@article {13732, title = {Longitudinal Associations of Neighborhood Social Cohesion With Self-Perceptions of Aging and Loneliness.}, journal = {The Journals of Gerontology, Series B, Psychological Sciences and Social Sciences}, volume = {79}, year = {2024}, abstract = {

OBJECTIVES: One{\textquoteright}s aging experience is structurally embedded in the social aspects of the residential environment. However, it is largely unknown how this upstream contextual factor may shape self-perceptions of aging (SPA) and loneliness, critical aspects of later-life psychological well-being with profound health implications. This study examines the longitudinal association of neighborhood social cohesion with SPA and -loneliness, as well as the potential bidirectional associations between outcomes.

METHODS: This study used 8-year data from the Health and Retirement Study, with an analytic sample of 9,299 U.S. adults aged 50 or older. Latent growth curve models were implemented to assess the associations of baseline neighborhood social cohesion with trajectories of SPA and loneliness. Path analysis was conducted to examine the longitudinal mediation mechanisms connecting neighborhood social cohesion with SPA and loneliness.

RESULTS: Respondents from cohesive neighborhoods at baseline started with and maintained more positive initial SPA over time, but their positive perceptions decreased faster over time. Cohesive neighborhoods were associated with lower levels of loneliness over an 8-year study period, but also with slower rates of decline in loneliness. Path analysis revealed that neighborhood social cohesion indirectly affected SPA and loneliness, via bidirectional mechanisms.

DISCUSSION: This study demonstrates the significant role of environmental factors beyond individual predictors and advocates for the potential of neighborhood environments as a target for interventions to foster positive aging perception and tackle loneliness. Furthermore, it indicates that loneliness and SPA could reciprocally influence each other in the context of neighborhood social cohesion, enriching our understanding of their dynamics.

}, keywords = {Aging, Humans, Loneliness, Residence Characteristics, Self Concept, social cohesion}, issn = {1758-5368}, doi = {10.1093/geronb/gbad148}, author = {Choi, Eun Young} } @article {13840, title = {Neighborhood Social Environment and Dementia: The Mediating Role of Social Isolation.}, journal = {Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences}, volume = {79}, year = {2024}, abstract = {

OBJECTIVES: Despite the potential importance of the neighborhood social environment for cognitive health, the connection between neighborhood characteristics and dementia remains unclear. This study investigated the association between the prospective risk of dementia and three distinct aspects of neighborhood social environment: socioeconomic deprivation, disorder, and social cohesion. We also examined whether objective and subjective aspects of individual-level social isolation may function as mediators.

METHODS: Leveraging data from the Health and Retirement Study (2006-2018; N = 9,251), we used Cox proportional hazards models to examine the association between time-to-dementia incidence and each neighborhood characteristic, adjusting for covariates and the propensity to self-select into disadvantaged neighborhoods. We used inverse odds weighting to decompose significant total effects of neighborhood characteristics into mediational effects of objective and subjective social isolation.

RESULTS: The risk of dementia was associated with deprivation and disorder but not low cohesion. In deprived neighborhoods, individuals had an 18\% increased risk of developing dementia (cause-specific hazard ratio [CHR] = 1.18, 95\% CI: 1.02 to 1.38), and those in disordered areas had a 27\% higher risk (CHR = 1.27, 95\% CI: 1.03 to 1.59). 20\% of the disorder{\textquoteright}s effects were mediated by subjective social isolation, while the mediational effects of objective isolation were nonsignificant. Deprivation{\textquoteright}s total effects were not partitioned into mediational effects given its nonsignificant associations with the mediators.

DISCUSSION: Neighborhood deprivation and disorder may increase middle to older adults{\textquoteright} risks of dementia. The disorder may adversely affect cognitive health through increasing loneliness. Our results suggest a clear need for dementia prevention targeting upstream neighborhood contexts, including the improvement of neighborhood conditions to foster social integration among residents.

}, keywords = {Aged, Dementia, Humans, Prospective Studies, Residence Characteristics, Social Environment, social isolation}, issn = {1758-5368}, doi = {10.1093/geronb/gbad199}, author = {Choi, Eun Young and Cho, Gawon and Chang, Virginia W} } @article {13113, title = {Everyday Discrimination, Neighborhood Perceptions, and Incidence of Activity Limitations Among Middle-Aged and Older African Americans.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {78}, year = {2023}, pages = {866-879}, abstract = {

OBJECTIVES: This study aims to examine the relationship between everyday discrimination, neighborhood perceptions, and the incidence of daily activity limitations (i.e., activities of daily living [ADL] and instrumental activities of daily living [IADL]) among middle-aged and older African Americans. This study also examines whether neighborhood perceptions moderate the association between discrimination and the incidence of daily activity limitations.

METHODS: Data were from the 2006 to 2016 waves of the Health and Retirement Study. African Americans aged 50 or older free of ADL limitations (N~=~1,934) and IADL limitations (N~=~2,007) at baseline were selected. Cox proportional hazards regression models were performed to test the study aims. Multiple imputations were applied to handle missing data.

RESULTS: One-unit increase in everyday discrimination was associated with a 25\% (p < .05) higher risk of ADL limitation onset. Perceived neighborhood social cohesion and physical disadvantage moderated the association between discrimination and IADL limitation onset.

DISCUSSION: Everyday discrimination represents a significant stressor that negatively affects older African Americans{\textquoteright} performance of daily activities. Community-level efforts that improve neighborhood perceptions are needed to alleviate the negative effects of discrimination on the incidence of activity limitations.

}, keywords = {Activities of Daily Living, Aged, Black or African American, Humans, Incidence, Middle Aged, Residence Characteristics, Retirement}, issn = {1758-5368}, doi = {10.1093/geronb/gbad001}, author = {Qin, Weidi and Nguyen, Ann W and Wang, Yi and Hamler, Tyrone C and Wang, Fei} } @article {13164, title = {Under Different Roofs? Coresidence With Adult Children and Parents{\textquoteright} Mental Health Across Race and Ethnicity Over Two Decades.}, journal = {Demography}, volume = {60}, year = {2023}, month = {2023 Apr 01}, pages = {461-492}, abstract = {

Many U.S. parents share a household with an adult child in later life. However, the reasons parents and adult children coreside may vary over time and across family race/ethnicity, shaping relationships with parents{\textquoteright} mental health. Using the Health and Retirement Study, this study investigates the determinants and mental health correlates of coresidence with adult children from 1998 to 2018 among White, Black, and Hispanic parents under age 65 and aged 65+. Findings show that the predictors of coresidence shifted with increasing odds that parents lived with an adult child, and several varied by parents{\textquoteright} age group and race/ethnicity. Compared with White parents, Black and Hispanic parents were more likely to live with adult children, especially at older ages, and to indicate that they helped their children with household finances or functional limitations. Living with adult children was associated with higher depressive symptoms among White parents, and mental health was negatively related to living with adult children who were not working or were helping parents with functional limitations. The findings highlight increasing diversity among adult child-coresident parents and underscore persistent differences in the predictors and meaning of coresidence with adult children across race/ethnicity.

}, keywords = {Adult, Adult children, ethnicity, Humans, Intergenerational Relations, Mental Health, Parents, Residence Characteristics}, issn = {1533-7790}, doi = {10.1215/00703370-10571923}, author = {Caputo, Jennifer and Cagney, Kathleen A} } @article {12430, title = {Defining Childlessness Among Middle-Aged and Older Americans: A Research Note.}, journal = {Demography}, volume = {59}, year = {2022}, pages = {813-826}, abstract = {

Measuring childlessness is complicated by the increasing complexity of family structure. Using data from the 2014 Health and Retirement Study, in this research note we compared three definitions of childlessness: (1) respondent never fathered/gave birth to a child, (2) respondent had no children who were living and in contact, and (3) respondent and spouse/partner had no children or stepchildren who were living and in contact. Results showed that the prevalence of childlessness among Americans aged 55 or older ranged from 9.2\% to 13.6\% depending on which definition was used. The association between select individual characteristics (gender and marital status) and the likelihood of childlessness, as well as the association between childlessness and loneliness and living arrangements, also varied depending on how childlessness was defined. Therefore, how we define childlessness can affect our understanding of its prevalence, correlates, and relationships with well-being. Future research on childlessness should carefully consider the choice of definition and its implications for research and policy discussions.

}, keywords = {Aged, Child, Family Characteristics, Gender Identity, Marital Status, Middle Aged, Residence Characteristics}, issn = {1533-7790}, doi = {10.1215/00703370-9987649}, author = {Xu, Xiao and Liang, Jersey and Raymo, James M and Kim, BoRin and Ofstedal, Mary Beth} } @article {11994, title = {Cross-Sectional and Longitudinal Association between Neighborhood Environment and Perceived Control in Older Adults: Findings from HRS.}, journal = {International Journal of Environmental Research and Public Health}, volume = {18}, year = {2021}, pages = {11344}, abstract = {

The current study examined how neighborhood environments are related to older adults{\textquoteright} perceived control over time. A longitudinal study design was employed using data sampled from the Health and Retirement Study (HRS) 2014 and 2018. In total, 3170 older adults, whose age ranged between 60 and 99 years at the baseline, were followed up with a 4-year lag. Measures included two domains of neighborhood characteristics: social cohesion and physical disorder (at baseline and follow-up) and perceived control (at follow-up). Path coefficients between the latent factors were examined using structural equation modeling. Results showed that there was a significant cross-sectional and longitudinal association between neighborhood social cohesion and older adults{\textquoteright} perceived control, while neighborhood physical disorder was cross-sectionally associated with perceived control. Study findings provide evidence for promoting social integration and social capital in their neighborhood that might contribute to older adults{\textquoteright} perceived competence and beliefs in control.

}, keywords = {Residence Characteristics, Retirement, Social capital}, issn = {1660-4601}, doi = {10.3390/ijerph182111344}, author = {Lee, Sunwoo} } @article {Chao2020, title = {Composite diagnostic criteria are problematic for linking potentially distinct populations: the case of frailty}, journal = {Scientific Reports}, volume = {10}, year = {2020}, note = {cited By 0}, type = {Article}, abstract = {{Composite diagnostic criteria are common in frailty research. We worry distinct populations may be linked to each other due to complicated criteria. We aim to investigate whether distinct populations might be considered similar based on frailty diagnostic criteria. The Functional Domains Model for frailty diagnosis included four domains: physical, nutritive, cognitive and sensory functioning. Health and Retirement Study participants with two or more deficiencies in the domains were diagnosed frail. The survival distributions were analyzed using discrete-time survival analysis. The distributions of the demographic characteristics and survival across the groups diagnosed with frailty were significantly different (p < 0.05). A deficiency in cognitive functioning was associated with the worst survival pattern compared with a deficiency in the other domains (adjusted p < 0.05). The associations of the domains with mortality were cumulative without interactions. Cognitive functioning had the largest effect size for mortality prediction (Odds ratios}, keywords = {Frail Elderly, Frailty Phenotype, Residence Characteristics}, issn = {20452322}, doi = {10.1038/s41598-020-58782-1}, url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85079339704\&doi=10.1038\%2fs41598-020-58782-1\&partnerID=40\&md5=ba7c890ffb416ce5b17f819b2c21936a}, author = {Yi-Sheng Chao and Chao-Jung Wu and Hsing-Chien Wu and Hui-Ting Hsu and Tsao, L.-C. and Cheng, Y.-P. and Lai, Y.-C. and Wei-Chih Chen} } @article {13276, title = {Study Protocol: Social Capital as a Resource for the Planning and Design of Socially Sustainable and Health Promoting Neighborhoods- A Mixed Method Study.}, journal = {Front Public Health}, volume = {8}, year = {2020}, pages = {581078}, abstract = {

Promoting inclusive, safe, resilient, and sustainable communities is one of the 17 Sustainable Development Goals ratified in 2015 by 193 UN member states, not least in Sweden. Social sustainability involves preserving particular societal values (e.g., local identity) as well as developing values (e.g., social cohesion) that are perceived as needed. Socially sustainable development also implies promoting integration and preventing segregation. Social capital is one important indicator to measure how socially sustainable an area is. This project aims to explore how social capital can be used as a conceptual tool in developing housing policy for social sustainability in Ume{\r a} Municipality. The three sub-studies in this project combine quantitative and qualitative methods. We will conduct a review of the municipality{\textquoteright}s documents to understand how the ideas of social sustainability have influenced political declarations and implemented social and housing policies and interventions during the period 2006-2020. The quantitative study includes a longitudinal follow-up to the 2006 survey{\textquoteright}s respondents to assess the longitudinal impacts of neighborhood social capital on health and well-being; as well as a new repeated cross-sectional survey to investigate how social capital has changed in local neighborhoods from 2006 to 2020. The qualitative study includes case studies in neighborhoods with different social capital dynamics to understand how different resident sub-groups perceive their neighborhoods and how implemented social and housing policies have influenced the social capital dynamics and responded to the needs of different sub-groups. The project is run in close collaboration with the Commission for a Socially Sustainable Ume{\r a}. This project will create new and unique perspectives on long-term structural changes of relevance for a socially sustainable housing policy; knowledge that is highly valuable for continuous municipal planning; and will outline recommendations to guide local housing policies for social sustainable neighborhoods in Ume{\r a} Municipality. This study has been assessed and approved by the Swedish Ethics Review Authority (Dnr: 2019-04395; Dnr: 2020-00160; Dnr 2020-02757). The dissemination goals of this project are (1) sustained engagement of key stakeholders throughout the project and (2) dissemination of the research findings through popular science, conferences, and scientific papers.

}, keywords = {Cross-Sectional Studies, Housing, Residence Characteristics, Review Literature as Topic, Social capital, Sweden}, issn = {2296-2565}, doi = {10.3389/fpubh.2020.581078}, author = {Santosa, Ailiana and Ng, Nawi and Zetterberg, Liv and Eriksson, Malin} } @article {10619, title = {The Longitudinal Associations of Perceived Neighborhood Disorder and Lack of Social Cohesion With Depression Among Adults Aged 50 Years or Older: An Individual-Participant-Data Meta-Analysis From 16 High-Income Countries}, journal = {American Journal of Epidemiology }, year = {2019}, type = {Report}, abstract = {Although residential environment might be an important predictor of depression among older adults, systematic reviews point to a lack of longitudinal investigations, and the generalizability of the findings is limited to a few countries. We used longitudinal data collected between 2012 and 2017 in 3 surveys including 15 European countries and the United States and comprising 32,531 adults aged 50 years or older. The risk of depression according to perceived neighborhood disorder and lack of social cohesion was estimated using 2-stage individualparticipant-data meta-analysis; country-specific parameters were analyzed by meta-regression. We conducted additional analyses on retired individuals. Neighborhood disorder (odds ratio (OR) = 1.25) and lack of social cohesion (OR = 1.76) were significantly associated with depression in the fully adjusted models. In retirement, the risk of depression was even higher (neighborhood disorder: OR = 1.35; lack of social cohesion: OR = 1.93). Heterogeneity across countries was low and was significantly reduced by the addition of country-level data on income inequality and population density. Perceived neighborhood problems increased the overall risk of depression among adults aged 50 years or older. Policies, especially in countries with stronger links between neighborhood and depression, should focus on improving the physical environment and supporting social ties in communities, which can reduce depression and contribute to healthy aging.}, keywords = {Cohort Studies, depression, Mental Health, meta-analysis, multicenter studies, Residence Characteristics}, doi = {10.1093/aje/kwz209}, url = {https://www.researchgate.net/profile/Gergo_Baranyi/publication/336217860_The_Longitudinal_Association_of_Perceived_Neighborhood_Disorder_and_Lack_of_Social_Cohesion_With_Depression_Among_Adults_Aged_50_and_Over_An_Individual_Participant_Data_Meta-Analysis}, author = {Baranyi, Gerg{\H o} and Sieber, Stefan and Cullati, St{\'e}phane and Pearce, Jamie and Chris J.L. Dibben and Courvoisier, Delphine S} } @article {10714, title = {Are coresidence and nursing homes substitutes? Evidence from Medicaid spend-down provisions.}, journal = {J Health Econ}, volume = {59}, year = {2018}, month = {2018 05}, pages = {125-138}, abstract = {

This paper measures the extent to which the price of nursing home care affects a potential substitute living arrangement: coresidence with adult children. Exploiting variation in state Medicaid income "spend-down" provisions over time, I find that living in a state with a spend-down provision decreases the prevalence of coresidence with adult children by 1-4 percentage points for single elderly individuals, with a corresponding increase in the use of nursing home care. These findings suggest that changes in Medicaid eligibility for long-term care benefits could have large impacts on living arrangements, care utilization patterns, and Medicaid expenditures.

}, keywords = {Adult children, Aged, Aged, 80 and over, Female, Health Expenditures, Homes for the Aged, Humans, Long-term Care, Male, Medicaid, Nursing homes, Residence Characteristics, United States}, issn = {1879-1646}, doi = {10.1016/j.jhealeco.2018.04.003}, author = {Corina D Mommaerts} } @article {8853, title = {Is Childhood Socioeconomic Status Independently Associated with Adult BMI after Accounting for Adult and Neighborhood Socioeconomic Status?}, journal = {PLoS One}, volume = {12}, year = {2017}, month = {2017}, pages = {e0168481}, abstract = {

Childhood socioeconomic status (SES) is inversely associated with adult weight in high income countries. Whether the influence of childhood SES on adult weight is best described using a critical period model or an accumulation of risk model is not yet settled. This research tests whether childhood SES is associated with adult BMI and likelihood of obesity independent of adult socioeconomic status and neighborhood characteristics. Data on individual childhood and adult characteristics come from the Health and Retirement Study (N = 13,545). Data on neighborhood characteristics come from the 2000 Decennial Census and American Community Survey (2005-2009). In the fully adjusted models, perceived financial hardship before the age of sixteen and having a father who was unemployed are associated with higher BMI among males and, among females, paternal education remains associated with adult BMI. However, childhood SES is not associated with likelihood of obesity after fully adjusting for adult SES and neighborhood characteristics, suggesting that the direct effects of early childhood SES on BMI are small relative to the other factors associated with obesity in adulthood.

}, keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Alabama, Body Mass Index, Child, Female, Health Behavior, Humans, Male, Middle Aged, Obesity, Residence Characteristics, Risk Factors, Social Class, Socioeconomic factors, Young Adult}, issn = {1932-6203}, doi = {10.1371/journal.pone.0168481}, url = {http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168481}, author = {Gregory Pavela} } @article {8828, title = {Neighborhood age structure and cognitive function in a nationally-representative sample of older adults in the U.S.}, journal = {Soc Sci Med}, volume = {174}, year = {2017}, month = {2017 02}, pages = {149-158}, abstract = {

Recent evidence suggests that living in a neighborhood with a greater percentage of older adults is associated with better individual health, including lower depression, better self-rated health, and a decreased risk of overall mortality. However, much of the work to date suffers from four limitations. First, none of the U.S.-based studies examine the association at the national level. Second, no studies have examined three important hypothesized mechanisms - neighborhood socioeconomic status and neighborhood social and physical characteristics - which are significantly correlated with both neighborhood age structure and health. Third, no U.S. study has longitudinally examined cognitive health trajectories. We build on this literature by examining nine years of nationally-representative data from the Health and Retirement Study (2002-2010) on men and women aged 51 and over linked with Census data to examine the relationship between the percentage of adults 65 and older in a neighborhood and individual cognitive health trajectories. Our results indicate that living in a neighborhood with a greater percentage of older adults is related to better individual cognition at baseline but we did not find any significant association with cognitive decline. We also explored potential mediators including neighborhood socioeconomic status, perceived neighborhood cohesion and perceived neighborhood physical disorder. We did not find evidence that neighborhood socioeconomic status explains this relationship; however, there is suggestive evidence that perceived cohesion and disorder may explain some of the association between age structure and cognition. Although more work is needed to identify the precise mechanisms, this work may suggest a potential contextual target for public health interventions to prevent cognitive impairment.

}, keywords = {Aged, Aged, 80 and over, Aging, Cognition, Female, Health Status, Humans, Interpersonal Relations, Male, Residence Characteristics, Social Support, Socioeconomic factors, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2016.12.005}, url = {http://linkinghub.elsevier.com/retrieve/pii/S0277953616306669http://api.elsevier.com/content/article/PII:S0277953616306669?httpAccept=text/plainhttp://api.elsevier.com/content/article/PII:S0277953616306669?httpAccept=text/xml}, author = {Esther M Friedman and Regina A Shih and Mary E Slaughter and Margaret M Weden and Kathleen A. Cagney} } @article {6513, title = {Are self-reported neighbourhood characteristics associated with onset of functional limitations in older adults with or without memory impairment?}, journal = {J Epidemiol Community Health}, volume = {70}, year = {2016}, month = {2016 Oct}, pages = {1017-23}, abstract = {

BACKGROUND: Neighbourhood resources may preserve functional independence in older adults, but little is known about whether benefits differ for individuals with normal and impaired memory. We evaluated the extent to which neighbourhood context was related to onset of instrumental and basic activities of daily living (I/ADL) limitations and whether relationships were modified by memory impairment.

METHODS: Health and Retirement Study participants 50+ years of age without baseline I/ADL limitations (n=8726 for IADL and n=8345 for ADL models) were interviewed biennially for up to 8 years. Self-reported neighbourhood characteristics were scaled from 0 (worst) to 1 (best). Memory, assessed by direct and proxy cognitive assessments, was dichotomised at the 20th centile. We used pooled logistic regression models, adjusted for demographics and individual characteristics.

RESULTS: Low neighbourhood physical disorder (OR=0.51 (95\% CI: 0.37 to 0.69)), high social cohesion (OR=0.46 (0.34 to 0.62)), and high safety (OR=0.59 (0.46 to 0.76)) were associated with reduced incidence of IADL limitations. These neighbourhood characteristics were also associated with lower incidence of ADL limitations (disorder OR=0.59 (0.43 to 0.81)); social cohesion OR=0.60 (0.45 to 0.81)); safety OR=0.74 (0.58 to 0.93)). High social ties were not related to ADLs (OR=1.01(0.80 to 1.28)) or IADLs (OR=0.93(0.74 to 1.17)). The benefits of these neighbourhood characteristics for ADLs were similar among those with and without memory impairment but primarily observed among those without memory impairment for IADLs.

CONCLUSIONS: Older adults living in neighbourhoods with low physical disorder, high social cohesion and high safety experience lower incidence of IADL and ADL limitations. Memory status modified the estimated effects of neighbourhood characteristics on IADL but not ADL limitations.

}, keywords = {Activities of Daily Living, Aged, Female, Humans, Independent Living, Interviews as Topic, Longitudinal Studies, Male, Memory Disorders, Middle Aged, Mobility Limitation, Residence Characteristics, Risk Factors, United States}, issn = {1470-2738}, doi = {10.1136/jech-2016-207241}, url = {http://jech.bmj.com/content/early/2016/05/06/jech-2016-207241.abstract}, author = {Thu T Nguyen and Rist, Pamela M and M. Maria Glymour} } @article {8400, title = {Can social policy influence socioeconomic disparities? Korean War GI Bill eligibility and markers of depression.}, journal = {Ann Epidemiol}, volume = {26}, year = {2016}, month = {2016 Feb}, pages = {129-135.e3}, publisher = {26}, abstract = {

PURPOSE: The Korean War GI Bill provided socioeconomic benefits to veterans; however, its association with health is unclear; we hypothesize GI Bill eligibility is associated with fewer depressive symptoms and smaller disparities.

METHODS: Data from 246 Korean War GI Bill eligible veterans and 240 nonveterans from the Health and Retirement Study were matched on birth year, southern birth, race, height, and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78 years) was assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale, dichotomized to reflect elevated depressive symptoms. Regression analyses were stratified into low (at least one parent < 8 years schooling/missing data, n = 167) or high (both parents >= 8 years schooling, n = 319) childhood socioeconomic status (cSES) groups.

RESULTS: Korean War GI Bill eligibility predicted fewer depressive symptoms among individuals from low cSES backgrounds [β = -0.64, 95\% confidence interval (CI) = (-1.18, -0.09), P = .022]. Socioeconomic disparities were smaller among veterans than nonveterans for number of depressive symptoms [β = -0.76, 95\% CI = (-1.33, -0.18), P = .010] and elevated depressive symptoms [β = -11.7, 95\% CI = (-8.2, -22.6), P = .035].

CONCLUSIONS: Korean War GI Bill eligibility predicted smaller socioeconomic disparities in depression markers.

}, keywords = {Aged, Aged, 80 and over, depression, Health Status Disparities, Humans, Korean War, Male, Public Policy, Residence Characteristics, Risk Factors, Socioeconomic factors, Veterans}, issn = {1873-2585}, doi = {10.1016/j.annepidem.2015.12.003}, url = {http://www.sciencedirect.com/science/article/pii/S1047279715300107}, author = {Anusha M Vable and Canning, David and M. Maria Glymour and Ichiro Kawachi and Marcia P Jimenez and S. V. Subramanian} } @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 {6437, title = {Functioning, Forgetting, or Failing Health: Which Factors Are Associated With a Community-Based Move Among Older Adults?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {71}, year = {2016}, month = {2016 Nov}, pages = {1120-1130}, abstract = {

OBJECTIVE: To examine whether the health and functioning of middle-aged and older adults are associated with an increased likelihood of community-based moves.

METHOD: Biennial data from adults aged 51 and older in the Health and Retirement Study (HRS) and discrete-time survival models were used to assess the likelihood of community-based moves from 2000 to 2010 as a function of 11 measures of health and functioning.

RESULTS: Respondents diagnosed with heart disease, stroke, hypertension, lung disease, and psychiatric problems were more likely to move during the study period than those with no such diagnosis. Changes in activities of daily living and instrumental activities of daily living functioning, cognitive impairment, and falls were also related to a greater likelihood of moving during the study period. Cancer and diabetes were not related to overall moves, although diabetes was associated with an increased likelihood of local moves. For the most part, it was longstanding not recent diagnoses that were significantly related to the likelihood of moving.

DISCUSSION: Although some health conditions precipitate moves among middle-aged and older adults, others do not. This work has important implications for understanding the role of different aspects of health and functioning in the likelihood of migration among older adults.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Cognitive Dysfunction, Female, Health Status, Health Surveys, Humans, Male, Middle Aged, Population Dynamics, Residence Characteristics, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbv075}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/10/07/geronb.gbv075.abstract}, author = {Esther M Friedman and Margaret M Weden and Regina A Shih and Stephanie Kovalchik and Singh, Reema and Jos{\'e} J Escarce} } @article {8542, title = {Lagged Associations of Metropolitan Statistical Area- and State-Level Income Inequality with Cognitive Function: The Health and Retirement Study.}, journal = {PLoS One}, volume = {11}, year = {2016}, month = {2016}, pages = {e0157327}, abstract = {

PURPOSE: Much variation in individual-level cognitive function in late life remains unexplained, with little exploration of area-level/contextual factors to date. Income inequality is a contextual factor that may plausibly influence cognitive function.

METHODS: In a nationally-representative cohort of older Americans from the Health and Retirement Study, we examined state- and metropolitan statistical area (MSA)-level income inequality as predictors of individual-level cognitive function measured by the 27-point Telephone Interview for Cognitive Status (TICS-m) scale. We modeled latency periods of 8-20 years, and controlled for state-/metropolitan statistical area (MSA)-level and individual-level factors.

RESULTS: Higher MSA-level income inequality predicted lower cognitive function 16-18 years later. Using a 16-year lag, living in a MSA in the highest income inequality quartile predicted a 0.9-point lower TICS-m score (β = -0.86; 95\% CI = -1.41, -0.31), roughly equivalent to the magnitude associated with five years of aging. We observed no associations for state-level income inequality. The findings were robust to sensitivity analyses using propensity score methods.

CONCLUSIONS: Among older Americans, MSA-level income inequality appears to influence cognitive function nearly two decades later. Policies reducing income inequality levels within cities may help address the growing burden of declining cognitive function among older populations within the United States.

}, keywords = {Cities, Cognition, Female, health, Humans, Income, Interviews as Topic, Linear Models, Male, Middle Aged, Multivariate Analysis, Residence Characteristics, Retirement, Socioeconomic factors, Statistics as Topic, Telephone, United States}, issn = {1932-6203}, doi = {10.1371/journal.pone.0157327}, url = {http://dx.doi.org/10.1371/journal.pone.0157327}, author = {Kim, Daniel and Griffin, Beth Ann and Mohammed U Kabeto and Jos{\'e} J Escarce and Kenneth M. Langa and Regina A Shih}, editor = {M. Maria Glymour} } @article {8477, title = {Neighborhood Support and Aging-in-Place Preference Among Low-Income Elderly Chinese City-Dwellers.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {71}, year = {2016}, month = {2016 Jan}, pages = {98-105}, abstract = {

OBJECTIVES: Preferences for aging-in-place are unclear among low-income elderly Chinese city-dwellers, who are more likely to be geographically bound, to have little care support, but possess strong filial values and family cohesiveness. This study investigated the preferences for aging-in-place and its contributing neighborhood factors among low-income Chinese elderly in a metropolitan city.

METHOD: We conducted interviews with 400 older people residing in public housing estates in Hong Kong.

RESULTS: The majority of low-income elderly persons (80.4\%) prefer to age in place even if their health and functioning has deteriorated beyond independent living. Logistic regression showed that (a) having very low income (

DISCUSSION: Low-income elderly Chinese city-dwellers prefer to age in place, given appropriate neighborhood support. These findings can be interpreted in light of Lawton{\textquoteright}s ecological theory of aging and suggest a service model similar to the Naturally Occurring Retirement Community with Supportive Service Programs.

}, keywords = {Aged, Aged, 80 and over, Aging, Asian Continental Ancestry Group, Female, Hong Kong, Humans, Independent Living, Interview, Psychological, Male, Middle Aged, Poverty, Quality of Life, Residence Characteristics, Social Support, Urban Population}, issn = {1758-5368}, doi = {10.1093/geronb/gbu154}, url = {http://www.ncbi.nlm.nih.gov/pubmed/25384636}, author = {Terry Y S Lum and Vivian W Q Lou and Chen, Yanyan and Wong, Gloria and Luo, Hao and Tracy Tong} } @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 {8233, title = {Gender Differences in Institutional Long-Term Care Transitions.}, journal = {Womens Health Issues}, volume = {25}, year = {2015}, month = {2015 Sep-Oct}, pages = {441-9}, publisher = {25}, abstract = {

INTRODUCTION: This study investigates the relationship between gender, the likelihood of discharge from institutional long-term care (LTC) facilities, and post-discharge living arrangements, highlighting sociodemographic, health, socioeconomic, and family characteristics.

METHODS: We use the Health and Retirement Study to examine individuals age 65 and older admitted to LTC facilities between 2000 and 2010 (n~=~3,351). We examine discharge patterns using survival analyses that account for the competing risk of death and estimate the probabilities of post-discharge living arrangements using multinomial logistic regression models.

RESULTS: Women are more likely than men to be discharged from LTC facilities during the first year of stay. Women are more likely to live alone or with kin after discharge, whereas men are more likely to live with a spouse or transfer to another institution. Gender differences in the availability and use of family support may partly account for the gender disparity of LTC discharge and post-discharge living arrangements.

CONCLUSION: Our findings suggest that women and men follow distinct pathways after LTC discharge. As local and federal efforts begin to place more emphasis on the transition from LTC facilities to prior communities (e.g., transitional care initiatives under the Patient Protection and Affordable Care Act), policymakers should take these gender differences into account in the design of community transition programs.

}, keywords = {Aged, Aged, 80 and over, Continuity of Patient Care, Family Characteristics, Female, Geriatric Assessment, Home Care Services, Humans, Length of Stay, Logistic Models, Long-term Care, Male, Marital Status, Middle Aged, Nursing homes, Patient Discharge, Residence Characteristics, Sex Characteristics, United States}, issn = {1878-4321}, doi = {10.1016/j.whi.2015.04.010}, url = {http://www.sciencedirect.com/science/article/pii/S1049386715000638}, author = {Mudrazija, Stipica and Thomeer, Mieke Beth and Jacqueline L. Angel} } @article {8157, title = {Race/Ethnic Differentials in the Health Consequences of Caring for Grandchildren for Grandparents.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 Sep}, pages = {793-803}, publisher = {70}, abstract = {

OBJECTIVES: The phenomenon of grandparents caring for grandchildren is disproportionately observed among different racial/ethnic groups in the United States. This study examines the influence of childcare provision on older adults{\textquoteright} health trajectories in the United States with a particular focus on racial/ethnic differentials.

METHOD: Analyzing nationally representative, longitudinal data on grandparents over the age of 50 from the Health and Retirement Study (1998-2010), we conduct growth curve analysis to examine the effect of living arrangements and caregiving intensity on older adults{\textquoteright} health trajectories, measured by changing Frailty Index (FI) in race/ethnic subsamples. We use propensity score weighting to address the issue of potential nonrandom selection of grandparents into grandchild care.

RESULTS: We find that some amount of caring for grandchildren is associated with a reduction of frailty for older adults, whereas coresidence with grandchildren results in health deterioration. For non-Hispanic black grandparents, living in a skipped generation household appears to be particularly detrimental to health. We also find that Hispanic grandparents fare better than non-Hispanic black grandparents despite a similar level of caregiving and rate of coresidence. Finally, financial and social resources assist in buffering some of the negative effects of coresidence on health (though this effect also differs by race/ethnicity).

DISCUSSION: Our findings suggest that the health consequences of grandchild care are mixed across different racial/ethnic groups and are further shaped by individual characteristics as well as perhaps cultural context.

}, keywords = {Aged, Black People, Female, Frail Elderly, Health Status, Health Status Disparities, Hispanic or Latino, Humans, Intergenerational Relations, Longitudinal Studies, Male, Middle Aged, Parenting, Residence Characteristics, Socioeconomic factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu160}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2014/12/06/geronb.gbu160.abstract}, author = {Chen, Feinian and Christine A Mair and Bao, Luoman and Yang Claire Yang} } @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 {8166, title = {Spouse and Child Availability for Newly Disabled Older Adults: Socioeconomic Differences and Potential Role of Residential Proximity.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 May}, pages = {462-9}, publisher = {70}, abstract = {

OBJECTIVES: To examine the potential role of child and spousal availability in facilitating community-based care for disabled older adults.

METHOD: We used the Health and Retirement Study, a nationally representative longitudinal study of older adults. The analysis sample included older adults who were nondisabled at baseline, but who then developed at least one activity of daily living (ADL) limitation over the subsequent 2-year period (N = 2,094). Using multivariate, multinomial logistic regression, we examined the association of child and spouse availability prior to disablement of the older adults with ADL care receipt status after the onset of disablement, after adjusting for other sociodemographic and clinical characteristics.

RESULTS: Lower socioeconomic status (SES) was associated with less availability of a spouse but greater availability of children at baseline. Compared with older adults who had no children nearby (i.e., all children lived further than 30 miles), older adults who had at least one child living with or near them prior to the onset of the ADL limitation were less likely to go to a nursing home (adjusted odds ratio [AOR]: 0.26 for coresident; AOR: 0.44 for 1- 30 miles) and less likely to depend on formal care (AOR: 0.39 for coresident; AOR: 0.51 for 1-30 miles) after the onset of new ADL limitation/s.

DISCUSSION: Understanding SES variations in the informal care resources, and potential role of child geographic availability, may inform the development of cost-effective community-based care programs and policies.

}, keywords = {Activities of Daily Living, Adult children, Aged, Aged, 80 and over, Aging, Disabled Persons, Female, Home Nursing, Humans, Male, Middle Aged, Nursing homes, Residence Characteristics, Social Class, Spouses}, issn = {1758-5368}, doi = {10.1093/geronb/gbu015}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2014/03/06/geronb.gbu015.abstract}, author = {Choi, Hwajung and Robert F. Schoeni and Kenneth M. Langa and Michele M Heisler} } @article {8123, title = {Perceived neighbourhood social cohesion and myocardial infarction.}, journal = {J Epidemiol Community Health}, volume = {68}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Nov}, pages = {1020-6}, publisher = {68}, abstract = {

BACKGROUND: The main strategy for alleviating heart disease has been to target individuals and encourage them to change their health behaviours. Although important, emphasis on individuals has diverted focus and responsibility away from neighbourhood characteristics, which also strongly influence people{\textquoteright}s behaviours. Although a growing body of research has repeatedly demonstrated strong associations between neighbourhood characteristics and cardiovascular health, it has typically focused on negative neighbourhood characteristics. Only a few studies have examined the potential health enhancing effects of positive neighbourhood characteristics, such as perceived neighbourhood social cohesion.

METHODS: Using multiple logistic regression models, we tested whether higher perceived neighbourhood social cohesion was associated with lower incidence of myocardial infarction. Prospective data from the Health and Retirement Study--a nationally representative panel study of American adults over the age of 50--were used to analyse 5276 participants with no history of heart disease. Respondents were tracked for 4 years and analyses adjusted for relevant sociodemographic, behavioural, biological and psychosocial factors.

RESULTS: In a model that adjusted for age, gender, race, marital status, education and total wealth, each SD increase in perceived neighbourhood social cohesion was associated with a 22\% reduced odds of myocardial infarction (OR=0.78, 95\% CI 0.63 to 0.94. The association between perceived neighbourhood social cohesion and myocardial infarction remained even after adjusting for behavioural, biological and psychosocial covariates.

CONCLUSIONS: Higher perceived neighbourhood social cohesion may have a protective effect against myocardial infarction.

}, keywords = {Aged, Aged, 80 and over, Confounding Factors, Epidemiologic, Female, Health Behavior, Health Status, Health Surveys, Humans, Incidence, Interviews as Topic, Male, Mental Health, Middle Aged, Multilevel Analysis, Myocardial Infarction, Perception, Prospective Studies, Protective factors, Residence Characteristics, Self Report, Social Environment, Socioeconomic factors, United States}, issn = {1470-2738}, doi = {10.1136/jech-2014-204009}, author = {Eric S Kim and Armani M. Hawes and Jacqui Smith} } @article {7880, title = {Urban neighbourhood unemployment history and depressive symptoms over time among late middle age and older adults.}, journal = {J Epidemiol Community Health}, volume = {67}, year = {2013}, month = {2013 Feb}, pages = {153-8}, publisher = {67}, abstract = {

BACKGROUND: Little is known about how a neighbourhood{\textquoteright}s unemployment history may set the stage for depressive symptomatology. This study examines the effects of urban neighbourhood unemployment history on current depressive symptoms and subsequent symptom trajectories among residentially stable late middle age and older adults. Contingent effects between neighbourhood unemployment and individual-level employment status (ie, cross-level interactions) are also assessed.

METHODS: Individual-level survey data are from four waves (2000, 2002, 2004 and 2006) of the original cohort of the nationally representative US Health and Retirement Study. Neighbourhoods are operationalised with US Census tracts for which historical average proportion unemployed between 1990 and 2000 and change in proportion unemployed between 1990 and 2000 are used to characterise the neighbourhood{\textquoteright}s unemployment history. Hierarchical linear regressions estimate three-level (time, individual and neighbourhood) growth models.

RESULTS: Symptoms in 2000 are highest among those residing in neighbourhoods characterised by high historical average unemployment beginning in 1990 and increasing unemployment between 1990 and 2000, net of a wide range of socio-demographic controls including individual-level employment status. These neighbourhood unemployment effects are not contingent upon individual-level employment status in 2000. 6-year trajectories of depressive symptoms decrease over time on average but are not significantly influenced by the neighbourhood{\textquoteright}s unemployment history.

CONCLUSIONS: Given the current US recession, future studies that do not consider historical employment conditions may underestimate the mental health impact of urban neighbourhood context. The findings suggest that exposure to neighbourhood unemployment earlier in life may be consequential to mental health later in life.

}, keywords = {Age Factors, depression, Female, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Multilevel Analysis, Residence Characteristics, Retirement, Risk Factors, Socioeconomic factors, Stress, Psychological, Surveys and Questionnaires, Time Factors, Unemployment, United States, Urban Population}, issn = {1470-2738}, doi = {10.1136/jech-2012-201537}, author = {Richard G Wight and Carol S Aneshensel and Barrett, Christopher and Michelle J Ko and Joshua Chodosh and Arun S Karlamangla} } @article {7714, title = {Association of chronic diseases and impairments with disability in older adults: a decade of change?}, journal = {Med Care}, volume = {50}, year = {2012}, month = {2012 Jun}, pages = {501-7}, publisher = {50}, abstract = {

BACKGROUND: Little is known about how the relationship between chronic disease, impairment, and disability has changed over time among older adults.

OBJECTIVE: To examine how the associations of chronic disease and impairment with specific disability have changed over time.

RESEARCH DESIGN: Repeated cross-sectional analysis, followed by examining the collated sample using time interaction variables, of 3 recent waves of the Health and Retirement Study.

SUBJECTS: The subjects included 10,390, 10,621 and 10,557 community-dwelling adults aged 65 years and above in 1998, 2004, and 2008.

MEASUREMENTS: : Survey-based history of chronic diseases including hypertension, heart disease, heart failure, stroke, diabetes, cancer, chronic lung disease, and arthritis; impairments, including cognition, vision, and hearing; and disability, including mobility, complex activities of daily living (ADL), and self-care ADL.

RESULTS: Over time, the relationship of chronic diseases and impairments with disability was largely unchanged; however, the association between hypertension and complex ADL disability weakened from 1998 to 2004 and 2008 [odds ratio (OR) = 1.24; 99\% confidence interval (CI), 1.06-1.46; OR = 1.07; 99\% CI, 0.90-1.27; OR = 1.00; 99\% CI, 0.83-1.19, respectively], as it did for hypertension and self-care disability (OR = 1.32; 99\% CI, 1.13-1.54; OR=0.97; 99\% CI, 0.82-1.14; OR = 0.99; 99\% CI, 0.83-1.17). The association between diabetes and self-care disability strengthened from 1998 to 2004 and 2008 (OR = 1.21; 99\% CI, 1.01-1.46; OR = 1.37; 99\% CI, 1.15-1.64; OR = 1.52; 99\% CI, 1.29-1.79), as it also did for lung disease and self-care disability (OR = 1.64; 99\% CI, 1.33-2.03; OR = 1.63; 99\% CI, 1.32-2.01; OR = 2.11; 99\% CI, 1.73-2.57).

CONCLUSIONS: Although relationships between diseases, impairments, and disability were largely unchanged, disability became less associated with hypertension and more with diabetes and lung disease.

}, keywords = {Activities of Daily Living, Aged, Aging, Cardiovascular Diseases, Chronic disease, Cognition Disorders, Cross-Sectional Studies, Diabetes Mellitus, Disabled Persons, Female, Health Surveys, Hearing loss, Humans, Hypertension, Male, Mobility Limitation, Residence Characteristics, Respiratory Tract Diseases, Self Care, Socioeconomic factors, United States, Vision Disorders}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e318245a0e0}, author = {William W. Hung and Joseph S. Ross and Boockvar, Kenneth S and Albert L Siu} } @article {7691, title = {Cohort differences in the availability of informal caregivers: are the Boomers at risk?}, journal = {Gerontologist}, volume = {52}, year = {2012}, month = {2012 Apr}, pages = {177-88}, publisher = {52}, abstract = {

PURPOSE OF THE STUDY: We compare the close family resources of Baby Boomers (BBs) to previous cohorts of older adults at population level and then examine individual-level cohort comparisons of age-related trajectories of informal care availability from midlife into old age.

DESIGN AND METHODS: Population data from the U.S. Census and from the Health and Retirement Study (HRS) are used to identify a cohort similar to the BBs on marital status and fertility rates. Using generalized linear mixed models and 10-year longitudinal data from Depression and WWII parents (DWP; n = 1,052) and the parents of BBs (PBB; n = 3,573) in the HRS, we examine cohort differences in the time-varying likelihoods of being married and of having an adult child living within 10 miles.

RESULTS: The DWP had similar informal care resources at entry to old age as is expected in the BB. Longitudinal analyses of the DWP and PBB cohorts in HRS reveal that the availability of family changes over time and that the DWP cohort was significantly less likely to have a spouse or a grown child living nearby.

IMPLICATIONS: These findings, and future projections based on them, have significant implications for institutions and public policy concerned with the informal caregiving needs of the Boomer cohort as they age.

}, keywords = {Aged, Aged, 80 and over, Aging, Caregivers, Censuses, Family Characteristics, Female, Health Status, Humans, Likelihood Functions, Longitudinal Studies, Male, Middle Aged, Nuclear Family, Population Growth, Residence Characteristics, Retirement, Risk, Socioeconomic factors}, issn = {1758-5341}, doi = {10.1093/geront/gnr142}, author = {Lindsay H Ryan and Jacqui Smith and Toni C Antonucci and James S Jackson} } @article {7622, title = {How safe is your neighborhood? Perceived neighborhood safety and functional decline in older adults.}, journal = {J Gen Intern Med}, volume = {27}, year = {2012}, month = {2012 May}, pages = {541-7}, abstract = {

BACKGROUND: Neighborhood characteristics are associated with health and the perception of safety is particularly important to exercise and health among older adults. Little is known about the relationship between perception of neighborhood safety and functional decline in older adults.

OBJECTIVE: To determine the relationship between perceived neighborhood safety and functional decline in older adults.

DESIGN/SETTING: Longitudinal, community-based.

PARTICIPANTS: 18,043 persons, 50~years or older, who participated in the 1998 and 2008 Health and Retirement Study.

MAIN MEASURES: The primary outcome was 10-year functional decline (new difficulty or dependence in any Activity of Daily Living, new mobility difficulty, and/or death). The primary predictor was perceived neighborhood safety categorized into three groups: "very safe", "moderately safe", and "unsafe." We evaluated the association between perceived neighborhood safety and 10-year functional decline using a modified Poisson regression to generate unadjusted and adjusted relative risks (ARR).

KEY RESULTS: At baseline 11,742 (68.0\%) participants perceived their neighborhood to be very safe, 4,477 (23.3\%) moderately safe, and 1,824 (8.7\%) unsafe. Over 10~years, 10,338 (53.9\%) participants experienced functional decline, including 6,266 (50.2\%) who had perceived their neighborhood to be very safe, 2,839 (61.2\%) moderately safe, and 1,233 (63.6\%) unsafe, P < 0.001. For the 11,496 (63.3\%) of participants who were functionally independent at baseline, perceived neighborhood safety was associated with 10-year functional decline (moderately safe ARR 1.15 95\% CI 1.09-1.20; unsafe ARR 1.21 95\% CI: 1.03-1.31 compared to very safe group). The relationship between perceived neighborhood safety and 10-year functional decline was not statistically significant for participants who had baseline functional impairment.

CONCLUSION: Asking older adults about their perceived neighborhood safety may provide important information about their risk of future functional decline. These findings also suggest that future studies might focus on assessing whether interventions that promote physical activity while addressing safety concerns help reduce functional decline in older adults.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Health Status Disparities, Humans, Longitudinal Studies, Male, Middle Aged, Perception, Residence Characteristics, Safety, Surveys and Questionnaires}, issn = {1525-1497}, doi = {10.1007/s11606-011-1943-y}, author = {Vivien K Sun and Irena Cenzer and Helen Kao and Cyrus Ahalt and Brie A Williams} } @article {7781, title = {Risk factors of falls in community-dwelling older adults: logistic regression tree analysis.}, journal = {Gerontologist}, volume = {52}, year = {2012}, month = {2012 Dec}, pages = {822-32}, publisher = {52}, abstract = {

PURPOSE OF THE STUDY: A novel logistic regression tree-based method was applied to identify fall risk factors and possible interaction effects of those risk factors.

DESIGN AND METHODS: A nationally representative sample of American older adults aged 65 years and older (N = 9,592) in the Health and Retirement Study 2004 and 2006 modules was used. Logistic Tree with Unbiased Selection, a computer algorithm for tree-based modeling, recursively split the entire group in the data set into mutually exclusive subgroups and fit a logistic regression model in each subgroup to generate an easily interpreted tree diagram.

RESULTS: A subgroup of older adults with a fall history and either no activities of daily living (ADL) limitation and at least one instrumental activity of daily living or at least one ADL limitation was classified as at high risk of falling. Additionally, within each identified subgroup, the best predictor of falls varied over subgroups and was also evaluated.

IMPLICATIONS: Application of tree-based methods may provide useful information for intervention program design and resource allocation planning targeting subpopulations of older adults at risk of falls.

}, keywords = {Accidental Falls, Activities of Daily Living, Aged, Aged, 80 and over, Decision Trees, Female, Geriatric Assessment, Health Surveys, Humans, Logistic Models, Male, Predictive Value of Tests, Residence Characteristics, Risk Assessment, Socioeconomic factors, United States}, issn = {1758-5341}, doi = {10.1093/geront/gns043}, author = {Takashi Yamashita and Noe, Douglas A. and John A. Bailer} } @article {7560, title = {Neighborhoods and chronic disease onset in later life.}, journal = {Am J Public Health}, volume = {101}, year = {2011}, month = {2011 Jan}, pages = {79-86}, publisher = {101}, abstract = {

OBJECTIVES: To strengthen existing evidence on the role of neighborhoods in chronic disease onset in later life, we investigated associations between multiple neighborhood features and 2-year onset of 6 common conditions using a national sample of older adults.

METHODS: Neighborhood features for adults aged 55 years or older in the 2002 Health and Retirement Study were measured by use of previously validated scales reflecting the built, social, and economic environment. Two-level random-intercept logistic models predicting the onset of heart problems, hypertension, stroke, diabetes, cancer, and arthritis by 2004 were estimated.

RESULTS: In adjusted models, living in more economically disadvantaged areas predicted the onset of heart problems for women (odds ratio [OR] = 1.20; P < .05). Living in more highly segregated, higher-crime areas was associated with greater chances of developing cancer for men (OR = 1.31; P < .05) and women (OR = 1.25; P < .05).

CONCLUSIONS: The neighborhood economic environment is associated with heart disease onset for women, and neighborhood-level social stressors are associated with cancer onset for men and women. The social and biological mechanisms that underlie these associations require further investigation.

}, keywords = {Aged, Chronic disease, Environment Design, Factor Analysis, Statistical, Female, Health Resources, Health Status Disparities, Humans, Logistic Models, Male, Middle Aged, Poverty Areas, Residence Characteristics, Risk Factors, Small-Area Analysis, Social Environment, Social Problems, Socioeconomic factors, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2009.178640}, author = {Vicki A Freedman and Irina B Grafova and Jeannette Rogowski} } @article {7567, title = {Trends in the incidence and prevalence of Alzheimer{\textquoteright}s disease, dementia, and cognitive impairment in the United States.}, journal = {Alzheimers Dement}, volume = {7}, year = {2011}, month = {2011 Jan}, pages = {80-93}, publisher = {7}, abstract = {

Declines in heart disease and stroke mortality rates are conventionally attributed to reductions in cigarette smoking, recognition and treatment of hypertension and diabetes, effective medications to improve serum lipid levels and to reduce clot formation, and general lifestyle improvements. Recent evidence implicates these and other cerebrovascular factors in the development of a substantial proportion of dementia cases. Analyses were undertaken to determine whether corresponding declines in age-specific prevalence and incidence rates for dementia and cognitive impairment have occurred in recent years. Data spanning 1 or 2 decades were examined from community-based epidemiological studies in Minnesota, Illinois, and Indiana, and from the Health and Retirement Study, which is a national survey. Although some decline was observed in the Minnesota cohort, no statistically significant trends were apparent in the community studies. A significant reduction in cognitive impairment measured by neuropsychological testing was identified in the national survey. Cautious optimism appears justified.

}, keywords = {Age Factors, Alzheimer disease, Cognition Disorders, Cohort Studies, Community Health Planning, Dementia, Humans, Incidence, Prevalence, Residence Characteristics, Retrospective Studies, Time Factors, United States}, issn = {1552-5279}, doi = {10.1016/j.jalz.2010.11.002}, author = {Walter A Rocca and Ronald C Petersen and David S Knopman and Liesi Hebert and Denis A Evans and Kathleen S Hall and Gao, Sujuan and Frederick W Unverzagt and Kenneth M. Langa and Eric B Larson and Lon R White} } @article {7611, title = {The urban neighborhood and cognitive functioning in late middle age.}, journal = {J Health Soc Behav}, volume = {52}, year = {2011}, month = {2011 Jun}, pages = {163-79}, publisher = {52}, abstract = {

This study examines the association of cognitive functioning with urban neighborhood socioeconomic disadvantage and racial/ethnic segregation for a U.S. national sample of persons in late middle age, a time in the life course when cognitive deficits begin to emerge. The key hypothesis is that effects of neighborhood on cognitive functioning are not uniform but are most pronounced among subgroups of the population defined by socioeconomic status and race/ethnicity. Data are from the third wave of the Health and Retirement Survey for the birth cohort of 1931 to 1941, which was 55 to 65 years of age in 1996 (analytic N = 4,525), and the 1990 U.S. Census. Neighborhood socioeconomic disadvantage has an especially large negative impact on cognitive functioning among persons who are themselves poor, an instance of compound disadvantage. These findings have policy implications supporting "upstream" interventions to enhance cognitive functioning, especially among those most adversely affected by neighborhood socioeconomic disadvantage.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aging, Chi-Square Distribution, Cognition, Cognition Disorders, ethnicity, Female, Health Status Disparities, Humans, Male, Middle Aged, Psychometrics, Residence Characteristics, Risk Factors, Socioeconomic factors, United States, Urban Population}, issn = {2150-6000}, doi = {10.1177/0022146510393974}, author = {Carol S Aneshensel and Michelle J Ko and Joshua Chodosh and Richard G Wight} } @article {7520, title = {Lifetime marital history and mortality after age 50.}, journal = {J Aging Health}, volume = {22}, year = {2010}, month = {2010 Dec}, pages = {1198-212}, publisher = {22}, abstract = {

OBJECTIVES: This article examines the relationship between lifetime marital history and mortality after age 50.

METHOD: Data are drawn from the Health and Retirement Study birth cohort of 1931 to 1941. The analysis utilizes three measures of marital history: number of marriages, proportion time married, and age at first marriage.

RESULTS: Three or more marriages and a lower proportion of adult life spent married are each associated with a higher hazard of dying after age 50 for both men and women even after controlling for current marital status and socioeconomic status. Smoking behavior accounts for part of the relationship of marital history and status with mortality.

DISCUSSION: Research on marital status and health should consider marital history as well as current status. Two topics are particularly important: examining the relationship in different cohorts and disentangling the potentially causal role of health behaviors such as smoking.

}, keywords = {Age Factors, Aging, Cohort Studies, Female, Health Status, Humans, Interpersonal Relations, Male, Marital Status, Middle Aged, Mortality, Multivariate Analysis, Proportional Hazards Models, Residence Characteristics, Risk Assessment, Risk-Taking, Smoking, Time Factors, United States}, issn = {1552-6887}, doi = {10.1177/0898264310374354}, author = {John C Henretta} } @article {12659, title = {Neighborhood disadvantage and self-assessed health, disability, and depressive symptoms: longitudinal results from the health and retirement study.}, journal = {Ann Epidemiol}, volume = {20}, year = {2010}, month = {2010 Nov}, pages = {856-61}, abstract = {

PURPOSE: By using a longitudinal cohort, we assessed the association between neighborhood disadvantage and incidence of poor health and function in three domains.

METHODS: More than 4,000 enrollees aged 55 to 65 years in the national Health and Retirement Study were assessed biennially from 1998 through 2006 for incidence of fair/poor self-rated health, elevated depressive symptoms, and limitations in six basic activities of daily living (disability). Each analysis was restricted to subjects without that condition in 1994 or 1996. Neighborhoods (census tracts, time-updated for moves), were considered disadvantaged if they fell below the 25th percentile in an index comprising six socioeconomic status indicators. Repeated measures logistic regressions, inverse probability weighted to account for individual confounders, selective survival, and loss to follow-up were used to estimate odds ratios (ORs) for incidence of each outcome in the wave after exposure to disadvantaged neighborhood.

RESULTS: After covariate adjustment, neighborhood disadvantage predicted onset of fair/poor SRH (OR, 1.36; 95\% confidence interval, 1.15-1.59) but not disability (OR, 0.97; 0.81-1.16) or elevated depressive symptoms (OR, 0.97; 0.81-1.16).

CONCLUSIONS: Results confirmed previous findings that neighborhood disadvantage predicts self-rated health in a longitudinal context but did not support an association between neighborhood disadvantage and onset of disability or elevated depressive symptoms.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Confidence Intervals, depression, Disabled Persons, Female, Health Status Disparities, Humans, Incidence, Logistic Models, Longitudinal Studies, Male, Middle Aged, Odds Ratio, Poverty, Residence Characteristics, Risk, Self-Assessment, Socioeconomic factors, Time Factors}, issn = {1873-2585}, doi = {10.1016/j.annepidem.2010.08.003}, author = {M. Maria Glymour and Mujahid, Mahasin and Wu, Qiong and White, Kellee and Tchetgen Tchetgen, Eric J} } @article {7462, title = {Older adults{\textquoteright} expectations to move: do they predict actual community-based or nursing facility moves within 2 years?}, journal = {J Aging Health}, volume = {22}, year = {2010}, month = {2010 Oct}, pages = {1029-53}, abstract = {

OBJECTIVE: This study examined the relationship between older adults{\textquoteright} expectations to move and actual residential relocation in the community or to a nursing facility within 2 years.

METHOD: Two waves of data (2000, 2002) from the Health and Retirement Study were used to compare expectations with subsequent moves. Logistic regression techniques were used to analyze the association between decision outcomes and expectations to move, health and functioning, physical environment, informal supports, and formal services.

RESULTS: Findings indicated that expectations to move did predict community-based moves but did not predict moves to nursing facilities. Additional factors had significant effects but did not diminish relationships between expectations and actual moves.

DISCUSSION: Results support the residential decision process as a dynamic one based on the cumulative effect of factors from an ecological model. Findings will inform policy makers and practitioners as they work to support older adults{\textquoteright} preferences to remain living in their homes.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Aging, Community Health Services, Decision making, Female, Humans, Logistic Models, Male, Odds Ratio, Residence Characteristics, Skilled Nursing Facilities, Social Support, Statistics as Topic, Time Factors, Transients and Migrants}, issn = {1552-6887}, doi = {10.1177/0898264310368296}, author = {Julie F. Sergeant and David J Ekerdt and Chapin, Rosemary K} } @article {7446, title = {Urban neighborhood context and mortality in late life.}, journal = {J Aging Health}, volume = {22}, year = {2010}, month = {2010 Mar}, pages = {197-218}, publisher = {22}, abstract = {

OBJECTIVE: To examine the contextual effects of urban neighborhood characteristics on mortality among older adults.

METHOD: Data are from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD). Death is assessed between the baseline assessment (1993) and the first follow-up interview (1995). Neighborhood data are from the 1990 Census.

RESULTS: The log odds of dying between the two time points are higher in high proportion Hispanic neighborhoods, net of individual-level sociodemographic variables, but this effect is partly mediated by individual-level health. The log odds of dying are significantly (p < .05) lower in affluent neighborhoods, controlling for all individual-level variables and neighborhood proportion Hispanic.

DISCUSSION: There are survival-related benefits of living in an affluent urban neighborhood, which we posit may be manifested through the diffusion of innovations in health care and health-promotion activities.

}, keywords = {Age Factors, Aged, Aging, Cognition, Confidence Intervals, depression, Female, Health Status, Humans, Los Angeles, Male, Middle Aged, Mortality, Odds Ratio, Poverty, Psychometrics, Residence Characteristics, Self Report, Socioeconomic factors, Statistics as Topic, Urban Population}, issn = {1552-6887}, doi = {10.1177/0898264309355980}, author = {Richard G Wight and Janet R. Cummings and Arun S Karlamangla and Carol S Aneshensel} } @article {7348, title = {Neighborhood safety, socioeconomic status, and physical activity in older adults.}, journal = {Am J Prev Med}, volume = {37}, year = {2009}, month = {2009 Sep}, pages = {207-13}, publisher = {37}, abstract = {

BACKGROUND: Neighborhood environment can have a substantial influence on the level of physical activity among older adults. Yet, the moderating influence of various measures of SES on the association between perceived neighborhood safety and leisure-time physical activity (LTPA) among older adults remains unknown.

PURPOSE: The study was designed to investigate the association between perceived neighborhood safety and LTPA in a nationally representative sample of older adults, and to evaluate SES characteristics as potential effect modifiers in the association between perceived neighborhood safety and LTPA.

METHODS: Cross-sectional data from the 2004 Health and Retirement Study of older adults aged >or=50 years were used to examine the association between perceived neighborhood safety and LTPA. Differences in LTPA were evaluated across three measures of SES: education, household income, and household wealth. SES was also evaluated as a potential effect modifier in the association between perceived neighborhood safety and LTPA. The analysis was conducted in 2008.

RESULTS: An SES gradient in LTPA was noted across measures of SES used in this study. After controlling for SES and demographic characteristics and functional limitations, older adults who perceived their neighborhood as safe had an 8\% higher mean rate of LTPA compared to older adults who perceived their neighborhood as unsafe. The association was no longer significant when self-rated health was added. Additionally, SES was not a significant effect modifier in the association between perceived neighborhood safety and LTPA.

CONCLUSIONS: SES, demographic characteristics, and functional limitations substantially attenuated the positive association between perceived neighborhood safety and LTPA; however, with the inclusion of self-rated health, the association was no longer present. This finding suggests that self-rated health may mediate this association. The lack of significance in the interaction between perceived neighborhood safety and SES suggests that prevention efforts to increase physical activity among older adults should consider perceptions of neighborhood safety as a potential barrier regardless of SES.

}, keywords = {Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Florida, Health Status, Humans, Leisure activities, Male, Middle Aged, Motor Activity, Recreation, Residence Characteristics, Safety, Sex Distribution, Social Support, Socioeconomic factors, Surveys and Questionnaires}, issn = {1873-2607}, doi = {10.1016/j.amepre.2009.06.005}, author = {Reginald D. Tucker-Seeley and Subramanian, S V and Li, Yi and Sorensen, Glorian} } @article {7331, title = {Urban neighborhood context and change in depressive symptoms in late life.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {64}, year = {2009}, month = {2009 Mar}, pages = {247-51}, publisher = {64B}, abstract = {

OBJECTIVES: This study examines associations between urban neighborhood sociodemographic characteristics and change over time in late-life depressive symptoms.

METHODS: Survey data are from three waves (1993, 1995, and 1998) of the Study of Assets and Health Dynamics Among the Oldest Old, a U.S. national probability sample of noninstitutionalized persons aged 70 years or older in 1993. Neighborhoods are 1990 U.S. Census tracts. Hierarchical linear regression is used to estimate multilevel models.

RESULTS: The average change over time in depressive symptoms varies significantly across urban neighborhoods. Change in depressive symptoms is significantly associated with neighborhood-level socioeconomic disadvantage and ethnic composition in unadjusted models but not in models that control for individual-level characteristics.

CONCLUSIONS: Findings indicate that apparent neighborhood-level effects on change in depressive symptoms over time among urban-dwelling older adults reflect, for the most part, differences in characteristics of the neighborhood residents.

}, keywords = {Aged, Aged, 80 and over, Aging, Cultural Diversity, depression, Disability Evaluation, Educational Status, Female, Humans, Longitudinal Studies, Los Angeles, Male, Personality Inventory, Poverty, Psychosocial Deprivation, Residence Characteristics, Risk Factors, Urban Population}, issn = {1758-5368}, doi = {10.1093/geronb/gbn016}, author = {Richard G Wight and Janet R. Cummings and Arun S Karlamangla and Carol S Aneshensel} } @article {7218, title = {Neighborhoods and disability in later life.}, journal = {Soc Sci Med}, volume = {66}, year = {2008}, month = {2008 Jun}, pages = {2253-67}, publisher = {66}, abstract = {

This paper uses the US Health and Retirement Study to explore linkages between neighborhood conditions and stages of the disablement process among adults aged 55 years and older in the United States. We consider multiple dimensions of the neighborhood including the built environment as well as social and economic conditions. In doing so, we use factor analysis to reduce indicators into eight neighborhood scales, which we incorporate into two-level logistic regression models along with controls for individual-level factors. We find evidence that economic conditions and the built environment, but not social conditions, matter. Neighborhood economic advantage is associated with a reduced risk of lower body limitations for both men and women. We also find for men that neighborhood economic disadvantage is linked to increased chances of reporting personal care limitations, particularly for those aged 55-64 years, and that high connectivity of the built environment is associated with reduced risk of limitations in instrumental activities. Our findings highlight the distinctive benefits of neighborhood economic advantage early in the disablement process. In addition, findings underscore the need for attention in the design and evaluation of disability-prevention efforts to the benefits that accrue from more physically connected communities and to the potential harm that may arise in later life from living in economically disadvantaged areas.

}, keywords = {Aging, Disabled Persons, Factor Analysis, Statistical, Female, Health Status Disparities, Humans, Male, Middle Aged, Residence Characteristics, Social Conditions, Socioeconomic factors, United States}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2008.01.013}, author = {Vicki A Freedman and Irina B Grafova and Robert F. Schoeni and Jeannette Rogowski} } @article {7255, title = {Neighborhoods and obesity in later life.}, journal = {Am J Public Health}, volume = {98}, year = {2008}, month = {2008 Nov}, pages = {2065-71}, publisher = {98}, abstract = {

OBJECTIVES: We examined the influence of neighborhood environment on the weight status of adults 55 years and older.

METHODS: We conducted a 2-level logistic regression analysis of data from the 2002 wave of the Health and Retirement Study. We included 8 neighborhood scales: economic advantage, economic disadvantage, air pollution, crime and segregation, street connectivity, density, immigrant concentration, and residential stability.

RESULTS: When we controlled for individual- and family-level confounders, living in a neighborhood with a high level of economic advantage was associated with a lower likelihood of being obese for both men (odds ratio [OR] = 0.86; 95\% confidence interval [CI] = 0.80, 0.94) and women (OR = 0.83; 95\% CI = 0.77, 0.89). Men living in areas with a high concentration of immigrants and women living in areas of high residential stability were more likely to be obese. Women living in areas of high street connectivity were less likely to be overweight or obese.

CONCLUSIONS: The mechanisms by which neighborhood environment and weight status are linked in later life differ by gender, with economic and social environment aspects being important for men and built environment aspects being salient for women.

}, keywords = {Aged, Air Pollution, Crime, Emigrants and Immigrants, Environment Design, Female, Health Status Indicators, Humans, Income, Logistic Models, Male, Middle Aged, Obesity, Odds Ratio, Overweight, Population Density, Residence Characteristics, Retirement, Social Class, Social Conditions, Social Environment, Socioeconomic factors, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2007.127712}, author = {Irina B Grafova and Vicki A Freedman and Kumar, Rizie and Jeannette Rogowski} } @article {7271, title = {Parental marital disruption, family type, and transfers to disabled elderly parents.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 Nov}, pages = {S349-58}, publisher = {63B}, abstract = {

OBJECTIVE: The objective of this study was to investigate the effect of parental marital status, marital history, and family type on intergenerational living arrangements and adult children{\textquoteright}s time and cash transfers to their unpartnered disabled elderly parents.

METHODS: We used data from the Asset and Health Dynamics Among the Oldest Old survey to estimate the joint probabilities that an adult child provides time and/or cash transfers to a parent and to analyze a five-level categorical variable capturing parent-child living arrangements.

RESULT: The estimates suggest significant detrimental effects of parental divorce and step relationship on time transfers and on the probability of coresidence with the index child. Family type, as captured by the composition of the index child{\textquoteright}s sibling network according to kin relationship to the parent, also affected transfers and living arrangement choices of adult children.

DISCUSSION: The findings that transfers from adult children to their unpartnered disabled elderly parents depend on parental marital status and kin relationship suggest that changing family patterns are altering the traditional role of the family as a support network. These findings raise concerns about the care likely to be available to future cohorts of elderly persons who will have experienced substantially higher rates of divorce, remarriage, and step parenthood than the cohort considered in this study.

}, keywords = {Adult, Aged, Altruism, Divorce, Family Characteristics, Female, Frail Elderly, Gift Giving, Humans, Likelihood Functions, Longitudinal Studies, Male, Multivariate Analysis, Parent-Child Relations, Residence Characteristics, Siblings, United States}, issn = {1079-5014}, doi = {10.1093/geronb/63.6.s349}, author = {Liliana E Pezzin and Robert A. Pollak and Barbara Steinberg Schone} } @article {7241, title = {Place of death among older Americans: does state spending on home- and community-based services promote home death?}, journal = {Med Care}, volume = {46}, year = {2008}, month = {2008 Aug}, pages = {829-38}, publisher = {46}, abstract = {

BACKGROUND: The majority of Americans die in institutions although most prefer to die at home. States vary greatly in their proportion of home deaths. Although individuals{\textquoteright} circumstances largely determine where they die, health policies may affect the range of options available to them.

OBJECTIVE: To examine whether states{\textquoteright} spending on home- and community-based services (HCBS) affects place of death, taking into consideration county health care resources and individuals{\textquoteright} family, sociodemographic, and health factors.

METHODS: Using exit interview data from respondents in the Health and Retirement Study born in 1923 or earlier who died between 1993 and 2002 (N = 3362), we conducted discrete-time survival analysis of the risk of end-of-life nursing home relocation to examine whether states{\textquoteright} HCBS spending would delay or prevent end-of-life nursing home admission. Then we ran logistic regression analysis to investigate the HCBS effects on place of death separately for those who relocated to a nursing home and those who remained in the community.

RESULTS: Living in a state with higher HCBS spending was associated with lower risk of end-of-life nursing home relocation, especially among people who had Medicaid. However, state HCBS support was not directly associated with place of death.

CONCLUSIONS: States{\textquoteright} generosity for HCBS increases the chance of dying at home via lowering the risk of end-of-life nursing home relocation. State-to-state variation in HCBS spending may partly explain variation in home deaths. Our findings add to the emerging encouraging evidence for continued efforts to enhance support for HCBS.

}, keywords = {Aged, Aged, 80 and over, Community Health Services, Death, Humans, Logistic Models, Nursing homes, Residence Characteristics, Terminal Care}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e3181791a79}, author = {Muramatsu, Naoko and Ruby L Hoyem and yin, Hongjun and Richard T. Campbell} } @article {7083, title = {Cohabitation among older adults: a national portrait.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {61}, year = {2006}, month = {2006 Mar}, pages = {S71-9}, publisher = {61}, abstract = {

OBJECTIVE: Older adults are increasingly likely to experience cohabitation, or living together unmarried in an intimate, heterosexual union. In order to begin building a conceptual framework, we provide a descriptive portrait of older adult cohabitors, emphasizing how they compare to older remarrieds and unpartnereds.

METHODS: We used data from both Census 2000 and the 1998 Health and Retirement Study ( HRS; Health and Retirement Study, 1998) to estimate the size and composition of the cohabiting population aged 51 and older. Also, using HRS data, we estimated multinomial logistic regression models to identify the correlates associated with cohabitation and remarriage (vs being unpartnered) among women and men who were previously married.

RESULT: More than 1 million older adults, composing 4\% of the unmarried population, currently cohabit. About 90\% of these individuals were previously married. We identify significant differences among cohabitors, remarrieds, and unpartnereds across several dimensions, including sociodemographic characteristics, economic resources, physical health, and social relationships. Cohabitors appear to be more disadvantaged than remarrieds, and this is especially evident for women.

DISCUSSION: Older cohabitors differ from individuals of other marital statuses, and therefore future work on marital status should explicitly incorporate cohabitation.

}, keywords = {Activities of Daily Living, Demography, Female, Health Status, Humans, Interpersonal Relations, Male, Marriage, Middle Aged, Residence Characteristics, Sexual Partners, Surveys and Questionnaires, United States}, issn = {1079-5014}, doi = {10.1093/geronb/61.2.s71}, author = {Susan L. Brown and Lee, Gary R. and Jennifer R. Bulanda} } @article {7087, title = {Urban neighborhood context, educational attainment, and cognitive function among older adults.}, journal = {Am J Epidemiol}, volume = {163}, year = {2006}, month = {2006 Jun 15}, pages = {1071-8}, publisher = {163}, abstract = {

Existing research has not addressed the potential impact of neighborhood context--educational attainment of neighbors in particular--on individual-level cognition among older adults. Using hierarchical linear modeling, the authors analyzed data from the 1993 Study of Assets and Health Dynamics Among the Oldest Old (AHEAD), a large, nationally representative sample of US adults born before 1924. Data from participants residing in urban neighborhoods (n = 3,442) were linked with 1990 US Census tract data. Findings indicate that 1) average cognitive function varies significantly across US Census tracts; 2) older adults living in low-education areas fare less well cognitively than those living in high-education areas, net of individual characteristics, including their own education; 3) this association is sustained when controlling for contextual-level median household income; and 4) the effect of individual-level educational attainment differs across neighborhoods of varying educational profiles. Promoting educational attainment among the general population living in disadvantaged neighborhoods may prove cognitively beneficial to its aging residents because it may lead to meliorations in stressful life conditions and coping deficiencies.

}, keywords = {Aged, Aged, 80 and over, Chi-Square Distribution, Cognition Disorders, Educational Status, Female, Humans, Linear Models, Male, Residence Characteristics, Risk Factors, Socioeconomic factors, United States, Urban Population}, issn = {0002-9262}, doi = {10.1093/aje/kwj176}, author = {Richard G Wight and Carol S Aneshensel and Miller-Martinez, Dana and Amanda L. Botticello and Janet R. Cummings and Arun S Karlamangla and Teresa Seeman} } @article {7021, title = {Health and living arrangements among older Americans: does marriage matter?}, journal = {J Aging Health}, volume = {17}, year = {2005}, month = {2005 Jun}, pages = {305-35}, publisher = {17}, abstract = {

OBJECTIVE: This research examines how physical and mental health influence living arrangements among older Americans and whether these effects differ for married and unmarried persons.

METHODS: Data came from the Asset and Health Dynamics Among the Oldest Old study. These two intervals were pooled, and hierarchical multinomial logistic regressions were used to analyze pooled time lags.

RESULTS: Functional status and cognitive functioning are significantly associated with living arrangements among those not married. Health conditions exert no significant effects among those married. Given the same functional status, unmarried elders are significantly more likely than their married counterparts to reside with their children or with others.

DISCUSSION: These results underscore the critical role of the spouse in influencing living arrangements, providing new evidence supporting the assertion that a spouse is the greatest guarantee of support in old age and the importance of the marriage institution.

}, keywords = {Adult children, Aged, Demography, Health Status, Humans, Institutionalization, Marital Status, Marriage, Mental Health, Parents, Residence Characteristics, Social Support, Socioeconomic factors, Spouses, United States}, issn = {0898-2643}, doi = {10.1177/0898264305276300}, author = {Jersey Liang and Brown, Joseph W. and Krause, Neal M. and Mary Beth Ofstedal and Joan M. Bennett} } @article {6978, title = {Cognitive deficits and the course of major depression in a cohort of middle-aged and older community-dwelling adults.}, journal = {J Am Geriatr Soc}, volume = {52}, year = {2004}, month = {2004 Jul}, pages = {1060-9}, publisher = {52}, abstract = {

OBJECTIVES: To examine associations between cognitive deficits and persistent significant depressive symptoms at baseline and 2- and 4-year follow-ups in a sample of community-dwelling middle-aged and older adults.

DESIGN: Prospective cohort study.

SETTING: A U.S. national prospective cohort study of middle-aged and older adults, the Health and Retirement Study.

PARTICIPANTS: A sample of 661 participants of the 1996 wave of the Health and Retirement Study who met criteria for 12-month Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised major depression (MD).

MEASUREMENTS: MD was assessed using the World Health Organization Composite International Diagnostic Interview-Short Form. Persistent significant depressive symptoms were assessed using an eight-item version of the Center for Epidemiological Studies Depression scale.

RESULTS: Cognitive deficits were associated with persistent significant depressive symptoms at follow-up. In a latent state-trait analysis, two stable and strongly correlated traits best explained variations in cognitive functioning and depressive symptoms across assessment points.

CONCLUSION: Trait-like cognitive deficits commonly complicate the course of MD in community-dwelling middle-aged and older adults and may help to explain the persistent course of depressive symptoms in a large subgroup of adults with MD in this age range.

}, keywords = {Aged, Chi-Square Distribution, Cognition Disorders, Depressive Disorder, Major, Female, Geriatric Assessment, Humans, Interviews as Topic, Logistic Models, Male, Middle Aged, Prospective Studies, Psychiatric Status Rating Scales, Residence Characteristics, Risk Factors, United States}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2004.52302.x}, author = {Ramin Mojtabai and Mark Olfson} } @article {6985, title = {Heart disease, comorbidity, and activity limitation in community-dwelling elderly.}, journal = {Eur J Cardiovasc Prev Rehabil}, volume = {11}, year = {2004}, month = {2004 Oct}, pages = {427-34}, publisher = {11}, abstract = {

PURPOSE: The purpose of this study was to describe the impact of self-report heart disease, other chronic comorbidities, and perceived health status on activity limitation among community dwelling persons older than 50 years of age.

METHODS: Odds ratios for activity limitation in activities of daily living, mobility, and other activities were estimated for respondents with self-report heart disease, eight other chronic comorbid conditions, and perceived health status using data generated in two nationally representative cross-sectional surveys, the Health and Retirement Survey (HRS; respondents aged 51 to 60 years) and the Assets and Health Dynamics of the Oldest Old study (AHEAD; respondents aged 70 years and older).

RESULTS: The prevalence of activity limitation increased significantly across the spectrum from activities of daily living to mobility to other activities in both surveys in respondents with and without heart disease. There was a significantly increased likelihood of mobility and other activity limitation among those with heart disease. Among the HRS respondents with heart disease, five or more of the eight comorbid conditions plus poor or fair perceived health were associated with a significantly increased limitation in each activity category. Among the AHEAD respondents with heart disease, three comorbid conditions plus perceived health were associated with a significantly increased limitation in activities of daily living whereas six comorbid conditions plus perceived health were associated with a significantly increased limitation in mobility and in other activities.

CONCLUSIONS: As a prime objective of cardiac rehabilitation is to reduce activity limitation, the strong associations between comorbidity and activity limitation observed in this study among persons older than 50 years with heart disease suggest that the burden of comorbidity-associated is considerable but should not be an automatic exclusion criterion for referral to cardiac rehabilitation. The lack of rigorous scientific information on how these associations may influence clinicians who refer patients to rehabilitation and those who manage these programs strongly reinforces the need for more research to explore the real-world spectrum of comorbidity among persons with heart disease and the impact on activity limitation.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Cross-Sectional Studies, Female, Health Status, Heart Diseases, Humans, Male, Middle Aged, Motor Activity, Residence Characteristics, Self Concept, Socioeconomic factors}, issn = {1741-8267}, doi = {10.1097/01.hjr.0000140716.25015.b8}, author = {Oldrige, Neil B. and Timothy E. Stump} } @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 {6897, title = {Immigrant status, living arrangements, and depressive symptoms among middle-aged and older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {58}, year = {2003}, month = {2003 Sep}, pages = {S305-13}, publisher = {58B}, abstract = {

OBJECTIVES: This research draws from social integration theory to explain the relationship between living arrangements and depressive symptoms among middle-aged and older adults. Particular attention is given to identifying differences between nonimmigrants and immigrants.

METHODS: The data come from the baseline and first 2-year follow-up of the Health and Retirement Study, which were collected in 1992 and 1994. The analysis is based on 6,391 primary respondents who were aged 51 to 61 at the baseline. Descriptive statistics, cross-sectional ordinary least squares regression models, and longitudinal residualized regression models are estimated for the entire sample and by immigrant status.

RESULTS: Living arrangements and immigrant status interact to influence depressive symptoms. The results confirm that depressive symptoms are higher among those who live alone, particularly among immigrants. Living with family or others is related to higher cross-sectional levels of depressive symptoms, especially for immigrants, and greater longitudinal increases in depressive symptoms among nonimmigrants.

DISCUSSION: The results highlight the important influence of social integration on mental health while demonstrating that context shapes the effect of social integration. They suggest that interventions should promote social integration, particularly among older adults living alone or with family or others. However, those programs should be sensitive to the unique needs of native-born and immigrant populations.

}, keywords = {Acculturation, Aged, Cross-Sectional Studies, depression, Emigration and Immigration, Female, Follow-Up Studies, Humans, Male, Middle Aged, Quality of Life, Residence Characteristics}, issn = {1079-5014}, doi = {10.1093/geronb/58.5.s305}, author = {Janet M Wilmoth and Pei-Chun Chen} }