for age and background characteristics.

RESULTS: We present results of cross-lagged auto-regressive models. Work status (level of work) predicted subsequent residual changes in immediate memory over time, whereas immediate memory predicted subsequent residual changes in work status over time, even after controlling for physical disability and depressive symptoms. Similar results were indicated for the associations between work status and physical disability and depressive symptoms over time.

DISCUSSION: Consistent with social causation and social selection traditions, the findings support bi-directional associations among changes in work status (the level of work), immediate memory, physical disability, and depressive symptoms in later years. Practical implications are discussed.

}, keywords = {Activities of Daily Living, Age Factors, Aged, depression, Educational Status, Employment, Female, Health Status, Humans, Longitudinal Studies, Male, Memory, Short-Term, Middle Aged, Neuropsychological tests, Psychiatric Status Rating Scales, Sex Factors}, issn = {1758-5368}, doi = {10.1093/geronb/gbt069}, author = {Kandauda Wickrama and Catherine W. O{\textquoteright}Neal and Kyung H. Kwag and Lee, Tae K.} } @article {10280, title = {Chiropractic episodes and the co-occurrence of chiropractic and health services use among older Medicare beneficiaries.}, journal = {Journal of Manipulative \& Physiological Therapeutics}, volume = {35}, year = {2012}, pages = {168-175}, abstract = {

OBJECTIVE: The purpose of this study was to define and characterize episodes of chiropractic care among older Medicare beneficiaries and to evaluate the extent to which chiropractic services were used in tandem with conventional medicine.

METHODS: Medicare Part B claims histories for 1991 to 2007 were linked to the nationally representative survey on Assets and Health Dynamics among the Oldest Old baseline interviews (1993-1994) to define episodes of chiropractic sensitive care using 4 approaches. Chiropractic and nonchiropractic patterns of service use were examined within these episodes of care. Of the 7447 Assets and Health Dynamics among the Oldest Old participants, 971 used chiropractic services and constituted the analytic sample.

RESULTS: There were substantial variations in the number and duration of episodes and the type and volume of services used across the 4 definitions. Depending on how the episode was constructed, the mean number of episodes per chiropractic user ranged from 3.74 to 23.12, the mean episode duration ranged from 4.7 to 28.8 days, the mean number of chiropractic visits per episode ranged from 0.88 to 2.8, and the percentage of episodes with co-occurrent use of chiropractic and nonchiropractic providers ranged from 4.9\% to 10.9\% over the 17-year period.

CONCLUSION: Treatment for back-related musculoskeletal conditions was sought from a variety of providers, but there was little co-occurrent service use or coordinated care across provider types within care episodes. Chiropractic treatment dosing patterns in everyday practice were much lower than that used in clinical trial protocols designed to establish chiropractic efficacy for back-related conditions.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Chiropractic, Combined Modality Therapy, Episode of Care, Female, Geriatric Assessment, Health Care Surveys, Health Services, Humans, Incidence, Insurance Claim Reporting, Low Back Pain, Medicare Part B, Musculoskeletal Diseases, Primary Health Care, Retrospective Studies, Sex Factors, Treatment Outcome, United States}, issn = {1532-6586}, doi = {10.1016/j.jmpt.2012.01.011}, author = {Paula A Weigel and Jason Hockenberry and Suzanne E Bentler and Kaskie, Brian and Frederic D Wolinsky} } @article {10933, title = {A comparison and cross-validation of models to predict basic activity of daily living dependency in older adults.}, journal = {Medical Care}, volume = {50}, year = {2012}, month = {2012 Jun}, pages = {534-9}, abstract = {

BACKGROUND: A simple method of identifying elders at high risk for activity of daily living (ADL) dependence could facilitate essential research and implementation of cost-effective clinical care programs.

OBJECTIVE: We used a nationally representative sample of 9446 older adults free from ADL dependence in 2006 to develop simple models for predicting ADL dependence at 2008 follow-up and to compare the models to the most predictive published model. Candidate predictor variables were those of published models that could be obtained from interview or medical record data.

METHODS: Variable selection was performed using logistic regression with backward elimination in a two-third random sample (n = 6233) and validated in a one-third random sample (n = 3213). Model fit was determined using the c-statistic and evaluated vis-a-vis our replication of a published model.

RESULTS: At 2-year follow-up, 8.0\% and 7.3\% of initially independent persons were ADL dependent in the development and validation samples, respectively. The best fitting, simple model consisted of age and number of hospitalizations in past 2 years, plus diagnoses of diabetes, chronic lung disease, congestive heart failure, stroke, and arthritis. This model had a c-statistic of 0.74 in the validation sample. A model of just age and number of hospitalizations achieved a c-statistic of 0.71. These compared with a c-statistic of 0.79 for the published model. Sensitivity analyses demonstrated model robustness.

CONCLUSIONS: Models based on a widely available data achieve very good validity for predicting ADL dependence. Future work will assess the validity of these models using medical record data.

}, keywords = {Accidental Falls, Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Aging, Body Mass Index, Chronic disease, Female, Humans, Male, Mobility Limitation, Models, Statistical, Risk Assessment, Sex Factors}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e318245a50c}, author = {Daniel O. Clark and Timothy E. Stump and Tu, Wanzhu and Douglas K Miller} } @article {7709, title = {Depressive symptoms in spouses of older patients with severe sepsis.}, journal = {Crit Care Med}, volume = {40}, year = {2012}, month = {2012 Aug}, pages = {2335-41}, abstract = {

OBJECTIVE: To examine whether spouses of patients with severe sepsis are at increased risk for depression independent of the spouse{\textquoteright}s presepsis history, whether this risk differs by sex, and is associated with a sepsis patient{\textquoteright}s disability after hospitalization.

DESIGN: Prospective longitudinal cohort study.

SETTING: Population-based cohort of U.S. adults over 50 yrs old interviewed as part of the Health and Retirement Study (1993-2008).

PATIENTS: Nine hundred twenty-nine patient-spouse dyads comprising 1,212 hospitalizations for severe sepsis.

MEASUREMENTS AND MAIN RESULTS: Severe sepsis was identified using a validated algorithm in Medicare claims. Depression was assessed with a modified version of the Center for Epidemiologic Studies Depression Scale. All analyses were stratified by gender. The prevalence of substantial depressive symptoms in wives of patients with severe sepsis increased by 14 percentage points at the time of severe sepsis (from 20\% at a median of 1.1 yrs presepsis to 34\% at a median of 1 yr postsepsis) with an odds ratio of 3.74 (95\% confidence interval: 2.20, 6.37), in multivariable regression. Husbands had an 8 percentage point increase in the prevalence of substantial depressive symptoms, which was not significant in multivariable regression (odds ratio 1.90, 95\% confidence interval 0.75, 4.71). The increase in depression was not explained by bereavement; women had greater odds of substantial depressive symptoms even when their spouse survived a severe sepsis hospitalization (odds ratio 2.86, 95\% confidence interval 1.06, 7.73). Wives of sepsis survivors who were disabled were more likely to be depressed (odds ratio 1.35 per activities of daily living limitation of sepsis survivor, 95\% confidence interval 1.12, 1.64); however, controlling for patient disability only slightly attenuated the association between sepsis and wives{\textquoteright} depression (odds ratio 2.61, 95\% confidence interval 0.93, 7.38).

CONCLUSIONS: Older women may be at greater risk for depression if their spouse is hospitalized for severe sepsis. Spouses of patients with severe sepsis may benefit from greater support and depression screening, both when their loved one dies and when their loved one survives.

}, keywords = {Age Factors, Aged, depression, Female, Hospitalization, Humans, Male, Multivariate Analysis, Prospective Studies, Psychiatric Status Rating Scales, Sepsis, Sex Factors, Spouses, Time Factors, United States}, issn = {1530-0293}, doi = {10.1097/CCM.0b013e3182536a81}, author = {Dimitry S Davydow and Catherine L Hough and Kenneth M. Langa and Theodore J Iwashyna} } @article {7743, title = {Determinants of retirement timing expectations in the United States and Australia: a cross-national comparison of the effects of health and retirement benefit policies on retirement timing decisions.}, journal = {J Aging Soc Policy}, volume = {24}, year = {2012}, month = {2012}, pages = {291-308}, publisher = {24}, abstract = {

Data from the U.S. Health and Retirement Study (N = 2,589) and the Australian Household Income and Labour Dynamics survey (N = 1,760) were used to compare the macro-level policy frameworks on individual retirement timing expectations for pre-baby boomers (61+ years) and early baby boomers (45 to 60 years). Australian workers reported younger expected age of retirement compared to the U.S. sample. Reporting poor health was more strongly associated with younger expected retirement age in the United States than in Australia. Cohort and gender differences in the United States were found for the effect of private health insurance on younger expected age at retirement. Our results draw attention to how cross-national comparisons can inform us on the effects of policies on retirement expectations among older workers.

}, keywords = {Activities of Daily Living, Age Factors, Australia, Cross-Cultural Comparison, Florida, Health Benefit Plans, Employee, Health Status, Humans, Job Satisfaction, Middle Aged, Pensions, Public Policy, Retirement, Sex Factors, Socioeconomic factors, Time Factors, United States}, issn = {1545-0821}, doi = {10.1080/08959420.2012.676324}, author = {K. A. Sargent-Cox and Kaarin J. Anstey and Kendig, H. and Skladzien, E.} } @article {7699, title = {Gender differences in the link between excessive drinking and domain-specific cognitive functioning among older adults.}, journal = {J Aging Health}, volume = {24}, year = {2012}, note = {.}, month = {2012 Dec}, pages = {1380-98}, abstract = {

OBJECTIVE: This study investigated gender differences in the relationship between excessive drinking and two cognitive domains among older adults.

METHOD: Using data from the Health and Retirement Study, 3,888 females and 2,350 males were analyzed separately. Multivariate regression was used to analyze the association between excessive drinking and fluid intelligence score. Logistic regression was conducted to examine the relationship between excessive drinking and crystallized intelligence.

RESULTS: Multivariate analysis showed that compared to non-excessive drinking, excessive drinking did not have a significant impact on fluid intelligence for either women or men, but it had a significantly negative association with a high crystallized intelligence score for women.

DISCUSSION: Findings suggest that the relationship between excessive drinking and cognition varies with gender when crystallized intelligence is measured. Clinicians and service providers should consider gender differences when developing strategies for the prevention and treatment of alcohol-related cognitive decline among older adults.

}, keywords = {Aged, Alcohol Drinking, Alcohol-Related Disorders, Cognition, Cognition Disorders, Cross-Sectional Studies, Female, Humans, Intelligence, Male, Multivariate Analysis, Regression Analysis, Sex Factors}, issn = {1552-6887}, doi = {10.1177/0898264312459346}, author = {Jiyoung Lyu and SeungAh H. Lee} } @article {7685, title = {The impact of socioeconomic inequalities and lack of health insurance on physical functioning among middle-aged and older adults in the United States.}, journal = {Health Soc Care Community}, volume = {20}, year = {2012}, note = {Kim, Jinhyun Richardson, Virginia England Health and social care in the community Health Soc Care Community. 2012 Jan;20(1):42-51. doi: 10.1111/j.1365-2524.2011.01012.x. Epub 2011 Jul 6.}, month = {2012 Jan}, pages = {42-51}, publisher = {20}, abstract = {

Socioeconomic inequalities and lack of private health insurance have been viewed as significant contributors to health disparities in the United States. However, few studies have examined their impact on physical functioning over time, especially in later life. The current study investigated the impact of socioeconomic inequalities and lack of private health insurance on individuals{\textquoteright} growth trajectories in physical functioning, as measured by activities of daily living. Data from the Health and Retirement Study (1994-2006) were used for this study, 6519 black and white adults who provided in-depth information about health, socioeconomic, financial and health insurance information were analysed. Latent growth curve modelling was used to estimate the initial level of physical functioning and its rate of change over time. Results showed that higher level of income and assets and having private health insurance significantly predicted better physical functioning. In particular, decline in physical functioning was slower among those who had private health insurance. Interestingly, changes in economic status, such as decreases in income and assets, had a greater impact on women{\textquoteright}s physical functioning than on men{\textquoteright}s. Black adults did not suffer more rapid declines in physical functioning than white adults after controlling for socioeconomic status. The current longitudinal study suggested that anti-poverty and health insurance policies should be enhanced to reduce the negative impact of socioeconomic inequalities on physical functioning throughout an individual{\textquoteright}s life course.

}, keywords = {Activities of Daily Living, Aged, Black or African American, Female, Health Status, Healthcare Disparities, Humans, Longitudinal Studies, Male, Medically Uninsured, Middle Aged, Poverty, Sex Factors, Socioeconomic factors, Time Factors, United States, White People}, issn = {1365-2524}, doi = {10.1111/j.1365-2524.2011.01012.x}, author = {Kim, Jinhyun and Virginia E. Richardson} } @article {7735, title = {Marriage, gender and obesity in later life.}, journal = {Econ Hum Biol}, volume = {10}, year = {2012}, month = {2012 Dec}, pages = {431-53}, abstract = {

A large body of literature argues that marriage promotes health and increases longevity. But do these benefits extend to maintaining a healthy body weight, as the economic theory of health investment suggests they should? They do not. Using the Health and Retirement Study (HRS), I find that entry into marriage among both men and women aged 51-70 is associated with weight gain and exit from marriage with weight loss. I evaluate three additional theories with respect to the cross-sectional and longitudinal variation in the data. First, it may be that a broader set of shared risk factors (such as social obligations regarding meals) raises body mass for married couples. However, the shared risk factor model predicts that the intra-couple correlation should increase with respect to marital duration. Instead, it declines. Second, scholars have recently promoted a "crisis" model of marriage in which marital transitions, not marital status, determine differences in body mass. The crisis model is consistent with short-term effects seen for divorce, but not for the persistent weight gains associated with marriage or the persistent weight loss following widowhood. And transition models, in general, cannot explain significant cross-sectional differences across marital states in a population that is no longer experiencing many transitions, nor can it account for the prominent gender differences (in late middle-age, the heaviest group is unmarried women and the lightest are unmarried men). Third, I argue that pressures of the marriage market, in combination with gendered preferences regarding partner BMI, can account for all the longitudinal and cross-sectional patterns found in the data.

}, keywords = {Age Factors, Aged, Body Mass Index, Female, Humans, Male, Marital Status, Middle Aged, Models, Statistical, Obesity, Sex Factors, United States, Weight Gain, Weight Loss}, issn = {1873-6130}, doi = {10.1016/j.ehb.2012.04.012}, author = {Sven E. Wilson} } @article {7620, title = {Overestimation of physical activity among a nationally representative sample of underactive individuals with diabetes.}, journal = {Med Care}, volume = {50}, year = {2012}, note = {Medical care Med Care. 2011 Dec 20.}, month = {2012 May}, pages = {441-5}, abstract = {

OBJECTIVES: Using data from the national Health and Retirement Study, we sought to: (a) estimate the proportion of the US adults with diabetes above the age of 50 who do not meet physical activity guidelines but believe they are sufficiently active; and (b) examine demographic and health-related correlates of such "overestimation."

RESEARCH DESIGN: Respondents who were classified as underactive according to a detailed activity inventory but reported exercising at least the "right amount," were designated as overestimating their physical activity. Multiple logistic regression was used to examine the association of demographic and health-related correlates with the odds of overestimation.

RESULTS: Fifty-four percent of the survey sample did not meet physical activity guidelines, and one quarter of this underactive group overestimated their physical activity. The adjusted odds of overestimation were higher among respondents who held the perception that they were about the right weight or underweight [odds ratio (OR)=2.42; 95\% confidence interval (CI), 1.49-3.94), who had good or better self-assessed diabetes control (OR=1.84; 95\% CI, 1.12-3.04), and who were Black or Hispanic (OR=1.89; 95\% CI, 1.13-3.16). Experiencing shortness of breath reduced the odds of overestimation (OR=0.34; 95\% CI, 0.19-0.61).

CONCLUSIONS: Overestimation of physical activity is common among adults with diabetes, and is associated with the perceptions that one is about the right weight and that one has good control of diabetes, and with being Black or Hispanic. Clinicians should be aware that these factors may affect their patients{\textquoteright} beliefs about how much physical activity is adequate.

}, keywords = {Age Factors, Data collection, Diabetes Mellitus, Disclosure, Dyspnea, Exercise, Female, Guideline Adherence, Guidelines as Topic, Health Status, Humans, Male, Middle Aged, Sedentary Behavior, Sex Factors, Socioeconomic factors, United States}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e3182422a52}, author = {Mary R Janevic and Sara J McLaughlin and Cathleen M. Connell} } @article {7702, title = {Transition to retirement and risk of cardiovascular disease: prospective analysis of the US health and retirement study.}, journal = {Soc Sci Med}, volume = {75}, year = {2012}, month = {2012 Aug}, pages = {526-30}, publisher = {75}, abstract = {

Transitioning from work to retirement could be either beneficial or harmful for health. We investigated the association between transition to retirement and risk of stroke and myocardial infarction (MI). We followed US Health and Retirement Study participants age 50+ working full-time for pay and free of major cardiovascular disease (n = 5422) in 1998 up to 10 years for transition to full retirement and self- or proxy-report of either stroke or MI (CVD; 665 events). We used discrete-time survival analysis to compare the CVD incidence for the fully retired versus the full-time working population. To distinguish short-term from long-term risks, we compared the association in the first year after retirement to estimates 2+ years after retirement. In the full model adjusting for age, sex, childhood and adult SES, behavior, and co-morbidities, being retired was associated with elevated odds of CVD onset (OR = 1.40, 95\% CI: 1.04, 1.90) compared to those remaining in the full-time labor force. The odds ratio for CVD incidence within the first year of retirement was 1.55 (95\% CI: 1.03, 2.33). From the second year post-retirement and thereafter, the retired had marginally elevated risk of CVD compared to those still working (OR = 1.35; 95\% CI: 0.96, 1.91). Although confidence intervals were wide for some sub-groups, there were no significant interactions by sex or socioeconomic status. Results suggest that CVD risk is increased after retirement.

}, keywords = {Age Factors, Aged, Cardiovascular Diseases, Female, Health Behavior, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Retirement, Risk Factors, Sex Factors, Socioeconomic factors, Survival Analysis, Time Factors, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2012.04.004}, author = {J Robin Moon and M. Maria Glymour and Subramanian, S V and Mauricio Avendano and Ichiro Kawachi} } @article {7631, title = {Assessment of cognition using surveys and neuropsychological assessment: the Health and Retirement Study and the Aging, Demographics, and Memory Study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66 Suppl 1}, year = {2011}, note = {Crimmins, Eileen M Kim, Jung Ki Langa, Kenneth M Weir, David R P30 AG17265/AG/NIA NIH HHS/United States U01 AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States The journals of gerontology. Series B, Psychological sciences and social sciences J Gerontol B Psychol Sci Soc Sci. 2011 Jul;66 Suppl 1:i162-71.}, month = {2011 Jul}, pages = {i162-71}, publisher = {66 Suppl 1}, abstract = {

OBJECTIVES: This study examines the similarity of cognitive assessments using 1 interview in a large population study, the Health and Retirement Study (HRS), and a subsample in which a detailed neuropsychiatric assessment has been performed (Aging, Demographics, and Memory Study [ADAMS]).

METHODS: Respondents are diagnosed in ADAMS as demented, cognitively impaired without dementia (CIND), or as having normal cognitive function. Multinomial logistic analysis is used to predict diagnosis using a variety of cognitive and noncognitive measures from the HRS and additional measures and information from ADAMS.

RESULTS: The cognitive tests in HRS predict the ADAMS diagnosis in 74\% of the sample able to complete the HRS survey on their own. Proxy respondents answer for a large proportion of HRS respondents who are diagnosed as demented in ADAMS. Classification of proxy respondents with some cognitive impairment can be predicted in 86\% of the sample. Adding a small number of additional tests from ADAMS can increase each of these percentages to 84\% and 93\%, respectively.

DISCUSSION: Cognitive assessment appropriate for diagnosis of dementia and CIND in large population surveys could be improved with more targeted information from informants and additional cognitive tests targeting other areas of brain function.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Cognition, Cognition Disorders, Dementia, Educational Status, Female, Humans, Interviews as Topic, Logistic Models, Longitudinal Studies, Male, Multivariate Analysis, Neuropsychological tests, Odds Ratio, Prevalence, Sex Factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr048}, author = {Eileen M. Crimmins and Jung K Kim and Kenneth M. Langa and David R Weir} } @article {7657, title = {Education and health: evidence on adults with diabetes.}, journal = {Int J Health Care Finance Econ}, volume = {11}, year = {2011}, note = {Ayyagari, Padmaja Grossman, Daniel Sloan, Frank 2R37-AG-17473-05A1/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States International journal of health care finance and economics Int J Health Care Finance Econ. 2011 Mar;11(1):35-54. Epub 2011 Jan 7.}, month = {2011 Mar}, pages = {35-54}, publisher = {11}, abstract = {

Although the education-health relationship is well documented, pathways through which education influences health are not well understood. This study uses data from a 2003-2004 cross sectional supplemental survey of respondents to the longitudinal Health and Retirement Study (HRS) who had been diagnosed with diabetes mellitus to assess effects of education on health and mechanisms underlying the relationship. The supplemental survey provides rich detail on use of personal health care services (e.g., adherence to guidelines for diabetes care) and personal attributes which are plausibly largely time invariant and systematically related to years of schooling completed, including time preference, self-control, and self-confidence. Educational attainment, as measured by years of schooling completed, is systematically and positively related to time to onset of diabetes, and conditional on having been diagnosed with this disease on health outcomes, variables related to efficiency in health production, as well as use of diabetes specialists. However, the marginal effects of increasing educational attainment by a year are uniformly small. Accounting for other factors, including child health and child socioeconomic status which could affect years of schooling completed and adult health, adult cognition, income, and health insurance, and personal attributes from the supplemental survey, marginal effects of educational attainment tend to be lower than when these other factors are not included in the analysis, but they tend to remain statistically significant at conventional levels.

}, keywords = {Aged, Cognition, Cross-Sectional Studies, Diabetes Complications, Diabetes Mellitus, Female, Health Behavior, Health Knowledge, Attitudes, Practice, Health Services, Humans, Male, Patient Education as Topic, Self Efficacy, Sex Factors, Socioeconomic factors, Time Factors}, issn = {1573-6962}, doi = {10.1007/s10754-010-9087-x}, author = {Padmaja Ayyagari and Grossman, Daniel and Frank A Sloan} } @article {7503, title = {Gender differences in health: results from SHARE, ELSA and HRS.}, journal = {Eur J Public Health}, volume = {21}, year = {2011}, month = {2011 Feb}, pages = {81-91}, abstract = {

BACKGROUND: We examine gender differences in health at ages 50 years and older in 11 European countries, England and the USA.

METHODS: We use the Survey of Health, Ageing and Retirement (SHARE) for 11 Continental European countries; the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS) for the USA to examine gender differences in health behaviours, functioning problems, disability, disease prevalence and self-rated health.

RESULTS: Women in all countries are more likely than men to have disabling, non-lethal conditions including functioning problems [odds ratio (OR) indicating the effect of female is 1.57-2.43], IADL difficulties (OR 1.45-2.94), arthritis (OR 1.46-2.90) and depressive symptoms (OR 1.45-3.35). On the other hand, self-reported heart disease is more common among men (OR indicating effect of female ranges from 0.43 to 0.86). These differences are not eliminated by controlling for smoking behaviour and weight. Self-reported hypertension (OR 0.72-1.53) is generally more common among women; stroke and diabetes do not show consistent sex differences. While subjective assessment of health is poorer among women, this is not true when indicators of functioning, disability and diseases are controlled.

CONCLUSION: There is remarkable consistency in direction of gender differences in health across these 13 countries. The size of the differences is affected in many cases by the similarity in behaviours of men and women.

}, keywords = {Activities of Daily Living, Aged, Aging, Body Weights and Measures, Chronic disease, Employment, Female, Global Health, Health Behavior, Health Status, Humans, Male, Middle Aged, Self Report, Sex Factors}, issn = {1464-360X}, doi = {10.1093/eurpub/ckq022}, author = {Eileen M. Crimmins and Jung K Kim and Sole-Auro, Aida} } @article {7667, title = {Higher education delays and shortens cognitive impairment: a multistate life table analysis of the US Health and Retirement Study.}, journal = {Eur J Epidemiol}, volume = {26}, year = {2011}, month = {2011 May}, pages = {395-403}, publisher = {26}, abstract = {

Improved health may extend or shorten the duration of cognitive impairment by postponing incidence or death. We assess the duration of cognitive impairment in the US Health and Retirement Study (1992-2004) by self reported BMI, smoking and levels of education in men and women and three ethnic groups. We define multistate life tables by the transition rates to cognitive impairment, recovery and death and estimate Cox proportional hazard ratios for the studied determinants. 95\% confidence intervals are obtained by bootstrapping. 55 year old white men and women expect to live 25.4 and 30.0 years, of which 1.7 [95\% confidence intervals 1.5; 1.9] years and 2.7 [2.4; 2.9] years with cognitive impairment. Both black men and women live 3.7 [2.9; 4.5] years longer with cognitive impairment than whites, Hispanic men and women 3.2 [1.9; 4.6] and 5.8 [4.2; 7.5] years. BMI makes no difference. Smoking decreases the duration of cognitive impairment with 0.8 [0.4; 1.3] years by high mortality. Highly educated men and women live longer, but 1.6 years [1.1; 2.2] and 1.9 years [1.6; 2.6] shorter with cognitive impairment than lowly educated men and women. The effect of education is more pronounced among ethnic minorities. Higher life expectancy goes together with a longer period of cognitive impairment, but not for higher levels of education: that extends life in good cognitive health but shortens the period of cognitive impairment. The increased duration of cognitive impairment in minority ethnic groups needs further study, also in Europe.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Body Mass Index, Cognition Disorders, Educational Status, Female, Health Surveys, Humans, Incidence, Life Expectancy, Life Tables, Male, Middle Aged, Prevalence, Proportional Hazards Models, Retirement, Sex Factors, Smoking, Time Factors, United States}, issn = {1573-7284}, doi = {10.1007/s10654-011-9553-x}, author = {Mieke Reuser and Frans J Willekens and Luc G Bonneux} } @article {7602, title = {Job strain, depressive symptoms, and drinking behavior among older adults: results from the health and retirement study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, month = {2011 Jul}, pages = {426-34}, publisher = {66B}, abstract = {

OBJECTIVE: To examine the relationship between job strain and two indicators of mental health, depression and alcohol misuse, among currently employed older adults.

METHOD: Data come from the 2004 and 2006 waves of the Health and Retirement Study (N = 2,902). Multivariable logistic regression modeling was used to determine the association between job strain, indicated by the imbalance of job stress and job satisfaction, with depression and alcohol misuse.

RESULTS: High job strain (indicated by high job stress combined with low job satisfaction) was associated with elevated depressive symptoms (odds ratio [OR] = 2.98, 95\% confidence interval [CI]: 1.99-4.45) relative to low job strain after adjusting for sociodemographic characteristics, labor force status, and occupation. High job stress combined with high job satisfaction (OR = 1.93) and low job stress combined with low job satisfaction (OR = 1.94) were also associated with depressive symptoms to a lesser degree. Job strain was unrelated to either moderate or heavy drinking. These associations did not vary by gender or age.

DISCUSSION: Job strain is associated with elevated depressive symptoms among older workers. In contrast to results from investigations of younger workers, job strain was unrelated to alcohol misuse. These findings can inform the development and implementation of workplace health promotion programs that reflect the mental health needs of the aging workforce.

}, keywords = {Age Factors, Aged, Alcoholism, Cohort Studies, Depressive Disorder, Female, Health Behavior, Health Surveys, Humans, Job Satisfaction, Logistic Models, Male, Middle Aged, Multivariate Analysis, Prospective Studies, Retirement, Sex Factors, Statistics as Topic, Stress, Psychological, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr021}, author = {Briana Mezuk and Amy S B Bohnert and Scott M Ratliff and Zivin, Kara} } @article {7653, title = {Partner caregiving in older cohabiting couples.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, note = {Noel-Miller, Claire M Research Support, N.I.H., Extramural United States The journals of gerontology. Series B, Psychological sciences and social sciences J Gerontol B Psychol Sci Soc Sci. 2011 May;66(3):341-53. Epub 2011 Apr 11.}, month = {2011 May}, pages = {341-53}, publisher = {66}, abstract = {

OBJECTIVES: Despite the rapidly increasing prevalence of cohabitation among older adults, the caregiving literature has exclusively focused on formally married individuals. Extending prior work on intra-couple care, this study contrasts frail cohabitors{\textquoteright} patterns of care receipt from a partner to that of frail spouses.

METHODS: Using nationally representative panel data from the Health and Retirement Study (2000, 2002, 2004, and 2006), we estimate random effects cross-sectional times series models predicting frail cohabitors{\textquoteright} likelihood of receiving partner care compared with their married counterparts{\textquoteright}. Conditional on the receipt of intra-couple care, we also examine differences in marital and nonmarital partners{\textquoteright} caregiving hours and caregiving involvement relative to other helpers.

RESULTS: Net of sociodemographic, disability, and comorbidity factors, we find that cohabitors are less likely to receive partner care than married individuals. However, caregiving nonmarital partners provide as many hours of care as spouses while providing a substantially larger share of disabled respondents{\textquoteright} care than marital partners.

DISCUSSION: Cohabitation and marriage have distinct implications for older adults{\textquoteright} patterns of partner care receipt. This study adds weight to a growing body of research emphasizing the importance of accounting for older adults{\textquoteright} nontraditional union forms and of examining the ramifications of cohabitation for older adults{\textquoteright} well-being.

}, keywords = {Aged, Caregivers, Disabled Persons, Family Characteristics, Female, Frail Elderly, Humans, Interpersonal Relations, Male, Marriage, Middle Aged, Sex Factors, Single Person, Social Support}, issn = {1758-5368}, doi = {10.1093/geronb/gbr027}, author = {Claire No{\"e}l-Miller} } @article {7547, title = {Socioeconomic inequalities in self-rated health among middle-aged and older adults.}, journal = {Soc Work Health Care}, volume = {50}, year = {2011}, month = {2011}, pages = {124-42}, publisher = {50}, abstract = {

Despite increased attention to health disparities in the United States, few studies have examined the impact of socioeconomic inequalities on self-rated health over time. Using data from the Health and Retirement Study, this article investigates socioeconomic inequalities in self-rated health among middle-aged and older adults. The findings indicated that higher level of income, assets, and education, and having private health insurance predicted better self-rated health. In particular, increases in income or assets predicted slower decline in self-rated health. Interestingly, economic status had greater impact on females{\textquoteright} decline in self-rated health. Blacks were less likely to suffer rapid decline in self-rated health than were whites. The findings led to the conclusion that health disparities should be understood as the interplay of socioeconomic status, gender, and race/ethnicity.

}, keywords = {Aged, Female, Health Status Disparities, Humans, Insurance Coverage, Insurance, Health, Male, Middle Aged, Self Report, Sex Factors, Socioeconomic factors}, issn = {1541-034X}, doi = {10.1080/00981389.2010.527787}, author = {Kim, Jinhyun} } @article {7596, title = {Understanding how race/ethnicity and gender define age-trajectories of disability: an intersectionality approach.}, journal = {Soc Sci Med}, volume = {72}, year = {2011}, month = {2011 Apr}, pages = {1236-48}, publisher = {72}, abstract = {

A number of studies have demonstrated wide disparities in health among racial/ethnic groups and by gender, yet few have examined how race/ethnicity and gender intersect or combine to affect the health of older adults. The tendency of prior research to treat race/ethnicity and gender separately has potentially obscured important differences in how health is produced and maintained, undermining efforts to eliminate health disparities. The current study extends previous research by taking an intersectionality approach (Mullings \& Schulz, 2006), grounded in life course theory, conceptualizing and modeling trajectories of functional limitations as dynamic life course processes that are jointly and simultaneously defined by race/ethnicity and gender. Data from the nationally representative 1994-2006 US Health and Retirement Study and growth curve models are utilized to examine racial/ethnic/gender differences in intra-individual change in functional limitations among White, Black and Mexican American Men and Women, and the extent to which differences in life course capital account for group disparities in initial health status and rates of change with age. Results support an intersectionality approach, with all demographic groups exhibiting worse functional limitation trajectories than White Men. Whereas White Men had the lowest disability levels at baseline, White Women and racial/ethnic minority Men had intermediate disability levels and Black and Hispanic Women had the highest disability levels. These health disparities remained stable with age-except among Black Women who experience a trajectory of accelerated disablement. Dissimilar early life social origins, adult socioeconomic status, marital status, and health behaviors explain the racial/ethnic disparities in functional limitations among Men but only partially explain the disparities among Women. Net of controls for life course capital, Women of all racial/ethnic groups have higher levels of functional limitations relative to White Men and Men of the same race/ethnicity. Findings highlight the utility of an intersectionality approach to understanding health disparities.

}, keywords = {Age Factors, Black or African American, Disability Evaluation, Disabled Persons, Female, Health Status Disparities, Health Surveys, Hispanic or Latino, Humans, Male, Middle Aged, Models, Statistical, Models, Theoretical, Sex Factors, Social Class, United States, White People}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2011.02.034}, author = {David F Warner and Tyson H Brown} } @article {7460, title = {Alcohol-consumption trajectories and associated characteristics among adults older than age 50.}, journal = {J Stud Alcohol Drugs}, volume = {71}, year = {2010}, month = {2010 Mar}, pages = {169-79}, publisher = {71}, abstract = {

OBJECTIVE: This study examined changes in drinking behavior after age 50 and baseline personal characteristics and subsequent life events associated with different alcohol-consumption trajectories during a 14-year follow-up period.

METHOD: Data were taken from the Health and Retirement Study. The study sample included individuals ages 51-61 in 1992 who survived the sample period (1992-2006) and had at least five interviews with alcohol consumption information, yielding an analysis sample of 6,787 (3,760 women). We employed linear regression to determine drinking trajectories over 1992-2006. Based on these findings, each sample person was classified into one of five drinking categories. We used multinomial logit analysis to assess the relationship between personal demographic, income, health, and attitudinal characteristics as well as life events and drinking-trajectory category.

RESULTS: Overall, alcohol consumption declined. However, rates of decline differed appreciably among sample persons, and for a minority, alcohol consumption increased. Persons with increasing consumption over time were more likely to be affluent (relative-risk ratio [RRR] = 1.09, 95\% CI [1.05, 1.12]), highly educated (RRR = 1.20, 95\% CI [1.09, 1.31]), male, White (RRR = 3.54, 95\% CI [1.01, 12.39]), unmarried, less religious, and in excellent to good health. A history of problem drinking before baseline was associated with increases in alcohol use, whereas the reverse was true for persons with histories of few or no drinking problems.

CONCLUSIONS: There are substantial differences in drinking trajectories at the individual level in midlife and late life. A problem-drinking history is predictive of alcohol consumption patterns in later life.

}, keywords = {Age Factors, Alcohol Drinking, Alcohol-Related Disorders, Educational Status, Female, Follow-Up Studies, Health Status, Health Surveys, Humans, Life Change Events, Linear Models, Male, Middle Aged, Sex Factors, Socioeconomic factors, Time Factors}, issn = {1938-4114}, doi = {10.15288/jsad.2010.71.169}, author = {Alyssa C Platt and Frank A Sloan and Philip Costanzo} } @article {7493, title = {Direct and indirect effects of obesity on U.S. labor market outcomes of older working age adults.}, journal = {Soc Sci Med}, volume = {71}, year = {2010}, note = {Using Smart Source Parsing pp. Jul Elsevier Science, Amsterdam The Netherlands}, month = {2010 Jul}, pages = {405-413}, publisher = {71}, abstract = {

In this paper, we study the impact of obesity on labor market decisions of older working age adults in USA. Labor market outcomes are defined as any one of three: working; not working due to a disability; or not working due to an early retirement. Based on existing medical literature, we deduce that obesity can largely impact labor market decisions directly through impairment of bodily functions and indirectly by being a risk factor for various diseases like hypertension, arthritis, etc. We use data from the US Health and Retirement Study on older adults who were no more than 64 years of age in 2002. In our modeling effort, we employ two estimation strategies. We first estimate a model in which employment outcome in 2002 is a function of weight status in 1992. In the second strategy, controlling for time-invariant individual heterogeneity, we first consider the impact of obesity on bodily impairments and chronic illnesses; then, we consider the impact of such impairments and illnesses on labor market outcomes. Our results indicate that, for men, obesity class 2 and 3 increases both the probability of taking an early retirement and the incidence of disability by 1.5 percentage points. For women, we find that obesity class 2 and 3 increases the probability of taking an early retirement by 2.5 percentage points and the incidence of disability by 1.7 percentage points.

}, keywords = {Chronic disease, Disabled Persons, Employment, Female, Humans, Male, Middle Aged, Obesity, Retirement, Risk Factors, Sex Factors, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2010.03.038}, author = {F. Renna and Thakur, Nidhi} } @article {7435, title = {An examination of older immigrants{\textquoteright} use of dental services in the United States.}, journal = {J Aging Soc Policy}, volume = {22}, year = {2010}, month = {2010 Jan}, pages = {18-32}, publisher = {22}, abstract = {

The recent influx of immigrants aged 65 and older in the United States triggers an increasing need to understand older immigrants{\textquoteright} dental services use. This paper uses data (n = 9,617) from the 2004 and 2006 waves of the Health and Retirement Study to examine the dental services use of older Americans. In particular, this study focuses on differences in dental services use between immigrants and natives and potential contributing factors. Multivariate logistic regression analyses showed, contrary to expectation, that older immigrants were more likely to use dental services than older natives despite numerous barriers (odds ratio = 1.30 in 2004). The results in 2006 confirmed these findings. The results from 2004 and 2006 analyses showed dental insurance coverage, sex, and marital status were associated differently with dental services use for immigrants and natives. Implications for current oral health policies and future research of older Americans are discussed, as well as methods for meeting older immigrants{\textquoteright} growing dental services needs.

}, keywords = {Age Factors, Aged, Dental Care for Aged, Educational Status, Emigrants and Immigrants, Female, Health Services Accessibility, Humans, Insurance, Dental, Logistic Models, Longitudinal Studies, Male, Marital Status, Middle Aged, Multivariate Analysis, Sex Factors, Socioeconomic factors, United States}, issn = {1545-0821}, doi = {10.1080/08959420903385593}, author = {Christina N Anderson and Hyungsoo Kim} } @article {7506, title = {Longitudinal changes in disabled husbands{\textquoteright} and wives{\textquoteright} receipt of care.}, journal = {Gerontologist}, volume = {50}, year = {2010}, month = {2010 Oct}, pages = {681-93}, publisher = {50}, abstract = {

PURPOSE OF THE STUDY: This study contrasts 2-year adjustments in disabled husbands{\textquoteright} and wives{\textquoteright} amount of received care following both worsening and recovery in personal (activities of daily living [ADLs]) and routine care (instrumental activities of daily living [IADLs]) disability.

DESIGN AND METHODS: Using longitudinal data on 789 husbands and 778 wives from the Health and Retirement Study (2000 and 2002), changes in marital partners{\textquoteright} monthly hours of spousal and nonspousal care were jointly modeled using bivariate Tobit models. In addition, asymmetry in the magnitude of responses to worsening and improvement of function was examined.

RESULTS: Disabled husbands receive more hours of spousal and nonspousal care following worsening in ADL function than wives. Conversely, disabled wives lose more spousal and nonspousal care hours following improvements in ADL disability than husbands. Moreover, wives recovering in ADL function lose more hours of spousal care than they receive following worsening in personal care disability. There is no evidence of corresponding gender differences in the dynamics of assistance received following changes in IADL function.

IMPLICATIONS: Compared with husbands, disabled wives are disadvantaged in the adjustment of their personal care hours. Although disabled married community residents receive more hours of care than their unmarried counterparts, there are important gender differences in the advantages offered by marriage.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Caregivers, Disabled Persons, Female, Humans, Long-term Care, Longitudinal Studies, Male, Marriage, Middle Aged, Models, Theoretical, Sex Factors, Social Support, Socioeconomic factors, Spouses, Surveys and Questionnaires, Time Factors}, issn = {1758-5341}, doi = {10.1093/geront/gnq028}, author = {Claire No{\"e}l-Miller} } @article {7445, title = {Obesity, physical activity, and depressive symptoms in a cohort of adults aged 51 to 61.}, journal = {J Aging Health}, volume = {22}, year = {2010}, month = {2010 Apr}, pages = {384-98}, publisher = {22}, abstract = {

OBJECTIVE: To determine associations between changes in obesity and vigorous physical activity (PA) status and depressive symptoms in a cohort aged 51 to 61 years at baseline.

METHOD: Two waves (1992, 1998) of Health and Retirement Study data were used to divide participants into four obesity and four vigorous PA status categories based on change in or maintenance of their 1992 status in 1998. Depressive symptoms were defined as the upper quintile score (women >/= 4, men >/= 3) on the eight-item Center for Epidemiologic Studies-Depression Scale. Logistic regression determined adjusted odds ratios for depressive symptoms associated with obesity and vigorous PA status.

RESULTS: Among men, no significant associations were found. Among women, decreasing from high vigorous PA status and maintenance of obese status were independently associated with increased odds for depressive symptoms in 1998.

DISCUSSION: The findings illustrate the importance of examining gender differences in studies of risk factors for depression.

}, keywords = {Activities of Daily Living, Age Factors, Aging, Chi-Square Distribution, Cohort Studies, Confidence Intervals, depression, Female, Health Status, Humans, Logistic Models, Male, Middle Aged, Motor Activity, Multivariate Analysis, Obesity, Odds Ratio, Psychometrics, Self Report, Sex Factors, United States}, issn = {1552-6887}, doi = {10.1177/0898264309359421}, author = {Dianna D Carroll and Heidi M Blanck and Mary K. Serdula and David R Brown} } @article {7458, title = {Physical health and depression: a dyadic study of chronic health conditions and depressive symptomatology in older adult couples.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65}, year = {2010}, month = {2010 Jul}, pages = {438-48}, abstract = {

This study examined the associations among chronic health conditions, sociodemographic factors, and depressive symptomatology in older married couples. Data from the 2004 wave of the Health and Retirement Study (n = 2,184 couples) were analyzed. Results indicated a reciprocal relationship in depressive symptoms between spouses. Additionally, post hoc analyses indicated that husbands{\textquoteright} stroke and high blood pressure were related to increased depressive symptomatology among wives. Beyond the reciprocal relationship, husbands were unaffected by wives{\textquoteright} health. These results suggest sex differences underlying psychological distress in the context of physical health among older adults and that older women with husbands who have high levels of depressive symptomatology, high blood pressure, or a history of stroke may be at particular risk of experiencing depressive symptoms.

}, keywords = {Age Factors, Aged, Chi-Square Distribution, Chronic disease, Cohort Studies, depression, Female, Health Status, Humans, Hypertension, Least-Squares Analysis, Male, Marriage, Middle Aged, Psychiatric Status Rating Scales, Risk Factors, Sex Factors, Socioeconomic factors, Spouses, Stroke}, issn = {1758-5368}, doi = {10.1093/geronb/gbq033}, author = {Brian J Ayotte and Frances Margaret Yang and Richard N Jones} } @article {7484, title = {Prior hospitalization and the risk of heart attack in older adults: a 12-year prospective study of Medicare beneficiaries.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {65}, year = {2010}, month = {2010 Jul}, pages = {769-77}, publisher = {65}, abstract = {

BACKGROUND: We investigated whether prior hospitalization was a risk factor for heart attacks among older adults in the survey on Assets and Health Dynamics among the Oldest Old.

METHODS: Baseline (1993-1994) interview data were linked to 1993-2005 Medicare claims for 5,511 self-respondents aged 70 years and older and not enrolled in managed Medicare. Primary hospital International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) 410.xx discharge codes identified postbaseline hospitalizations for acute myocardial infarctions (AMIs). Participants were censored at death or postbaseline managed Medicare enrollment. Traditional risk factors and other covariates were included. Recent postbaseline non-AMI hospitalizations (ie, prior hospitalizations) were indicated by a time-dependent marker, and sensitivity analyses identified their peak effect.

RESULTS: The total number of person-years of surveillance was 44,740 with a mean of 8.1 (median = 9.1) per person. Overall, 483 participants (8.8\%) suffered postbaseline heart attacks, with 423 participants (7.7\%) having their first-ever AMI. As expected, significant traditional risk factors were sex (men); race (whites); marital status (never being married); education (noncollege); geography (living in the South); and reporting a baseline history of angina, arthritis, diabetes, and heart disease. Risk factors were similar for both any postbaseline and first-ever postbaseline AMI analyses. The time-dependent recent non-AMI hospitalization marker did not alter the effects of the traditional risk factors but increased AMI risk by 366\% (adjusted hazards ratio = 4.66, p < .0001). Discussion. Our results suggest that some small percentage (<3\%) of heart attacks among older adults might be prevented if effective short-term postdischarge planning and monitoring interventions were developed and implemented.

}, keywords = {Aged, Educational Status, Female, Hospitalization, Humans, Male, Marital Status, Medicare, Myocardial Infarction, Patient Discharge, Proportional Hazards Models, Prospective Studies, Risk Factors, Sex Factors, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glq003}, author = {Frederic D Wolinsky and Suzanne E Bentler and Li Liu and Michael P Jones and Kaskie, Brian and Jason Hockenberry and Elizabeth A Chrischilles and Kara B Wright and John F Geweke and Maksym Obrizan and Robert L. Ohsfeldt and Gary E Rosenthal and Robert B Wallace} } @article {7317, title = {Can self-reported strokes be used to study stroke incidence and risk factors?: evidence from the health and retirement study.}, journal = {Stroke}, volume = {40}, year = {2009}, month = {2009 Mar}, pages = {873-9}, publisher = {40}, abstract = {

BACKGROUND AND PURPOSE: Most stroke incidence studies use geographically localized (community) samples with few national data sources available. Such samples preclude research on contextual risk factors, but national samples frequently collect only self-reported stroke. We examine whether incidence estimates from clinically verified studies are consistent with estimates from a nationally representative US sample assessing self-reported stroke.

METHODS: Health and Retirement Study (HRS) participants (n=17 056) age 50+ years were followed for self- or proxy-reported first stroke (1293 events) from 1998 to 2006 (average, 6.8 years). We compared incidence rates by race, sex, and age strata with those previously documented in leading geographically localized studies with medically verified stroke. We also examined whether cardiovascular risk factor effect estimates in HRS are comparable to those reported in studies with clinically verified strokes.

RESULTS: The weighted first-stroke incidence rate was 10.0 events/1000 person-years. Total age-stratified incidence rates in whites were mostly comparable with those reported elsewhere and were not systematically higher or lower. However, among blacks in HRS, incidence rates generally appeared higher than those previously reported. HRS estimates were most comparable with those reported in the Cardiovascular Health Study. Incidence rates approximately doubled per decade of age and were higher in men and blacks. After demographic adjustment, all risk factors predicted stroke incidence in whites. Smoking, hypertension, diabetes, and heart disease predicted incident stroke in blacks.

CONCLUSIONS: Associations between known risk factors and stroke incidence were verified in HRS, suggesting that misreporting is nonsystematic. HRS may provide valuable data for stroke surveillance and examination of classical and contextual risk factors.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Algorithms, Epidemiologic Methods, ethnicity, Female, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Risk Factors, Sex Factors, Stroke, Treatment Outcome, United States}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.108.529479}, author = {M. Maria Glymour and Mauricio Avendano} } @article {7355, title = {Does job loss cause ill health?}, journal = {Health Econ}, volume = {18}, year = {2009}, month = {2009 Sep}, pages = {1075-89}, publisher = {18}, abstract = {

This study estimates the effect of job loss on health for near elderly employees based on longitudinal data from the Health and Retirement Study. Previous studies find a strong negative correlation between unemployment and health. To control for possible reverse causality, this study focuses on people who were laid off for an exogenous reason - the closure of their previous employers{\textquoteright} business. I find no causal effect of exogenous job loss on various measures of physical and mental health. This suggests that the inferior health of the unemployed compared to the employed could be explained by reverse causality.

}, keywords = {Activities of Daily Living, Age Factors, Cohort Studies, Cross-Sectional Studies, Employment, Female, Health Status, Humans, Male, Mental Health, Middle Aged, Sex Factors, Smoking, Socioeconomic factors}, issn = {1099-1050}, doi = {10.1002/hec.1537}, author = {Salm, Martin} } @article {7328, title = {Factors associated with long-stay nursing home admissions among the U.S. elderly population: comparison of logistic regression and the Cox proportional hazards model with policy implications for social work.}, journal = {Soc Work Health Care}, volume = {48}, year = {2009}, month = {2009}, pages = {154-68}, publisher = {48}, abstract = {

Two statistical methods were compared to identify key factors associated with long-stay nursing home (LSNH) admission among the U.S. elderly population. Social Work{\textquoteright}s interest in services to the elderly makes this research critical to the profession. Effectively transitioning the "baby boomer" population into appropriate long-term care will be a great societal challenge. It remains a challenge paramount to the practice of social work. Secondary data analyses using four waves (1995, 1998, 2000, and 2002) of the Health Retirement Study (HRS) coupled with the Assets and Health Dynamics among the Oldest Old (AHEAD) surveys were conducted. Multivariable logistic regression and Cox proportional hazards model were performed and compared. Older age, lower self-perceived health, worse instrumental activities of daily living (IADL), psychiatric problems, and living alone were found significantly associated with increased risk of LSNH admission. In contrast, being female, African American, or Hispanic; owning a home; and having lower level of cognitive impairment reduced the admission risk. Home ownership showed a significant effect in logistic regression, but a marginal effect in the Cox model. The Cox model generally provided more precise parameter estimates than logistic regression. Logistic regression, used frequently in analyses, can provide a good approximation to the Cox model in identifying factors of LSNH admission. However, the Cox model gives more information on how soon the LSNH admission may happen. Our analyses, based on two models, dually identified the factors associated with LSNH admission; therefore, results discussed confidently provide implications for both public and private long-term care policies, as well as improving the assessment capabilities of social work practitioners for development of screening programs among at-risk elderly. Given the predicted surge in this population, significant factors found from this study can be utilized in a strengths-based empowerment approach by social workers to aid in avoiding LSNH utilization.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Female, Geriatric Assessment, Health Status, Homes for the Aged, Humans, Logistic Models, Male, Mental Health, Nursing homes, Proportional Hazards Models, Risk Factors, Sex Factors, Social work, Socioeconomic factors, United States}, issn = {0098-1389}, doi = {10.1080/00981380802580588}, author = {Cai, Qian and J. Warren Salmon and Mark E. Rodgers} } @article {7389, title = {Financial hardship and mortality among older adults using the 1996-2004 Health and Retirement Study.}, journal = {Ann Epidemiol}, volume = {19}, year = {2009}, month = {2009 Dec}, pages = {850-7}, publisher = {19}, abstract = {

PURPOSE: We investigated the effect of financial hardship on mortality risk in a community-dwelling sample of adults 50 years of age and olderin the United States.

METHOD: The 1996 Health and Retirement Study cohorts were followed prospectively to 2004 (N = 8,377). Gender-stratified grouped Cox models were used to estimate the difference in the relative risk (RR) of mortality between a specific number of financial hardships (one, two, or three or more) and no hardships; and the predictive utility of each individual financial hardship for mortality during the follow-up period.

RESULTS: Gender-stratified models adjusted for demographics, socioeconomic characteristics, and functional limitations in 1996 showed that women reporting one (hazard ratio [HR] = 1.42; 95\% confidence interval [CI]: 1.05-1.92) or three or more (HR = 1.60; 95\% CI: 1.05-2.46) and men reporting two (HR = 1.80; 95\% CI: 1.21-2.69) financial hardships had a substantially higher probability of mortality compared to those reporting no financial hardships. Individual financial hardships that predicted mortality in fully adjusted models for women included receiving Medicaid (HR = 2.23; 95\% CI: 1.68-2.98) and for men receiving Medicaid (HR = 2.11; 95\% CI: 1.57-2.84) and receiving food stamps (HR = 1.59; 95\% CI: 1.09-2.33).

CONCLUSIONS: These findings suggest that over and above the influence of traditional measures of socioeconomic status, financial hardship exerts an influence on the risk of mortality among older adults and that the number and type of hardships important in predicting mortality may differ for men and women.

}, keywords = {Aged, Female, Geriatric Assessment, Health Surveys, Humans, Male, Medicaid, Middle Aged, Mortality, Poverty, Proportional Hazards Models, Prospective Studies, Retirement, Risk, Sex Factors, United States}, issn = {1873-2585}, doi = {10.1016/j.annepidem.2009.08.003}, author = {Reginald D. Tucker-Seeley and Li, Yi and Subramanian, S V and Sorensen, Glorian} } @article {7325, title = {Functional limitations, socioeconomic status, and all-cause mortality in moderate alcohol drinkers.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 Jun}, pages = {955-62}, publisher = {57}, abstract = {

OBJECTIVES: To determine whether the survival benefit associated with moderate alcohol use remains after accounting for nontraditional risk factors such as socioeconomic status (SES) and functional limitations.

DESIGN: Prospective cohort.

SETTING: The Health and Retirement Study (HRS), a nationally representative study of U.S. adults aged 55 and older.

PARTICIPANTS: Twelve thousand five hundred nineteen participants were enrolled in the 2002 wave of the HRS.

MEASUREMENTS: Participants were asked about their alcohol use, functional limitations (activities of daily living, instrumental activities of daily living, and mobility), SES (education, income, and wealth), psychosocial factors (depressive symptoms, social support, and the importance of religion), age, sex, race and ethnicity, smoking, obesity, and comorbidities. Death by December 31, 2006, was the outcome measure.

RESULTS: Moderate drinkers (1 drink/d) had a markedly more-favorable risk factor profile, with higher SES and fewer functional limitations. After adjusting for demographic factors, moderate drinking (vs no drinking) was strongly associated with less mortality (odds ratio (OR)=0.50, 95\% confidence interval (CI)=0.40-0.62). When traditional risk factors (smoking, obesity, and comorbidities) were also adjusted for, the protective effect was slightly attenuated (OR=0.57, 95\% CI=0.46-0.72). When all risk factors including functional status and SES were adjusted for, the protective effect was markedly attenuated but still statistically significant (OR=0.72, 95\% CI=0.57-0.91).

CONCLUSION: Moderate drinkers have better risk factor profiles than nondrinkers, including higher SES and fewer functional limitations. Although these factors explain much of the survival advantage associated with moderate alcohol use, moderate drinkers maintain their survival advantage even after adjustment for these factors.

}, keywords = {Activities of Daily Living, Aged, Alcohol Drinking, Comorbidity, Education, Female, Humans, Income, Male, Obesity, Risk Factors, Sex Factors, Smoking, Socioeconomic factors}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02184.x}, author = {Sei J. Lee and Rebecca L. Sudore and Brie A Williams and Lindquist, Karla and Helen L. Chen and Kenneth E Covinsky} } @article {7356, title = {Marital trajectories and mortality among US adults.}, journal = {Am J Epidemiol}, volume = {170}, year = {2009}, month = {2009 Sep 01}, pages = {546-55}, publisher = {170}, abstract = {

More than a century of empirical evidence links marital status to mortality. However, the hazards of dying associated with long-term marital trajectories and contributing risk factors are largely unknown. The authors used 1992-2006 prospective data from a cohort of US adults to investigate the impact of current marital status, marriage timing, divorce and widow transitions, and marital durations on mortality. Multivariate hazard ratios were significantly higher for adults currently divorced and widowed, married at young ages (< or =18 years), who accumulated divorce and widow transitions (among women), and who were divorced for 1-4 years. Results also showed significantly lower risks of mortality for men married after age 25 years compared with on time (ages 19-25 years) and among women experiencing > or =10 years of divorce and > or =5 years of widowhood relative to those without exposure to these statuses. For both sexes, accumulation of marriage duration was the most robust predictor of survival. Results from risk-adjusted models indicated that socioeconomic resources, health behaviors, and health status attenuated the associations in different ways for men and women. The study demonstrates that traditional measures oversimplify the relation between marital status and mortality and that sex differences are related to a nexus of marital experiences and associated health risks.

}, keywords = {Age Factors, Cohort Studies, Female, Health Behavior, Humans, Male, Marital Status, Middle Aged, Mortality, Retirement, Retrospective Studies, Risk Factors, Sex Factors, Time Factors, United States}, issn = {1476-6256}, doi = {10.1093/aje/kwp194}, author = {Matthew E Dupre and Audrey N Beck and Sarah O. Meadows} } @article {7349, title = {Prevalence of depression among older Americans: the Aging, Demographics and Memory Study.}, journal = {Int Psychogeriatr}, volume = {21}, year = {2009}, note = {PMID: 19519984}, month = {2009 Oct}, pages = {879-88}, publisher = {21}, abstract = {

BACKGROUND: Previous studies have attempted to provide estimates of depression prevalence in older adults. The Aging, Demographics and Memory Study (ADAMS) is a population-representative study that included a depression assessment, providing an opportunity to estimate the prevalence of depression in late life in the U.S.A.

METHODS: The ADAMS sample was drawn from the larger Health and Retirement Study. A total of 851 of 856 ADAMS participants aged 71 and older had available depression data. Depression was measured using the Composite International Diagnostic Interview - Short Form (CIDI-SF) and the informant depression section of the Neuropsychiatric Inventory (NPI). We estimated the national prevalence of depression, stratified by age, race, sex, and cognitive status. Logistic regression analyses were performed to examine the association of depression and previously reported risk factors for the condition.

RESULTS: When combining symptoms of major or minor depression with reported treatment for depression, we found an overall depression prevalence of 11.19\%. Prevalence was similar for men (10.19\%) and women (11.44\%). Whites and Hispanics had nearly three times the prevalence of depression found in African-Americans. Dementia diagnosis and pain severity were associated with increased depression prevalence, while black race was associated with lower rates of depression.

CONCLUSIONS: The finding of similar prevalence estimates for depression in men and women was not consistent with prior research that has shown a female predominance. Given the population-representativeness of our sample, similar depression rates between the sexes in ADAMS may result from racial, ethnic and socioeconomic diversity.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Black People, Cohort Studies, Comorbidity, Cross-Sectional Studies, Depressive Disorder, Female, Health Status, Hispanic or Latino, Humans, Male, Neuropsychological tests, Personality Assessment, Sex Factors, Socioeconomic factors, United States, White People}, issn = {1041-6102}, doi = {10.1017/S1041610209990044}, author = {David C Steffens and Gwenith G Fisher and Kenneth M. Langa and Guy G Potter and Brenda L Plassman} } @article {7399, title = {Work expectations, realizations, and depression in older workers.}, journal = {J Ment Health Policy Econ}, volume = {12}, year = {2009}, note = {Journal Article}, month = {2009 Dec}, pages = {175-86}, publisher = {12}, abstract = {

AIMS OF THE STUDY: In this study, we explore whether ex ante work expectations, conditional on work force status at age 62, affect self-reported depressive symptoms at age 62.

METHODS: Our sample includes 4,387 participants of the Health and Retirement Study, a national longitudinal survey of individuals born between 1931 and 1941, and their spouses. The sample is composed of workers who were less than 62 years of age at the study baseline (1992), and who had reached age 62 by the current study endpoint (2004). This sample enables comparison of realized work status with prior expectations. We estimate the impact of expected work status on self-reported depressive symptoms using negative binomial and logistic regression methods. Sex-stratified regressions are estimated according to full-time work status at age 62. The primary outcome is a summary measure of self-reported depressive symptoms based on a short form of the Center for Epidemiologic Studies-Depression (CES-D) scale. The explanatory variable of interest is the subjective probability of working full-time at the age of 62, reported by participants at the 1992 HRS baseline. We control for baseline socioeconomic and demographic variables as well as life events and changes in macroeconomic conditions that occur within the study timeframe.

RESULTS: Among participants who were not working full time at age 62, we find that men who provided a higher ex ante likelihood of full-time employment at 62 had significantly worse self-reported depressive symptoms than men who provided a lower ex ante likelihood. A similar effect was not found for women. Among participants who were working full time at age 62, we do not find a statistical relationship between ex ante expectations and age-62 self-reported depressive symptoms, for either men or women.

DISCUSSION: The results suggest that an earlier-than-anticipated work exit is detrimental to mental health for men nearing normal retirement age. Previous research has demonstrated that stress is a causal factor in depression, and a premature labor force departure, which is inconsistent with an individual{\textquoteright}s cognitive judgment of a suitably timed exit from work, is a psychologically stressful transition that could realistically induce depression. This may be especially true of men, who in this cohort, have stronger labor force attachment than women and tend to define their roles by their occupation. The advantages of the study include nationally representative data, a baseline depression control that circumscribes the effect of endogeneity, and a reasonably long follow-up. Despite our efforts to infer causality, unmeasured factors may account for part of the observed relationship. IMPLICATIONS FOR HEALTH POLICY AND RESEARCH: Depression is a disease that, if untreated, may have serious consequences for behavioral, medical, and social well-being. Our results suggest that further research should aim to estimate the magnitude of clinically severe and mild depression in populations of those who retire earlier than expected, especially for men. Such information could help health care planners and policy makers to direct resources to the mental health needs of men who retire prematurely.

}, keywords = {Age Factors, depression, Employment, Female, Health Behavior, Humans, Longitudinal Studies, Male, Middle Aged, Psychometrics, Retirement, Sex Factors, Stress, Psychological}, issn = {1091-4358}, url = {URL:http://www.icmpe.org/test1/journal/journal.htm Publisher{\textquoteright}sURL}, author = {Tracy Falba and Jody L Sindelar and William T Gallo} } @article {7225, title = {Depression and retirement in late middle-aged U.S. workers.}, journal = {Health Serv Res}, volume = {43}, year = {2008}, month = {2008 Apr}, pages = {693-713}, publisher = {43}, abstract = {

OBJECTIVE: To determine whether late middle-aged U.S. workers with depression are at an increased risk for retirement.

DATA SOURCE: Six biennial waves (1992-2002) of the Health and Retirement Study, a nationally representative panel survey of noninstitutionalized 51-61-year-olds and their spouses started in 1992.

STUDY DESIGN: Workers aged 53-58 years in 1994 were followed every 2 years thereafter, through 2002. Depression was coded as lagged time-dependent variables measuring active depression and severity of depression. The main outcome variable was a transition to retirement which was measured using two distinct definitions to capture different stages in the retirement process: (1) Retirement was defined as a transition out of the labor force in the sample of all labor force participants (N=2,853); (2) In addition a transition out of full time work was used as the retirement definition in the subset of labor force participants who were full time workers (N=2,288).

PRINCIPAL FINDINGS: In the sample of all labor force participants, the presence of active depression significantly increased the hazard of retirement in both late middle-aged men (adjusted OR: 1.37 [95 percent CI 1.05, 1.80]) and women (adjusted OR: 1.40 [95 percent CI 1.10, 1.78]). For women, subthreshold depression was also a significant predictor of retirement. In the sample of full time workers, the relationship between depression and retirement was considerably weaker for women yet remained strong for men.

CONCLUSIONS: Depression and depressive symptoms were significantly associated with retirement in late middle-aged U.S. workers. Policymakers must consider the potentially adverse impact of these labor market outcomes when estimating the cost of untreated depression and evaluating the value of interventions to improve the diagnosis and treatment of depression.

}, keywords = {Activities of Daily Living, Comorbidity, depression, Employment, Female, Humans, Male, Middle Aged, Retirement, Severity of Illness Index, Sex Factors, Socioeconomic factors, United States}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2007.00782.x}, author = {Jalpa A Doshi and Cen, Liyi and Daniel Polsky} } @article {7252, title = {Gender differences in functional status in middle and older age: are there any age variations?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 Sep}, pages = {S282-92}, publisher = {63B}, abstract = {

OBJECTIVES: The present study examines gender differences in changes in functional status after age 50 and how such differences vary across different age groups.

METHODS: Data came from the Health and Retirement Study, involving up to six repeated observations of a national sample of Americans older than 50 years of age between 1995 and 2006. We employed hierarchical linear models with time-varying covariates in depicting temporal variations in functional status between men and women.

RESULTS: As a quadratic function, the worsening of functional status was more accelerated in terms of the intercept and rate of change among women and those in older age groups. In addition, gender differences in the level of functional impairment were more substantial in older persons than in younger individuals, although differences in the rate of change between men and women remained constant across age groups.

DISCUSSION: A life course perspective can lead to new insights regarding gender variations in health within the context of intrapersonal and interpersonal differences. Smaller gender differences in the level of functional impairment in the younger groups may reflect improvement of women{\textquoteright}s socioeconomic status, greater rate of increase in chronic diseases among men, and less debilitating effects of diseases.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Disabled Persons, Female, Health Status, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, Sex Factors, United States}, issn = {1079-5014}, doi = {10.1093/geronb/63.5.s282}, author = {Jersey Liang and Joan M. Bennett and Benjamin A Shaw and Ana R Qui{\~n}ones and Wen Ye and Xiao Xu and Mary Beth Ofstedal} } @article {7217, title = {Impact of functional limitations and medical comorbidity on subsequent weight changes and increased depressive symptoms in older adults.}, journal = {J Aging Health}, volume = {20}, year = {2008}, month = {2008 Jun}, pages = {367-84}, publisher = {20}, abstract = {

OBJECTIVE: The primary goal of this study was to determine the effect of the onset of major medical comorbidity and functional decline on subsequent weight change and increased depressive symptoms.

METHODS: The sample included a prospective cohort of 53 to 63 year olds (n = 10,150) enrolled in the Health and Retirement Study. Separate lagged covariate models for men and women were used to study the impact of functional decline and medical comorbidity on subsequent increases in depressive symptoms and weight change 2 years later.

RESULTS: Functional decline and medical comorbidity were individual predictors of subsequent weight changes but not increased depressive symptoms. Most specific incident medical comorbidities or subtypes of functional decline predicted weight changes in both directions.

DISCUSSION: The elevated risk of weight gain subsequent to functional decline or onset of medical comorbidities may require the receipt of preventive measures to reduce further weight-related complications.

}, keywords = {Activities of Daily Living, Age Factors, Arthritis, Comorbidity, depression, Depressive Disorder, Diabetes Complications, Diabetes Mellitus, Disabled Persons, Female, Health Surveys, Heart Diseases, Humans, Hypertension, Lung Diseases, Male, Mental Disorders, Middle Aged, Neoplasms, Obesity, Risk Factors, Sex Factors, Stroke, United States, Weight Gain}, issn = {0898-2643}, doi = {10.1177/0898264308315851}, 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 {7263, title = {Measurement differences in depression: chronic health-related and sociodemographic effects in older Americans.}, journal = {Psychosom Med}, volume = {70}, year = {2008}, month = {2008 Nov}, pages = {993-1004}, publisher = {70}, abstract = {

OBJECTIVE: To evaluate the influence of five chronic health conditions (high blood pressure, heart conditions, stroke, diabetes, and lung diseases) and four sociodemographic characteristics (age, gender, education, and race/ethnicity) on the endorsement patterns of depressive symptoms in a sample of community-dwelling older adults.

METHOD: Participants were adults aged >or=65 years from the 2004 Health and Retirement Study (n = 9448). Depressive symptoms were measured with a nine-item Center for Epidemiologic Studies-Depression scale. Measurement differences attributable to health and sociodemographic factors were assessed with a multidimensional model based on item response theory.

RESULTS: Evidence for unidimensionality was equivocal. We used a bifactor model to express symptom endorsement patterns as resulting from a general factor and three specific factors ("dysphoria," "psychosomatic," and "lack of positive affect"). Even after controlling for the effects of health on the psychosomatic factor, heart conditions, stroke, diabetes, and lung diseases had significant positive effects on the general factor. Significant effects due to gender and educational levels were observed on the "lack of positive affect" factor. Older adults self-identifying as Latinos had higher levels of general depression. On the symptom level, meaningful measurement noninvariance due to race/ethnic differences were found in the following five items: depressed, effort, energy, happy, and enjoy life.

CONCLUSIONS: The increased tendency to endorse depressive symptoms among persons with specific health conditions is, in part, explained by specific associations among symptoms belonging to the psychosomatic domain. Differences attributable to the effects of health conditions may reflect distinct phenomenological features of depression. The bifactor model serves as a vehicle for testing such hypotheses.

}, keywords = {Aged, Aged, 80 and over, Chronic disease, Cohort Studies, Comorbidity, Confounding Factors, Epidemiologic, Culture, depression, Diabetes Mellitus, Educational Status, ethnicity, Factor Analysis, Statistical, Female, Heart Diseases, Humans, Hypertension, Interviews as Topic, Lung Diseases, Male, Self-Assessment, Sex Factors, Stroke, United States}, issn = {1534-7796}, doi = {10.1097/PSY.0b013e31818ce4fa}, author = {Frances Margaret Yang and Richard N Jones} } @article {7208, title = {Using subjective expectations to forecast longevity: do survey respondents know something we don{\textquoteright}t know?}, journal = {Demography}, volume = {45}, year = {2008}, month = {2008 Feb}, pages = {95-113}, publisher = {45}, abstract = {

Old-age mortality is notoriously difficult to predict because it requires not only an understanding of the process of senescence-which is influenced by genetic, environmental, and behavioral factors-but also a prediction of how these factors will evolve. In this paper I argue that individuals are uniquely qualified to predict their own mortality based on their own genetic background, as well as environmental and behavioral risk factors that are often known only to the individual. Given this private information, individuals form expectations about survival probabilities that may provide additional information to demographers and policymakers in their challenge to predict mortality. From expectations data from the 1992 Health and Retirement Study (HRS), I construct subjective, cohort life tables that are shown to predict the unusual direction of revisions to U.S. life expectancy by gender between 1992 and 2004: that is, for these cohorts, the Social Security Actuary (SSA) raised male life expectancy in 2004 and at the same lowered female life expectancy, narrowing the gender gap in longevity by 25\% over this period. Further, although the subjective life expectancies for men appear to be roughly in line with the 2004 life tables, the subjective expectations of women suggest that female life expectancies estimated by the SSA might still be on the high side.

}, keywords = {Aged, Aged, 80 and over, Aging, Data collection, Demography, Female, health policy, Humans, Life Expectancy, Life Tables, Longevity, Male, Middle Aged, Mortality, Risk Factors, Sex Factors, United States}, issn = {0070-3370}, doi = {10.1353/dem.2008.0010}, author = {Maria Perozek} } @article {7176, title = {Change in depression of spousal caregivers of dementia patients following patient{\textquoteright}s death.}, journal = {Omega (Westport)}, volume = {56}, year = {2007}, month = {2007-2008}, pages = {217-28}, publisher = {56}, abstract = {

Caring for an elderly spouse with dementia places a heavy burden on spousal caregivers and often results in chronic depression. Little has been written about change in depression caregivers experience from before to after the death of the spouse with dementia. This longitudinal study examines change in depression of spousal caregivers that occurs following death of the dementia patient. Two theoretical models, the Relief and Stress Models, are discussed in terms of caregiver depression after the death of the dementia-patient care-recipient spouse. These two theoretical models were tested using longitudinal data from the National Institute on Aging sponsored Health and Retirement Study. Both male and female spousal caregivers report an increase in depression after the death of the dementia-patient care-recipient spouse. As time passed following the spouse{\textquoteright}s death, the conjugally bereaved husbands showed a decrease in depression while the conjugally bereaved wives continued to report increased depression.

}, keywords = {Adaptation, Psychological, Aged, Aged, 80 and over, Bereavement, Caregivers, Dementia, depression, Female, Humans, Life Change Events, Long-term Care, Longitudinal Studies, Male, Sex Factors, Spouses, Surveys and Questionnaires, United States}, issn = {0030-2228}, doi = {10.2190/om.56.3.a}, author = {Tweedy, Maureen P. and Charles A Guarnaccia} } @article {7137, title = {Gender differences in the link between childhood socioeconomic conditions and heart attack risk in adulthood.}, journal = {Demography}, volume = {44}, year = {2007}, month = {2007 Feb}, pages = {137-58}, publisher = {44}, abstract = {

A growing body of evidence shows that childhood socioeconomic status (SES) is predictive of disease risk in later life, with those from the most disadvantaged backgrounds more likely to experience poor adult-health outcomes. Most of these studies, however are based on middle-aged male populations and pay insufficient attention to the pathways between childhood risks and specific adult disorders. This article examines gender differences in the link between childhood SES and heart attack risk trajectories and the mechanisms by which early environments affect future disease risk. By using methods that model both latent and path-specific influences, we identify heterogeneity in early life conditions and human, social, and health capital in adulthood that contribute to diverse heart attack risk trajectories between and among men and women as they age into their 60s and 70s. We find that key risk factors for heart attack operate differently for men and women. For men, childhood SES does not differentiate those at low, increasing, and high risk for heart attack. In contrast, women who grew up without a father and/or under adverse economic conditions are the most likely to experience elevated risk for heart attack, even after we adjust for the unequal distribution of working and living conditions, social relationships, access to health care, and adult lifestyle behaviors that influence health outcomes.

}, keywords = {Adult, Age Factors, Child, Child Welfare, Health Status, Humans, Middle Aged, Myocardial Infarction, North Carolina, Poverty, Risk Assessment, Risk Factors, Sex Factors, Social Class, Socioeconomic factors, Time}, issn = {0070-3370}, doi = {10.1353/dem.2007.0004}, author = {Jenifer Hamil-Luker and Angela M O{\textquoteright}Rand} } @article {7153, title = {Latent variable analyses of age trends of cognition in the Health and Retirement Study, 1992-2004.}, journal = {Psychol Aging}, volume = {22}, year = {2007}, month = {2007 Sep}, pages = {525-545}, publisher = {22}, abstract = {

The present study was conducted to better describe age trends in cognition among older adults in the longitudinal Health and Retirement Study (HRS) from 1992 to 2004 (N = 17,000). The authors used contemporary latent variable models to organize this information in terms of both cross-sectional and longitudinal inferences about age and cognition. Common factor analysis results yielded evidence for at least 2 common factors, labeled Episodic Memory and Mental Status, largely separable from vocabulary. Latent path models with these common factors were based on demographic characteristics. Multilevel models of factorial invariance over age indicated that at least 2 common factors were needed. Latent curve models of episodic memory were based on age at testing and showed substantial age differences and age changes, including impacts due to retesting as well as several time-invariant and time-varying predictors.

}, keywords = {Aged, Aged, 80 and over, Aging, Cognition, Female, Health Surveys, Humans, Individuality, Longitudinal Studies, Male, Mental Recall, Mental Status Schedule, Middle Aged, Models, Statistical, Neuropsychological tests, Psychometrics, Retention, Psychology, Sex Factors, United States}, issn = {0882-7974}, doi = {10.1037/0882-7974.22.3.525}, author = {John J McArdle and Gwenith G Fisher and Kelly M Kadlec} } @article {7132, title = {Self-rated health trajectories and mortality among older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 Jan}, pages = {S22-7}, publisher = {62}, abstract = {

OBJECTIVES: For this article, we evaluated whether measures of prior self-rated health (SRH) trajectories had associations with subsequent mortality that were independent of current SRH assessment and other covariates.

METHODS: We used multivariable logistic regression that incorporated four waves of interview data (1993, 1995, 1998, and 2000) from the Asset and Health Dynamics Among the Oldest Old Survey in order to predict mortality during 2000-2002. We defined prior SRH trajectories for each individual based on the slope estimated from a simple linear regression of their own SRH between 1993 and 1998 and the variance around that slope. In addition to SRH reported in 2000, other covariates included in the mortality models reflected health status, health-related behaviors, and individual resources.

RESULTS: Among the 3,129 respondents in the analytic sample, SRH in 2000 was significantly (p <.0001) associated with mortality, but the measures of prior SRH trajectories were not. Prior SRH trajectory was, however, a significant determinant of current SRH. We observed significant independent associations with mortality for age, sex, education, lung disease, and having ever smoked.

DISCUSSION: Although measures of prior SRH trajectories did not have significant direct associations with mortality, they did have important indirect effects via their influence on current SRH.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Attitude to Health, Cardiovascular Diseases, Cause of Death, Female, Follow-Up Studies, Health Status, Health Status Indicators, Humans, Logistic Models, Longitudinal Studies, Lung Diseases, Male, Mortality, Multivariate Analysis, Risk Factors, Sex Factors, Smoking, Socioeconomic factors, Survival Analysis, United States}, issn = {1079-5014}, doi = {10.1093/geronb/62.1.s22}, author = {Thomas R Miller and Frederic D Wolinsky} } @article {7131, title = {Weight and depressive symptoms in older adults: direction of influence?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 Jan}, pages = {S43-51}, publisher = {62}, abstract = {

OBJECTIVE: . The purpose of this study was to clarify the direction of the relationship between changes in depressive symptoms and changes in weight in older adults. Methods. The sample included a prospective cohort of individuals aged 53-63 (n = 9,130) enrolled in the Health and Retirement Study. We used separate cross-lagged models for men and women in order to study the impact of weight change on subsequent increases in depressive symptoms 2 years later and vice versa.

RESULT: . Weight gain did not lead to increased depressive symptoms, and weight loss preceded increased depressive symptoms only in unadjusted models among men (odds ratio [OR] = 1.26, 95\% confidence interval [CI] = 1.04-1.53). Increased depressive symptoms were not predictive of subsequent weight loss, but they were predictive of subsequent weight gain in unadjusted models only (men: OR = 1.24, 95\% CI = 1.00-1.54; women: OR = 1.12, 95\% CI = 1.00-1.26). In adjusted models, baseline depressive symptoms predicted both weight loss and weight gain among both men and women. Increase in functional limitations and medical conditions were significant predictors of both weight loss and weight gain. Baseline functional limitations also predicted increased depressive symptoms. Discussion. Based on our findings, it is apparent that researchers need to examine the pathways between changes in weight and increases in depressive symptoms in the context of functional limitations and medical comorbidity.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Body Mass Index, Cohort Studies, Comorbidity, Depressive Disorder, Female, Health Status Indicators, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Odds Ratio, Prospective Studies, Sex Factors, Statistics as Topic, United States, Weight Gain, Weight Loss}, issn = {1079-5014}, doi = {10.1093/geronb/62.1.s43}, author = {Valerie L Forman-Hoffman and Jon W. Yankey and Stephen L Hillis and Robert B Wallace} } @article {7105, title = {Driving cessation and consumption expenses in the later years.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {61}, year = {2006}, month = {2006 Nov}, pages = {S347-53}, publisher = {61B}, abstract = {

OBJECTIVES: This study examined the association between consumption and driving status among older persons within the context of selected variables, including self-rated health and functional status.

METHODS: The data were from the 1998, 2000, and 2002 Health and Retirement Study and the 2003 Health and Retirement Study Consumption and Activities Mail Survey. We conducted Tobit regression analyses on five consumption categories of basic needs (such as food) and higher order needs (such as trips and dining out).

RESULTS: Consumption and driving status were significantly associated, showing that driving cessation was related to a 46\% to 63\% reduction in spending on trips, tickets, and dining out. Another significant relationship emerged between consumption and having never driven. Driving cessation was minimally related to consumption of basic needs (such as food and clothing) and was more strongly associated with higher order needs (such as trips).

DISCUSSION: The findings demonstrate the association between older people{\textquoteright}s driving status and consumption, specifically higher order activities. Older persons who drive and, presumably, have more opportunities to go to stores, restaurants, and other outside events, spend more on food, tickets, and dining out than those who cease driving or have never driven. Although the direction of causality remains unclear, these findings have implications for those concerned with alternative transportation resources for older adults.

}, keywords = {Aged, Automobile Driving, Economics, Female, Health Status, Humans, Male, Sex Factors, Surveys and Questionnaires, Transportation}, issn = {1079-5014}, doi = {10.1093/geronb/61.6.s347}, author = {Hyungsoo Kim and Virginia E. Richardson} } @article {7070, title = {Effects of retirement and grandchild care on depressive symptoms.}, journal = {Int J Aging Hum Dev}, volume = {62}, year = {2006}, month = {2006}, pages = {1-20}, publisher = {62}, abstract = {

This study explores how grandchild care in conjunction with grandparents{\textquoteright} retirement affects depressive symptoms, using data from the Health and Retirement Survey. The findings demonstrate that retirement moderates the influence of grandchild care obligations on well-being, measured by depressive symptoms. For retired men, freedom from grandchild care obligations is associated with heightened well-being. Among women, continued employment seems to protect against potential negative effects of extensive grandchild care obligations on well-being. The results for men seem most in line with the argument that family care obligations spoil retirement, whereas the results for women suggest a scenario that is most compatible with the role enhancement thesis.

}, keywords = {Aged, Aging, Child, Child Rearing, depression, Family Characteristics, Female, Holistic health, Humans, Intergenerational Relations, Leisure activities, Longitudinal Studies, Male, Middle Aged, Retirement, Sex Factors, Social Responsibility, Surveys and Questionnaires, United States}, issn = {0091-4150}, doi = {10.2190/8Q46-GJX4-M2VM-W60V}, author = {Maximiliane E Szinovacz and Adam Davey} } @article {7447, title = {Postretirement earnings relative to preretirement earnings: gender and racial differences.}, journal = {J Gerontol Soc Work}, volume = {47}, year = {2006}, note = {Using Smart Source Parsing pp. May Sage Publications, Thousand Oaks CA}, month = {2006}, pages = {63-82}, publisher = {32}, abstract = {

As the social security program comes under increasing financial pressure in the coming decades, the federal government will encourage elderly people to continue to work. Data from the Social Security Administration indicate that earnings are already a sizable component of retirement income. But there is public concern about how women and minorities will fare economically in this changing policy environment. To what extent can women and minorities keep earning money after they reach retirement age? This article presents the results of a study that investigated the postretirement earnings, relative to the preretirement earnings, of women and minorities, and compared the results with those for men and whites. The major finding, based on regression analyses, was that women{\textquoteright}s postretirement earnings, relative to their preretirement earnings, were greater than those of men. Furthermore, the regression results indicate that nonwhites{\textquoteright} postretirement earnings could not be predicted by their preretirement earnings or by any of the independent variables used in the study, including age, gender, education, marital status, number of children, occupation, and preretirement earnings.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Data collection, Employment, Female, Humans, Income, Male, Men, Minority Groups, Pensions, Retirement, Salaries and Fringe Benefits, Sex Factors, Social Security, Time Factors, United States, White People, women}, issn = {0163-4372}, doi = {10.1300/J083v47n03_05}, author = {Martha N. Ozawa and Hong, Baeg-Eui} } @article {7110, title = {Reported expectations for nursing home placement among older adults and their role as risk factors for nursing home admissions.}, journal = {Gerontologist}, volume = {46}, year = {2006}, month = {2006 Aug}, pages = {464-73}, publisher = {46}, abstract = {

PURPOSE: Individual expectations among community-dwelling older adults and their subsequent effect on placement status have recently been considered. Previous studies, however, have been limited by eligibility and exclusion criteria, treating expectations as a continuous measure, omitting potential confounders, and ignoring Race x Gender interactions.

DESIGN AND METHODS: We used data on 6,242 Black or White self-respondents who were 70 years old or older when they were enrolled in the survey of Assets and Health Dynamics Among the Oldest Old. We modeled expectations for nursing home placement over the next 5 years, as well as actual placement status, by using multivariable multinomial and binomial logistic regression models.

RESULTS: Expectations are not normally distributed: 14\% of the participants refused to answer, 51\% estimated no chance, 10\% indicated a 1\% to 50\% chance, 21\% indicated an 11\% to 50\% chance and 4\% indicated a 51\% to 100\% chance. Age, gender, education, social supports, and health status were associated with expectations, as well as an interaction effect for Black men. Age, social supports, health status, prior hospital or nursing home use, and expectations were associated with subsequent placement.

IMPLICATIONS: Black and White older adults{\textquoteright} expectations for nursing home placement rationally reflect their individual risk profiles and are associated with subsequent placement status. The expectations question may facilitate the early identification of high-risk individuals for further evaluation.

}, keywords = {Age Factors, Aged, Female, Health Status, Homes for the Aged, Humans, Male, Nursing homes, Patient Admission, Risk Factors, Sex Factors, Social Support, Socioeconomic factors}, issn = {0016-9013}, doi = {10.1093/geront/46.4.464}, author = {Adaeze B Akamigbo and Frederic D Wolinsky} } @article {7017, title = {Health insurance coverage during the years preceding medicare eligibility.}, journal = {Arch Intern Med}, volume = {165}, year = {2005}, month = {2005 Apr 11}, pages = {770-6}, publisher = {165}, abstract = {

BACKGROUND: Adults in late middle age who lack health insurance are more likely to die or experience a decline in their overall health. Because most estimates of the uninsured are cross-sectional, the true number of individuals whose health is at risk from being uninsured is unclear.

METHODS: We analyzed a nationally representative sample of 6065 US adults 51 to 57 years old who were interviewed in 1992, 1994, 1996, 1998, and 2000 as part of the Health and Retirement Study. Insurance coverage was determined at the time of each interview and classified as private, public, or uninsured. Longitudinal data were used to determine the proportion of individuals who were uninsured at any interview during the 8-year study period.

RESULTS: The proportion of participants who were uninsured at the time of the 1992, 1994, 1996, 1998, and 2000 interviews was 14.3\%, 10.8\%, 9.7\%, 8.8\%, and 8.2\%, respectively. People frequently transitioned between having insurance and being uninsured. As a result, despite the declining prevalence of being uninsured, the percentage who were uninsured at least once during the 8-year period rose to 23.3\% by 2000; few participants (2.6\%) were continuously uninsured. Only 60.1\% of participants were continuously enrolled in private insurance across all 5 interviews.

CONCLUSIONS: The proportion of US adults in late middle age at risk from being uninsured over a 10-year follow-up period was 2 to 3 times higher than cross-sectional estimates. At least one quarter of older adults will be uninsured at some point during the years preceding eligibility for Medicare.

}, keywords = {Age Factors, Black or African American, Cohort Studies, Female, Health Status, Hispanic or Latino, Humans, Insurance Coverage, Insurance, Health, Male, Medically Uninsured, Middle Aged, Sex Factors, Socioeconomic factors, United States, White People}, issn = {0003-9926}, doi = {10.1001/archinte.165.7.770}, author = {David W. Baker and Joseph J Sudano} } @article {7011, title = {The impact of childhood and adult SES on physical, mental, and cognitive well-being in later life.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {60}, year = {2005}, month = {2005 Mar}, pages = {S93-S101}, publisher = {60B}, abstract = {

OBJECTIVES: To examine the relationships between socioeconomic status (SES) and health across the life course and their variations by gender and race/ethnicity.

METHODS: The sample included 19,949 respondents aged 50 or over from the 1998 Health and Retirement Study.

RESULTS: Lower childhood SES was associated with worse health outcomes in later life. Part of the effect of childhood SES on adult health occurred through childhood health. The impact of childhood SES on education and income in adulthood explained an even larger share of this effect. We also found a stronger effect of adult SES for those with lower childhood SES than for those with more advantaged childhoods. Moreover, childhood SES had a similar impact on health in later life for women and men and for Whites and non-Whites. However, college education seemed more important for women{\textquoteright}s later health, whereas income seemed more important for men{\textquoteright}s health. Education appeared to have a weaker effect on adult health for Blacks and Hispanics than for Whites.

DISCUSSION: Both childhood and adult SES are important for health. The negative impact of low childhood SES can be partially ameliorated if people from a low SES position during childhood mobilize to higher status in adulthood.

}, keywords = {Aged, Aging, Black People, Child, Cognition, Cohort Studies, Data collection, Education, ethnicity, Female, Health Status, Hispanic or Latino, Humans, Income, Male, Mental Health, Middle Aged, Quality of Life, Retirement, Sex Factors, Social Class, White People}, issn = {1079-5014}, doi = {10.1093/geronb/60.2.s93}, author = {Ye Luo and Linda J. Waite} } @article {6962, title = {Changes in weight among a nationally representative cohort of adults aged 51 to 61, 1992 to 2000.}, journal = {Am J Prev Med}, volume = {27}, year = {2004}, month = {2004 Jul}, pages = {8-15}, publisher = {27}, abstract = {

BACKGROUND: Few studies have examined patterns and predictors of changes in body weight among adults in late middle age.

METHODS: Prospective cohort study of 7391 community-dwelling U.S. adults aged 51 to 61 years at baseline (1992), using publicly available data files from the 1992, 1994, 1996, 1998, and 2000 Health and Retirement Survey interviews. Changes in weight and body mass index (BMI) were examined for different racial/ethnic groups of men and women. The predictors of changes in body weight and BMI were determined using gender-specific linear regression.

RESULTS: Mean body weight and BMI increased in both genders and all ethnic groups. The mean weight gain was higher for women (1.67 kg, 95\% confidence interval [CI]=1.34-1.99) than for men (1.43 kg, 95\% CI=1.17-1.68). White men and women had the lowest baseline BMI but tended to gain more weight than other racial/ethnic groups. In multivariate analyses, individuals who were older or had higher baseline weight showed less weight gain. Men were less likely to gain weight if their self-reported overall health at baseline was poor compared to those in excellent health. Regular light or vigorous recreational activities and work-related activities were not associated with less weight gain. Race, education, and income were not associated with weight gain in multivariate analyses.

CONCLUSIONS: All population subgroups are at risk for weight gain. Public health messages should target diverse populations. The current levels of physical activity attained by this population do not appear to protect against weight gain.

}, keywords = {Body Mass Index, Body Weight, Female, Health Surveys, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, Motor Activity, Multivariate Analysis, Prospective Studies, Racial Groups, Sex Factors, United States}, issn = {0749-3797}, doi = {10.1016/j.amepre.2004.03.016}, author = {Xiaoxing He and David W. Baker} } @article {6928, title = {Honeymoons and joint lunches: effects of retirement and spouse{\textquoteright}s employment on depressive symptoms.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {59}, year = {2004}, month = {2004 Sep}, pages = {P233-45}, publisher = {59B}, abstract = {

With hypotheses derived from a life course perspective in conjunction with life event stress and role theories, we examine whether a spouse{\textquoteright}s employment and length of retirement affect a person{\textquoteright}s postretirement depressive symptoms and whether such effects differ by gender. Analyses use pooled data from Waves 1-4 of the Health and Retirement Survey, using a subsample of married individuals who either remained continuously employed over time or completely retired since the Wave 1 interviews (N = 2,695). Recently retired men seem to be negatively affected by their spouses{\textquoteright} continuous employment when compared with men whose wives were continuously not employed. In contrast, spouses{\textquoteright} joint retirement has a beneficial influence on both recently retired and longer-retired men. However, for recently retired men, the positive effect of wives{\textquoteright} retirement seems to be contingent on spouses{\textquoteright} enjoyment of joint activities. Among women, effects of spouses{\textquoteright} employment occur only among very recently retired wives (0-6 months). These wives report more depressive symptoms if their spouses were already nonemployed prior to wives{\textquoteright} retirement. These results demonstrate the complexity of retirement adaptation processes and suggest that marital context plays an important role in retirement well-being.

}, keywords = {Adaptation, Psychological, Aged, Aging, Data collection, depression, Employment, Female, Humans, Life Change Events, Longitudinal Studies, Male, Mental Health, Middle Aged, Retirement, Sex Factors, Spouses}, issn = {1079-5014}, doi = {10.1093/geronb/59.5.p233}, author = {Maximiliane E Szinovacz and Adam Davey} } @article {6969, title = {Major depression in community-dwelling middle-aged and older adults: prevalence and 2- and 4-year follow-up symptoms.}, journal = {Psychol Med}, volume = {34}, year = {2004}, month = {2004 May}, pages = {623-34}, publisher = {34}, abstract = {

BACKGROUND: Although major depression is a common condition across the age range, there is some evidence from clinical studies that it may be more persistent and disabling in older adults. This study examined the demographic, socio-economic and clinical factors associated with major depression and with persistence of depressive symptoms at 2- and 4-year follow-ups in a large population sample of middle-aged and older adults.

METHOD: In a sample of 9747 participants aged over 50 in the 1996 wave of the US Health and Retirement Study, the authors assessed the 12-month prevalence of major depression using the Composite International Diagnostic Interview-Short Form (CIDI-SF). Significant depressive symptoms at the time of 1996, 1998 and 2000 interviews were assessed using a short form of the Center for Epidemiological Studies Depression Scale (CES-D).

RESULTS: The 12-month prevalence of CIDI-SF major depression was 6.6\%. With age, prevalence declined, but the likelihood of significant depressive symptoms at follow-ups increased. Both prevalence and persistence of significant depressive symptoms at follow-ups were associated with socio-economic disadvantage and physical illness. Persistence of depressive symptoms at follow-ups was also associated with symptoms of anhedonia, feelings of worthlessness, and thoughts of death at baseline.

CONCLUSIONS: Sociodemographic, physical health and a specific profile of depressive symptoms are associated with a poorer course of major depression in the middle-aged and older adults. These indicators may identify a subgroup of patients in need of more careful follow-up and intensive treatment.

}, keywords = {Age Factors, Aged, Depressive Disorder, Major, Female, Follow-Up Studies, Health Status, Humans, Logistic Models, Male, Middle Aged, Prevalence, Residence Characteristics, Sex Factors, Socioeconomic factors, Time Factors, United States}, issn = {0033-2917}, doi = {10.1017/S0033291703001764}, author = {Ramin Mojtabai and Mark Olfson} } @article {6989, title = {Workplace characteristics and work disability onset for men and women.}, journal = {Soz Praventivmed}, volume = {49}, year = {2004}, month = {2004}, pages = {122-31}, publisher = {49}, abstract = {

OBJECTIVES: This paper investigates the association between job characteristics and work disability among men and women in older working ages in the United States. We examine whether the association persists when controlling for major chronic disease experience. We also address whether job characteristics are ultimately associated with the receipt of disability benefits.

METHODS: Data are from the Health and Retirement Survey and are nationally representative of noninstitutionalized persons 51-61 in 1992. Disability onset is estimated using a hazard modeling approach for those working at wave 1 (N = 5,999). A logistic regression analysis of disability benefits is based on a risk set of 525 persons who become work-disabled before the second interview.

RESULTS: Women{\textquoteright}s disability onset and health problems appear less related to job characteristics than men{\textquoteright}s. For men, work disability is associated with stressful jobs, lack of job control, and environmentally hazardous conditions but is not associated with physical demands. Participation in disability benefit programs among those with work disability is unrelated to most job characteristics or health conditions.

CONCLUSIONS: Understanding of the differing process to work disability for men and women and the relationship between work and health by gender is important for current policy development.

}, keywords = {Disabled Persons, Female, Humans, Logistic Models, Male, Middle Aged, Occupational Diseases, Proportional Hazards Models, Retirement, Risk, Sex Factors, Sick Leave, Stress, Psychological, United States, Workers{\textquoteright} compensation, Workload, Workplace}, issn = {0303-8408}, doi = {10.1007/s00038-004-3105-z}, author = {Eileen M. Crimmins and Mark D Hayward} } @article {6865, title = {The labor market consequences of race differences in health.}, journal = {Milbank Q}, volume = {81}, year = {2003}, month = {2003}, pages = {441-73}, publisher = {81}, keywords = {Adult, Age Distribution, Age Factors, Attitude to Health, Black or African American, Cross-Cultural Comparison, Data Interpretation, Statistical, Employment, Female, Health Services Needs and Demand, Health Status Indicators, Humans, Indians, North American, Male, Middle Aged, Sex Distribution, Sex Factors, Socioeconomic factors, United States, White People}, issn = {0887-378X}, doi = {10.1111/1468-0009.t01-1-00063}, author = {John Bound and Timothy A Waidmann and Michael Schoenbaum and Bingenheimer,Jeffrey B.} } @article {6845, title = {Life expectancy with cognitive impairment in the older population of the United States.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {58}, year = {2003}, month = {2003 May}, pages = {S179-86}, publisher = {58B}, abstract = {

OBJECTIVES: This article provides estimates of the prevalence of cognitive impairment by age and sex for a nationally representative sample of the U.S. population aged 70 and over. From these estimates, years of life with and without cognitive impairment are calculated.

METHODS: Using data from the Assets and Health Dynamics of the Oldest Old (AHEAD) survey, the prevalence of cognitive impairment is estimated for a sample representing both the community-dwelling and institutionalized older American population. Sullivan{\textquoteright}s method is used to calculate the average number of years an elderly person can expect to live with and without cognitive impairment.

RESULTS: The prevalence of moderate to severe cognitive impairment in the total U.S. population aged 70 and over is 9.5\%. At age 70, the average American can expect 1.5 years with cognitive impairment. Expected length of life with cognitive impairment is longer for women than men because of their longer life expectancy.

DISCUSSION: As total life expectancy continues to increase, the length of life with cognitive impairment for the American population will increase unless age-specific prevalence is reduced. There is great potential for improvement in future early treatment and diagnosis of this condition.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Cross-Sectional Studies, Female, Humans, Life Expectancy, Male, Neuropsychological tests, Probability, Psychometrics, Sex Factors, Survival Analysis, United States}, issn = {1079-5014}, doi = {10.1093/geronb/58.3.s179}, author = {Suthers, Kristen and Jung K Kim and Eileen M. Crimmins} } @article {6748, title = {Childlessness and the psychological well-being of older persons.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {56}, year = {2001}, month = {2001 Sep}, pages = {S311-20}, publisher = {56B}, abstract = {

OBJECTIVES: Rapid growth in the size of the childless elderly population has prompted concerns about the negative effects of childlessness on psychological well-being. This study adds to this line of inquiry by examining the effects of childlessness on two important dimensions of elderly persons{\textquoteright} psychological well-being: loneliness and depression.

METHODS: Using the 1993 Asset and Health Dynamics Among the Oldest Old data set, the authors estimated logistic and ordinary least squares regression models of psychological well-being for a nationally representative sample of people aged 70 and older (N = 6,517).

RESULTS: Childlessness per se did not significantly increase the prevalence of loneliness and depression at advanced ages, net of other factors. There also was no statistical evidence for the hypothesis that childlessness increases loneliness and depression for divorced, widowed, and never married elderly persons. Sex, however, altered how childlessness and marital status influenced psychological well-being. Divorced, widowed, and never married men who were childless had significantly higher rates of loneliness compared with women in comparable circumstances; divorced and widowed men who were childless also had significantly higher rates of depression than divorced and widowed women.

DISCUSSION: The findings suggest that it is important to understand the consequences of childlessness in the context of marital status and sex.

}, keywords = {Aged, Aged, 80 and over, depression, Family Planning Services, Female, Geriatric Assessment, Humans, Loneliness, Male, Marital Status, Risk Factors, Sex Factors}, issn = {1079-5014}, doi = {10.1093/geronb/56.5.s311}, author = {Zhang, Zhenmei and Mark D Hayward} } @article {6737, title = {Predictors of transitions in disease and disability in pre- and early-retirement populations.}, journal = {J Aging Health}, volume = {13}, year = {2001}, month = {2001 Aug}, pages = {379-409}, publisher = {13}, abstract = {

OBJECTIVES: This study analyzed rates of prevalence and incidence of, and transitions in, disease and disability statuses of those aged 51 to 61 years and the predictors of the transition outcomes-remaining free of disease or disability, getting better, or getting worse-over a 2-year period.

METHODS: Data from the 1992 and 1994 interview waves of the Health and Retirement Study were used for gender-separate binary and multinomial logistic regression analyses.

RESULTS: Despite high prevalence and incidence rates of chronic disease and functional limitations, the improvement rates in disabilities were also high. For both genders, age, years of education, health-related behaviors, and comorbidity factors were significant predictors of the transition outcomes.

DISCUSSION: The significance of health-related behaviors as predictors of transitions suggests that lifestyle factors may have a bigger influence on this age group than on older groups.

}, keywords = {Activities of Daily Living, Aged, Black or African American, Chronic disease, Disabled Persons, Female, Health Status, Hispanic or Latino, Humans, Male, Middle Aged, Retirement, Risk Factors, Sex Factors, Socioeconomic factors, United States, White People}, issn = {0898-2643}, doi = {10.1177/089826430101300304}, author = {Namkee G Choi and Schlichting-Ray, L.} } @article {6724, title = {Older adults and financial bequests.}, journal = {Int J Aging Hum Dev}, volume = {50}, year = {2000}, month = {2000}, pages = {227-44}, publisher = {50}, abstract = {

Using data from Aging and Health Dynamics (AHEAD), this research investigated a model predicting an older adult{\textquoteright}s assessment regarding the chances (from 0 to 100) of leaving a financial bequest. Structural equation modeling analyses revealed three significant predictors of a high assessment (i.e., older age, high sense of control, and high socioeconomic status) and three predictors of a low assessment (i.e., race, physical health problems, and assessment of the chances of medical expenses depleting savings). Whites had higher financial bequests assessments than non-Whites. Physical health problems and the depleting savings assessment exerted negative effects on the financial bequest assessment. Marital status and negative psychological functioning exerted indirect effects through sense of control and through the depleting savings assessment.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Aging, Attitude, Female, Health Care Costs, Health Status, Humans, Male, Mental Health, Michigan, Models, Economic, Sampling Studies, Sex Factors, Socioeconomic factors, Spouses, Surveys and Questionnaires, Wills}, issn = {0091-4150}, doi = {10.2190/AJJ3-AVG7-QKMW-R21R}, author = {Goetting, Marsha A. and Peter Martin and Johnson, Christine} } @article {6707, title = {Pathways to retirement: patterns of labor force participation and labor market exit among the pre-retirement population by race, Hispanic origin, and sex.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {55}, year = {2000}, month = {2000 Jan}, pages = {S14-27}, publisher = {55B}, abstract = {

OBJECTIVES: This study examines the pre-retirement labor force participation behavior of Black, White, and Hispanic men and women to determine how patterns of labor market exit differ among groups.

METHODS: We combine data from the first and second waves of the Health and Retirement Study and apply multinomial logit regression techniques to model labor force status in the first wave of the HRS and change over time.

RESULTS: Black, Hispanic, and female elderly persons experience more involuntary job separation in the years immediately prior to retirement, and the resulting periods of joblessness often eventuate in "retirement" or labor force withdrawal. Minority disadvantage in human capital, health, and employment characteristics accounts for a large part of racial and ethnic differences in labor force withdrawal. Nevertheless, Black men and Hispanic women experience more involuntary labor market exits than Whites with similar socioeconomic and demographic characteristics.

DISCUSSION: Workers most vulnerable to labor market difficulties during their youth confront formidable obstacles maintaining their desired level of labor force attachment as they approach their golden years. This has significant policy implications for the contours of gender and race/ethnic inequality among elderly persons, particularly as life expectancy and the size of the minority elderly population continue to increase.

}, keywords = {Aged, Black or African American, Cross-Cultural Comparison, Employment, Female, Hispanic or Latino, Humans, Logistic Models, Male, Middle Aged, Personnel Downsizing, Regression Analysis, Retirement, Sex Factors, Socioeconomic factors, United States, White People}, issn = {1079-5014}, doi = {10.1093/geronb/55.1.s14}, author = {Chenoa Flippen and Tienda, Marta} } @article {7308, title = {Characteristics of individuals with integrated pensions.}, journal = {Soc Secur Bull}, volume = {62}, year = {1999}, month = {1999}, pages = {28-40}, publisher = {49}, abstract = {

Employer pensions that integrate benefits with Social Security have been the focus of relatively little research. Since changes in Social Security benefit levels and other program characteristics can affect the benefit levels and other features of integrated pension plans, it is important to know who is covered by these plans. This article examines the characteristics of workers covered by integrated pension plans, compared to those with nonintegrated plans and those with no pension coverage. Integrated pension plans are those that explicitly adjust their benefit structure to help compensate for the employer{\textquoteright}s contributions to the Social Security program. There are two basic integration methods used by defined benefit (DB) plans. The offset method causes a reduction in employer pension benefits by up to half of the Social Security retirement benefit; the excess rate method is characterized by an accrual rate that is lower for earnings below the Social Security taxable maximum than above it. Defined contribution (DC) pension plans can be integrated along the lines of the excess rate method. To date, research on integrated pensions has focused on plan characteristics, as reported to the Bureau of Labor Statistics (BLS) through its Employee Benefits Survey (EBS). This research has examined the prevalence of integration among full-time, private sector workers by industry, firm size, and broad occupational categories. However, because the EBS provides virtually no data on worker characteristics, analyses of the effects of pension integration on retirement benefits have used hypothetical workers, varying according to assumed levels of earnings and job tenure. This kind of analysis is not particularly helpful in examining the potential effects of changes in the Social Security program on workers{\textquoteright} pension benefits. However, data on pension integration at the individual level are available, most recently from the Health and Retirement Study (HRS), a nationally representative survey of individuals aged 51-61 in 1992. This dataset provides the basis for the analysis presented here. The following are some of the major findings from this analysis. The incidence of pension integration in the HRS sample is 32 percent of all workers with a pension (14 percent of all workers). The HRS can also identify integrated DC plans, a statistic that is not available from BLS data. The rate of integration for workers with only DC plans is 8 percent. After controlling for other variables, several socio-demographic characteristics are significantly related to the incidence of integration. The probability of having an integrated pension is 4.6 percentage points less for men compared to women. Non-Hispanic blacks are 6.4 percentage points less likely than non-Hispanic whites to have integrated pensions. Union members are 14 percentage points less likely to have integrated pensions, while workers with less than a graduate level education are at least 15 percentage points more likely to have a pension that is integrated. Some earnings and pension characteristics are also significantly correlated with pension integration. Earnings are positively related, with the probability of having an integrated pension increasing by 2 percentage points for an increase of $1,000 in annual pay. An even larger effect comes from earning at or above the Social Security taxable maximum. Workers at or above this income level are 10 percentage points more likely to have an integrated plan, but for those with more than one plan the probability of pension integration goes up by 13 percentage points.

}, keywords = {Bias, Data collection, Educational Status, ethnicity, Female, Humans, Income, Labor Unions, Male, Middle Aged, Occupations, Pensions, Regression Analysis, Reproducibility of Results, Retirement, Sex Factors, Social Security, Socioeconomic factors, United States}, issn = {0037-7910}, author = {Bender, K A} } @article {6672, title = {A comparison of correlates of cognitive functioning in older persons in Taiwan and the United States.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {54}, year = {1999}, month = {1999 Sep}, pages = {S291-301}, publisher = {54B}, abstract = {

OBJECTIVES: This article compares patterns of association between cognitive functioning and a number of sociodemographic and health correlates among older persons in Taiwan and the United States.

METHODS: The study uses data from the 1993 Survey of Health and Living Status of the Elderly in Taiwan and the 1993 Study of Asset and Health Dynamics Among the Oldest Old in the United States. Separate multivariate regression models are employed for each country to examine the effects of sociodemographic and health factors on cognitive functioning, and to examine the marginal impact of cognitive functioning on activities of daily living (ADL) and instrumental ADL (IADL) functioning.

RESULTS: Results of the multivariate analyses show similar patterns of association across the two countries and replicate findings from previous studies. Increasing age, female gender, lower education, depression, and selected health conditions are associated with lower cognitive functioning. In addition, although a significant predictor of both ADL and IADL impairments, cognitive functioning is more powerful with respect to explaining IADL impairments.

DISCUSSION: Study findings suggest that the cognitive measures are capturing similar dimensions in Taiwan and the United States, and that factors associated with cognitive functioning and its consequences with respect to physical functioning are similar in the two countries.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Cognition, Cross-Cultural Comparison, depression, Educational Status, Female, Geriatric Assessment, Health Status, Humans, Male, Multivariate Analysis, Regression Analysis, Sex Factors, Socioeconomic factors, Surveys and Questionnaires, Taiwan, United States}, issn = {1079-5014}, doi = {10.1093/geronb/54b.5.s291}, author = {Mary Beth Ofstedal and Zachary Zimmer and Hui-Sheng Lin} } @article {6646, title = {Conjugal loss and syndromal depression in a sample of elders aged 70 years or older.}, journal = {Am J Psychiatry}, volume = {156}, year = {1999}, month = {1999 Oct}, pages = {1596-601}, publisher = {156}, abstract = {

OBJECTIVE: The goal of this study was to describe the association between conjugal loss and both syndromal depression and depressive symptoms in a prospective cohort study of people aged 70 years or older.

METHOD: A measure of syndromal depression, the shortform Composite International Diagnostic Interview (CIDI), and a revised version of the Center for Epidemiologic Studies--Depression Scale (CES-D Scale) were administered to a group of 5,449 elders in a longitudinal cohort study. The authors compared the rates of syndromal depression (CIDI diagnosis) and depressive symptoms (six CES-D Scale symptoms) in married participants and those who lost spouses between the first and second waves of assessment.

RESULTS: The rate of syndromal depression in the newly bereaved was nearly nine times as high as the rate for married individuals, and the rate of depressive symptoms was nearly four times as high. The percentage of the bereaved respondents who had scores above threshold on the revised CES-D Scale was higher for those interviewed up to 2 years after loss of a spouse than for married respondents. Age, sex, prior psychiatric history, and the expectedness of the death did not differ between depressed and nondepressed newly bereaved subjects.

CONCLUSIONS: Recent bereavement is a significant risk factor for syndromal depression in the elderly. Some widows and widowers experienced high levels of depressive symptoms up to 2 years after the loss of their spouses. Neither demographic variables nor variables concerning the nature of the spouse{\textquoteright}s death predicted bereavement-related depression.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Bereavement, Cohort Studies, depression, Depressive Disorder, Female, Humans, Logistic Models, Longitudinal Studies, Male, Marital Status, Odds Ratio, Psychiatric Status Rating Scales, Risk Factors, Sex Factors, Widowhood}, issn = {0002-953X}, doi = {10.1176/ajp.156.10.1596}, author = {Carolyn L. Turvey and Carney, C. and Arndt, Stephan and Robert B Wallace and A. Regula Herzog} } @article {6644, title = {Gender differences in pension wealth: estimates using provider data.}, journal = {Gerontologist}, volume = {39}, year = {1999}, month = {1999 Jun}, pages = {320-33}, publisher = {39}, abstract = {

Information from pension providers was examined to investigate gender differences in pension wealth at midlife. For full-time wage and salary workers approaching retirement age who had pension coverage, median pension wealth on the current job was 76\% greater for men than women. Differences in wages, years of job tenure, and industry between men and women accounted for most of the gender gap in pension wealth on the current job. Less than one third of the wealth difference could not be explained by gender differences in education, demographics, or job characteristics. The less-advantaged employment situation of working women currently in midlife carries over into worse retirement income prospects. However, the gender gap in pensions is likely to narrow in the future as married women{\textquoteright}s employment experiences increasingly resemble those of men.

}, keywords = {Female, Humans, Male, Occupations, Pensions, Sex Factors, United States, Women, Working}, issn = {0016-9013}, doi = {10.1093/geront/39.3.320}, author = {Richard W. Johnson and Sambamoorthi, Usha and Crystal, Stephen} } @article {6572, title = {Do smokers understand the mortality effects of smoking? Evidence from the Health and Retirement Survey.}, journal = {Am J Public Health}, volume = {87}, year = {1997}, month = {1997 May}, pages = {755-9}, publisher = {87}, abstract = {

OBJECTIVES: This study examined whether smokers recognize that smoking is likely to shorten their lives and, if so, whether they understand the magnitude of this effect.

METHODS: People{\textquoteright}s expectations about their chances of reaching age 75 were compared with epidemiological predictions from life tables for never, former, current light, and current heavy smokers. Data on expectations of reaching age 75 came from the Health and Retirement Survey, a national probability sample of adults aged 50 through 62 years. Predictions came from smoking-specific life tables constituted from the 1986 National Mortality Followback Survey and the 1985 and 1987 National Health Interview Surveys.

RESULTS: Among men and women, the survival expectations of never, former, and current light smokers were close to actual predictions. However, among current heavy smokers, expectations of reaching age 75 were nearly twice as high as actuarial predictions.

CONCLUSIONS: These findings suggest that at least heavy smokers significantly underestimate their risk of premature mortality.

}, keywords = {Cognition, Female, Health Surveys, Humans, Life Tables, Longevity, Male, Middle Aged, Retirement, Risk, Sex Factors, Smoking, Survival Analysis}, issn = {0090-0036}, doi = {10.2105/ajph.87.5.755}, author = {Michael Schoenbaum} } @article {6545, title = {Disentangling the effects of disability status and gender on the labor supply of Anglo, black, and Latino older workers.}, journal = {Gerontologist}, volume = {36}, year = {1996}, month = {1996 Jun}, pages = {299-310}, publisher = {36}, abstract = {

Utilizing data from the 1991 Health and Retirement Study Early Release File, this article examines the effects of disability status on labor force participation and earnings of preretirement workers aged 50 to 64. Results from our hierarchical regression models suggest that poor health and the presence of a work disability significantly reduced the labor force participation and earnings of older men and women. These analyses also suggest that economic well-being was constrained by the costs associated with additional "minority statuses." For example, the odds of being employed were reduced by approximately 46\% for black men with disabilities. Further, the earnings of black men were 17\% lower than the earnings of their nondisabled counterparts.

}, keywords = {Black or African American, Disabled Persons, Employment, Female, Hispanic or Latino, Humans, Male, Middle Aged, Models, Theoretical, Multivariate Analysis, Sex Factors, United States, White People}, issn = {0016-9013}, doi = {10.1093/geront/36.3.299}, author = {Santiago, A.M. and Clara G. Muschkin} } @article {6541, title = {Physical activity and smoking: gender comparisons among older African American adults.}, journal = {J Health Care Poor Underserved}, volume = {7}, year = {1996}, month = {1996 Aug}, pages = {232-51}, publisher = {7}, abstract = {

Little effort has been expended on the examination of systematic health risk behaviors among adult African Americans by gender. Using data from the national Health and Retirement Study (HRS), this article compares differences between male and female physical activity and smoking behaviors of African Americans aged 50 to 61. The analysis highlights a clear pattern of socioeconomic differences with current male smokers, who are more likely to be unmarried and in the lower income and educational levels. Among women, the relationship between smoking patterns, income, and education is less definitive and consistent. Our findings, confirmed by earlier studies, indicate that the largest percentage of the study population, both male and female, are not engaged in any form of regular physical exercise. Thus human service providers must be more attentive to gender and sociodemographic differences in smoking habits and patterns of physical activities to tailor policies and programs accordingly.

}, keywords = {Age Factors, Black or African American, Education, Exercise, Female, Humans, Income, Male, Marital Status, Middle Aged, Risk Factors, Sampling Studies, Sex Factors, Smoking, Smoking cessation}, issn = {1049-2089}, doi = {10.1353/hpu.2010.0617}, author = {Lockery, Shirley A. and Stanford, E. Percil} } @article {6547, title = {Retirement expectations: differences by race, ethnicity, and gender.}, journal = {Gerontologist}, volume = {36}, year = {1996}, month = {1996 Jun}, pages = {373-82}, publisher = {36}, abstract = {

Analyses by race and ethnicity of several important dimensions of labor market behavior have been constrained in the past by limited samples of the African American and Hispanic populations. This article uses data from the first wave of the Health and Retirement Survey, which oversamples these populations, to compare the retirement plans of African American, Hispanic, and white married men and women. Findings suggest that retirement expectations may accurately forecast retirement behavior and that the differences by race and ethnicity, as well as by gender, that are evident in retirement plans are likely to be reflected in retirement outcomes.

}, keywords = {ethnicity, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged, Models, Theoretical, Pensions, Retirement, Sex Factors, Social Security, United States}, issn = {0016-9013}, doi = {10.1093/geront/36.3.373}, author = {Honig, Marjorie} } @article {6552, title = {Risk factors for occupational injuries among older workers: an analysis of the health and retirement study.}, journal = {Am J Public Health}, volume = {86}, year = {1996}, month = {1996 Sep}, pages = {1306-9}, publisher = {86}, abstract = {

OBJECTIVES: This study examined risk factors for occupational injury among older workers.

METHODS: We analyzed data on 6854 employed nonfarmers from the Health and Retirement Study (HRS), a population-based sample of Americans 51 through 61 years old.

RESULTS: Occupational injuries were associated with the following: the occupations of mechanics and repairers (odds ratio [OR] = 2.27), service personnel (OR = 1.68), and laborers (OR = 2.18); jobs requiring heavy lifting (OR = 2.75); workers{\textquoteright} impaired hearing (OR = 1.60) and impaired vision (OR = 1.53); and jobs requiring good vision (OR = 1.43). Self-employment was associated with fewer injuries (OR = 0.47).

CONCLUSIONS: These results emphasize the importance of a good match between job demands and worker capabilities.

}, keywords = {Accidents, Occupational, Cross-Sectional Studies, Educational Status, Female, Health Status, Humans, Male, Middle Aged, Occupational Diseases, Regression Analysis, Retirement, Risk Factors, Sex Factors, United States, Wounds and Injuries}, issn = {0090-0036}, doi = {10.2105/ajph.86.9.1306}, author = {Zwerling, Craig and Nancy L. Sprince and Robert B Wallace and Charles S. Davis and Paul S. Whitten and Steven G Heeringa} }